Kodikara Sarathchandra
Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka.
Indian J Pathol Microbiol. 2012 Apr-Jun;55(2):227-9. doi: 10.4103/0377-4929.97884.
Pericardial neoplasms are rare. Among pericardial neoplasms, metastatic spread is more common and primary synovial sarcomas of the pericardium are exceedingly rare. A 61-year-old man was found dead in bed. Autopsy revealed the cause of death as atherosclerotic and hypertensive heart disease. There was a pericardial soft tissue mass lying predominantly over the left atrium. The cut surface was bulging out and grayish white in color with cystic changes. Microscopy showed spindle cells in densely cellular fascicles surrounding the epithelial cells. The epithelial cells were cuboidal and formed glandular structures and cleft-like spaces. Immunohistochemistry demonstrated cytokeratin and vimentin positivity in the spindled areas. Molecular analysis confirmed the diagnosis. Synovial sarcoma may be mistaken for other common neoplasms occurring in the pericardium due to its rarity. In all cases of pericardial tumors, a diligent search for synovial sarcoma by way of histological analysis including, immunohistochemistry and molecular analysis is indicated.
心包肿瘤较为罕见。在心包肿瘤中，转移性扩散更为常见，而原发性心包滑膜肉瘤极为罕见。一名61岁男性被发现死在床上。尸检显示死因是动脉粥样硬化性和高血压性心脏病。心包有一个软组织肿块，主要位于左心房上方。切面隆起，呈灰白色，伴有囊性改变。显微镜检查显示梭形细胞密集排列成束，围绕上皮细胞。上皮细胞呈立方形，形成腺管结构和裂隙样间隙。免疫组织化学显示梭形区域细胞角蛋白和波形蛋白呈阳性。分子分析确诊了病情。由于滑膜肉瘤罕见，可能会被误诊为心包发生的其他常见肿瘤。在所有心包肿瘤病例中，都需要通过包括免疫组织化学和分子分析在内的组织学分析，仔细排查滑膜肉瘤。
