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J Thorac Cardiovasc Surg 2004;128:756-758
© 2004 The American Association for Thoracic Surgery

Brief communication

Metastatic left atrial synovial sarcoma mimicking a myxoma

Sanjay Kumar, MCh, FRCSa,*, Mubarak A. Chaudhry, FRCSa, Irfan Khan, MRCSa, David J. R. Duthie, MD, FRCAb, Steve Lindsay, MD, MRCPc, Pankaj Kaul, MCh, FRCS (CTh)a

a Department of Cardiothoracic Surgery, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, United Kingdom
b Department of Anaesthesia, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, United Kingdom
c Department of Cardiology, Bradford Royal Infirmary, Bradford, United Kingdom

Received for publication March 8, 2004; accepted for publication March 22, 2004.

* Address for reprints: Pankaj Kaul, MCh, FRCS, Floor D, Jubilee Building, Yorkshire Heart Centre, Leeds General Infirmary, Great George St, Leeds, West Yorkshire LS1 3EX, United Kingdom
pankajkaul@supanet.com

The first 20% of the full text of this article appears below.

Heart neoplasms are of increasing interest to clinicians and surgeons. A synovial sarcoma of the heart, either primary or secondary in origin, is extremely uncommon.1 To our knowledge, this report is the first documented metastatic synovial sarcoma of the left atrium and emphasizes that this tumor, although rare, should be considered in the differential diagnosis of left atrial myxoma. The pathology, clinical implication, and management options are discussed.

Clinical summary

A 27-year-old man presented with a 4-month history of palpitations and dyspnea. Of note, there was no history of syncope, constitutional symptoms, or previous asbestos exposure. Within the last few weeks, he had also noticed a tender swelling in his right calf. Apart from the presence of the calf swelling, his physical examination was unremarkable. Transthoracic echocardiography showed a 4 x 2.5–cm mass arising from the mitral valve and adjoining atrial wall (Figure 1). The appearance was deemed consistent with that of a myxoma, although its site of origin was unusual.


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  		Figure 1. Transesophageal echocardiogram showing the tumor (T)..in the left atrium (LA).. A, attached to the anterior mitral leaflet (AML)..in systole; B, protruding through the mitral valve orifice close to the anterior mitral leaflet in diastole. The left ventricle (LV).. right atrium (RA).. and right ventricle (RV)..are also shown.

 
The patient was admitted expeditiously for excision of the left atrial mass. Through a median sternotomy, cardiopulmonary bypass was established after aortobicaval cannulation. The heart was arrested with antegrade cold blood cardioplegia. An atriotomy was made in a . . . [Full Text of this Article]






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