Pericardial Synovial Sarcoma: A Rare Clinical Entity

A Clinico-Pathologic Approach to the Differential Diagnosis of Pericardial Tumors

PURPOSE OF REVIEW

Tumors of the pericardium are rare, but a wide variety of congenital, infectious, inflammatory, and neoplastic processes have been reported. Pericardial tumors can be categorized as non-neoplastic or neoplastic. Neoplastic lesions can be further divided into benign or malignant, with malignancies being either primary or secondary (metastatic). Clinical, radiographic, and pathologic features of the most common entities are discussed.

RECENT FINDINGS

Metastatic neoplasms involving the heart and pericardium are far more common than primary pericardial neoplasms. Of primary pericardial malignancies, mesothelioma is the most common; notably, cytology of effusion fluid is relatively insensitive to the diagnosis. The prognosis for most malignancies of the pericardium, primary or secondary, is poor. Increasingly, clinically recognized diseases that involve the pericardium include Erdheim-Chester and IgG4-related disease. This article provides a comprehensive review of the most recent literature to develop a structured framework to the differential diagnosis of pericardial tumors.

Pericardial Synovial Sarcoma: Case Report, Literature Review and Pooled Analysis

BACKGROUND

Pericardial synovial sarcomas (PSS) are very rare tumors, with dismal prognosis and limited data. We describe the clinical features and identify prognostic factors of primary PSS.

CASE REPORT

We describe the case of a 56-year-old male patient with PSS managed by the multidisciplinary team of thoracic oncology. The therapeutic plan comprised surgery, chemotherapy, stereotactic radiosurgery and targeted therapy, with excellent results.

MATERIALS AND METHODS

Data from 37 cases reported in English during the past 20 years were gathered and analyzed. PSS was found to occur at a mean age of 36±17.082 (range=13-67) years. Survival analysis was performed on 20 cases with follow-up of at least 6 months.

CONCLUSION

Only complete resection of the tumor seems to be an independent prognostic factor. To our knowledge, this is the first report on the safety and effectivity of pazopanib in PSS and may provide guidance for similar cases in the future.

Pericardial synovial sarcoma presenting with unstable angina

A 43-year-old man had an incidental finding of a large anterior mediastinal mass. He suddenly presented with unstable angina and an emergency coronary angiogram showed severe proximal circumflex artery and left anterior descending artery stenosis from external compression. He underwent emergency coronary artery bypass graft surgery and excision of the tumor. At surgery, the tumor was found to be invading the left ventricle, so debulking of the mediastinal tumor was performed. Histology showed a biphasic pericardial synovial sarcoma. The patient was recommended chemotherapy and radiotherapy but he refused. He died 13 months after surgery.