Right atrial synovial sarcoma with thrombocytopenia: A deceptive presentation

Abstract

Introduction Primary cardiac synovial sarcoma is an exceedingly rare soft tissue malignant tumor, involving either the pericardium or chambers, with a striking male predominance, prevalently seen in the fourth decade. These tumours most commonly present as breathlessness on exertion. These patients readily exhibit gastrointestinal and systemic symptoms but sometimes the presentation can be fallacious. Methods A 37‐year old male presented with fever, breathlessness on exertion and hematuria who was managed for dengue feverat another hospital. Patient also had features of right heart failure and congestive hepatomegaly. Patient was evaluated thoroughlyand diagnosed as right atrial tumour mass for which surgical resection was done. Results The tumour mass was diagnosed as right atrial biphasic synovial sarcoma after immunohistochemistry. Patient also had thrombocytopenia which was due to increased consumption of platelets. Conclusions Right heart biphasic synovial sarcoma, arising from the tricuspid valve in association with thrombocytopenia and right heart failure is an extremely rare entity and that can have a deceptive presentation.

Primary cardiac sarcoma presenting with easy bruising: a case report

“…The platelet count returned rapidly to normal after tumour excision. 9 In our case, the temporary platelet count improvement with immunoglobulin treatment supports an autoimmune-like disorder. The presence of increased LDH and schistocytes suggests a component of mechanical destruction.…”

“…Arrhythmias or pericardial effusions can occur due to local invasion. 8 , 9 A right-sided tumour can embolize, causing a pulmonary embolize, while left-sided tumours can embolize into the systemic circulation, causing stroke or other end-organ damage. Some tumours can cause systemic or constitutional symptoms.…”

Primary cardiac atrial sarcomas. Report of two histologically different cases and review of the literature

“…Cardiac SS is an extremely rare and aggressive malignancy accounting for 3-5% of heart tumors with a significant male predominance and right heart location [2,50,51,52]. The most common cardiac location is pericardium with atrium being the second one [52].…”

“…Cases of atrial synovial sarcoma[2,3,6,50,51,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71] …”

Primary Cardiac Lymphoma Presenting with Thrombocytopenia, Right Heart Failure, and Cardiogenic Shock

“…Patients with PCL typically present with dyspnoea and constitutional symptoms such as weight loss and anorexia [2]. Trombocytopenia has rarely been described in association with PCL [3] and other primary cardiac tumours [4][5][6][7][8] and can add substantial morbidity to the diagnosis if present. We report to our knowledge, the second case of primary cardiac lymphoma presenting with marked thrombocytopenia which subsequently resolved with chemotherapy.…”