Ouarrak Safia, El Ouali Zakaria, Elkebir Asmaa, Moumna Kawthar, Karkouri Mehdi, Azzouzi Leila, Habbal Rachida
Department of Cardiology, University Hospital of Ibn Rochd, Casablanca , Morocco.
Department of Rheumatology, University Hospital of Ibn Rochd, Casablanca, Morocco.
Eur Heart J Case Rep. 2021 Mar 10;5(3):ytab039. doi: 10.1093/ehjcr/ytab039. eCollection 2021 Mar.
Cardiac synovial sarcoma (CSS) is an extremely rare malignant tumour with a poor prognosis. We report the case of a 31-year-old woman who presented with a CSS in the right atrium and was initially misdiagnosed with a tuberculoma. The aim of this article is to focus on the importance of having broad differential diagnoses including rare entities.
A 31-year-old White woman, with a close contact with a relative having pulmonary tuberculosis, presented to the emergency unit with severe dyspnoea. Chest radiography and echocardiography showed a large pericardial effusion with a mass in the right atrium. Pericardiocentesis removed bloody exudative fluid with adenosine desaminase at 17 UI/L and no malignant cells in the cytological study. Cardiac magnetic resonance revealed a tuberculoma of the right atrium. Intraoperatively, the mass was only biopsied because of the local invasion. Histological study concluded to a CSS. The patient died 3 days later.
This case highlights the importance of having broad differential diagnoses including rare entities. Histology was the key investigation for the diagnosis of CSS which has no clinical nor laboratory or imaging pathognomonic signs.
心脏滑膜肉瘤（CSS）是一种极其罕见的恶性肿瘤，预后较差。我们报告一例31岁女性，其右心房出现CSS，最初被误诊为结核瘤。本文旨在强调进行广泛鉴别诊断（包括罕见疾病）的重要性。
一名31岁白人女性，与一名患有肺结核的亲属密切接触，因严重呼吸困难就诊于急诊科。胸部X线和超声心动图显示大量心包积液，右心房有一肿块。心包穿刺抽出血性渗出液，腺苷脱氨酶为17 UI/L，细胞学检查未发现恶性细胞。心脏磁共振显示右心房结核瘤。术中，由于局部侵犯，仅对肿块进行了活检。组织学检查确诊为CSS。患者3天后死亡。
该病例强调了进行广泛鉴别诊断（包括罕见疾病）的重要性。组织学是诊断CSS的关键检查，CSS没有临床、实验室或影像学特征性表现。
