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Primary pericardial synovial sarcoma: diagnosis of recurrence via multimodal imaging—a case report

Year: 2025

Type: article

Abstract: Background: Primary pericardial synovial sarcoma (PSS) is an extremely rare malignancy. Diagnosis and management primarily rely on multimodal imaging, with definitive diagnosis typically requiring a biopsy for histopathological confirmation. Although no established treatment protocol exists, complete tumour resection followed by adjuvant chemotherapy and radiotherapy is often considered. Case summary: A 68-year-old man presented with 1 month of shortness of breath and no significant medical history. Initial examination revealed cardiomegaly, a large pericardial effusion, and a solid mass adjacent to the right atrium. Multimodal imaging, including contrast-enhanced computed tomography and positron emission-T, identified a pericardial mass with metabolic activity. A thoracoscopic biopsy revealed atypical spindle-shaped cells, confirming the diagnosis of synovial sarcoma. This led to total tumour excision and lymph node dissection. Eighteen months post-surgery, imaging revealed recurrence, and the mass from the pericardium near the superior vena cava was resected via thoracotomy. Histopathological examination confirmed recurrent synovial sarcoma. Postoperative chemotherapy was administered; however, lung metastases developed, leading to further treatment 12 months post second surgery. Discussion: PSS is associated with poor prognosis and a high recurrence risk, highlighting the importance of regular follow-up imaging. While complete surgical resection remains the primary treatment, adjunct therapies may improve outcomes. This case underscores the need for multimodal imaging in diagnosing and monitoring PSS.

Source: European Heart Journal - Case Reports

DOI: 10.1093/ehjcr/ytaf132

Authors: Kanna Nakamura, Taiji Okada, Jiro Esaki, Shigeo Hara, Yutaka Furukawa

Institution: Kobe City Medical Center General Hospital

Language: English

Topic: Cardiac tumors and thrombi

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $815