title: Pericardial synovial sarcoma, a potential for misdiagnosis: clinicopathologic and molecular cytogenetic analysis of three cases with literature review.
abstract: Synovial sarcomas arising in unexpected locations may lead to diagnostic challenges. In this report, we describe 3 cases of synovial sarcoma that manifested clinically as primary pericardial lesions. All 3 cases occurred in men in their fourth decade. Fever, cough, chest pain, and chest distress were the most common symptoms. Histologically, 2 of the tumors were spindle cell monophasic, and 1 tumor was biphasic. By immunohistochemical studies, the tumor cells were positive for cytokeratins and epithelial membrane antigen. In addition, the tumor cells displayed focal immunoreactivity for calretinin, cytokeratin 5/6, and HBME-1, resulting in the initial interpretations of malignant mesotheliomas. None of the 3 cases were diagnosed correctly until subsequent molecular cytogenetic assays demonstrated the presence of SYT gene rearrangements. As there are overlapping morphologic features between pericardial synovial sarcoma and mesothelioma, molecular analysis is essential for differential diagnoses.
authors.affiliation: Department of Pathology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China.
authors.forename: Yufan
authors.initials: Y
authors.lastname: Cheng
authors.forename: Weiqi
authors.initials: W
authors.lastname: Sheng
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Zhou
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor / Q000378:metabolism; D003582:Cytogenetics; D004273:DNA, Neoplasm / Q000032:analysis; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control; D015321:Gene Rearrangement; D006338:Heart Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000378:metabolism; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis; D010496:Pericardium / Q000378:metabolism / Q000473:pathology*; D011518:Proto-Oncogene Proteins / Q000235:genetics / Q000378:metabolism; D012097:Repressor Proteins / Q000235:genetics / Q000378:metabolism; D013584:Sarcoma, Synovial / Q000175:diagnosis* / Q000235:genetics / Q000378:metabolism
chemical_list: D014408:Biomarkers, Tumor; D004273:DNA, Neoplasm; D011518:Proto-Oncogene Proteins; D012097:Repressor Proteins; C093961:SS18 protein, human