Primary pericardial synovial sarcoma: a case report

Introduction and importance: Primary pericardial synovial sarcoma is an extremely rare malignant tumor, with only a few dozen well-documented cases worldwide. Its prognosis remains poorly defined. This work has been reported in line with the SCARE criteria. Case presentation: A 56-year-old man presented with progressive dyspnea, fatigue, and cough. Imaging revealed a massive pericardial tumor compressing the heart, with bilateral pleural effusions. An ultrasound-guided biopsy suggested a high-grade spindle cell neoplasm. Cytoreductive surgery was performed, including tumor debulking, atypical wedge resection of the left lower lobe of the lung, and mediastinal lymph node dissection. Histopathology confirmed monophasic spindle cell synovial sarcoma, FNCLCC grade 3, with microscopically involved margins and metastases in two mediastinal lymph nodes (pT4N1). JOURNAL/ijscr/04.03/01612930-990000000-01069/figure1/v/2026-11-02T094137Z/r/image-jpeg JOURNAL/ijscr/04.03/01612930-990000000-01069/figure2/v/2026-11-02T094137Z/r/image-jpeg JOURNAL/ijscr/04.03/01612930-990000000-01069/figure3/v/2026-11-02T094137Z/r/image-jpeg Clinical discussion: Complete resection is often not feasible because of invasion of vital structures. Multimodal therapy – including surgery, systemic chemotherapy, and selective radiotherapy – represents the optimal approach when feasible. Early recognition using echocardiography and cross-sectional imaging is essential. Conclusion: Cytoreductive surgery combined with adjuvant therapy can provide symptomatic relief and may prolong survival. Systematic reporting and multidisciplinary management are crucial.