Heart Failure Resulting from Giant Left Atrial Synovial Sarcoma Metastasis

Abstract

Synovial sarcoma metastasis affecting the heart and infiltrating the mitral valve is a very rare pathology. We report the case of a 44-year-old male treated with chemotherapy for atypical synovial sarcoma of the oral mucosa who presented to our clinic after cardiac decompensation with a presumptive diagnosis of myxoma of the left atrium. A large necrotic tumour positive for CK 22, EMA, CD 99 and BCL-2 but negative for translocation in COBRA-FISH analysis by break-apart probe could be excised and revealed a very rare subtype of synovial sarcoma metastasis arising from the endocard of the left atrium. The tumour was resected and the mitral valve reconstructed through ring annuloplasty.

Keywords

heart disease - heart valve surgery - cardiomyopathy

• References

• 1 Kumar S, Chaudhry MA, Khan I, Duthie DJ, Lindsay S, Kaul P. Metastatic left atrial synovial sarcoma mimicking a myxoma. J Thorac Cardiovasc Surg 2004; 128 (5) 756-758
• 2 Miller DV, Deb A, Edwards WD, Zehr KJ, Oliveira AM. Primary synovial sarcoma of the mitral valve. Cardiovasc Pathol 2005; 14 (6) 331-333
• 3 Hazelbag HM, Szuhai K, Tanke HJ, Rosenberg C, Hogendoorn PC. Primary synovial sarcoma of the heart: a cytogenetic and molecular genetic analysis combining RT-PCR and COBRA-FISH of a case with a complex karyotype. Mod Pathol 2004; 17 (11) 1434-1439
• 4 Policarpio-Nicolas ML, Alasadi R, Nayar R, De Frias DV. Synovial sarcoma of the heart: Report of a case with diagnosis by endoscopic ultrasound-guided fine needle aspiration biopsy. Acta Cytol 2006; 50 (6) 683-686