Primary cardiac synovial sarcoma that was continuous with the mitral valve caused severe thrombocytopenia: A case report

Abstract

Background: Primary cardiac sarcomas are exceedingly rare, and they commonly result in nonspecific constitutional symptoms such as shortness of breath, weight loss, and anaemia-related fatigue and malaise. However, thrombocytopenia has very rarely been reported in association with cardiac tumours, either benign or malignant. We report one case of primary cardiac synovial sarcoma continuous with the mitral valve, which was accompanied by severe thrombocytopenia, and the platelet counts returned rapidly to a normal range early after tumour excision and without any special therapies. Case presentation: A 52-year-old male diagnosed with atrial myxoma with severe thrombocytopenia was admitted to our hospital. Blood analysis showed severe thrombocytopenia, whereas erythrocyte and leucocyte counts were within the normal range. A 50 × 35 mm mobile mass continuous with the mitral valve was found to be present in the left atrium upon echocardiography. Bone marrow aspiration and related examinations excluded thrombocytopenia caused by haematologic malignancies. The patient received a platelet transfusion, but platelet counts decreased quickly. Glucocorticoid therapy and immunoglobulin transfusion were also used, but were ineffective. Although the operation risk was high, tumour resection was performed via a median sternotomy with a cardiopulmonary bypass system. The postoperative pathological diagnosis was biphasic cardiac synovial sarcoma. Surprisingly, the platelet counts returned rapidly to a normal range early after tumour excision without any special therapies. The disappearance of the tumour from the annular region was confirmed on transthoracic echocardiography 6 days after surgery, and an FDG-PET scan performed 8 days after surgery showed no abnormal accumulation. Unfortunately, the patient died suddenly 6 months later without unknown cause. Conclusions: We report that a rare primary cardiac synovial sarcoma case continuous with the mitral valve caused severe thrombocytopenia; this provides further support for the awareness and diagnosis of primary cardiac synovial sarcoma. We also highlight that thrombocytopenia might be one rare symptom of a solid cardiac tumour but need more cases for support.