Synovial sarcoma of the heart arising from a so-called mesothelioma of the atrio-ventricular node

Our plain-English summary of Synovial sarcoma of the heart arising from a so-called mesothelioma of the atrio-ventricular node, by E.A. Sheffield, B. Corrin, B.J. Addis, et al (Histopathology, 1988).

The study

• Authors: E.A. Sheffield, B. Corrin, B.J. Addis, C. Gelder
• Journal: Histopathology
• Published: 1988;12(2):191-201
• Type of article: Case report
• Cited by: 29 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A primary tumour of the right atrium with morphological, ultrastructural and immunohistochemical features of a synovial sarcoma is described. This appeared to have arisen from a benign so-called mesothelioma of the atrio-ventricular node and had metastasized to the lungs. The histogenesis and relationship of these two tumours are discussed.

In plain English

This article was a case report from Brompton Hospital, London, about a 53-year-old man with a 6-week history of dry cough and breathlessness. A chest X-ray showed multiple rounded shadows in both lungs. Surgeons removed a 5 cm tumour from the right atrium of the heart, in the region of the atrio-ventricular node. Light microscopy, antibody staining and electron microscopy showed that the main tumour had the features of a synovial sarcoma, a cancer containing both spindle-shaped cells and gland-forming cells. In the tumour's stalk, the cancer merged with a benign lesion that the authors identified as a so-called mesothelioma of the atrio-ventricular node. The authors reported that this lesion's staining and microscopic structure argued against a mesothelial origin and suggested an endodermal origin. They also reported that malignant mesothelioma was excluded. The article does not discuss asbestos. The patient died 6 months after the operation with numerous lung metastases. The authors concluded that this was an unusual example of a synovial sarcoma arising in a pre-existing benign lesion unrelated to any synovial structures.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report (single patient), with light microscopy, immunohistochemistry and electron microscopy of the surgically removed tumour
• Who was studied: One 53-year-old man with a tumour of the right atrium, reported from Brompton Hospital, London; no dates of treatment given (article accepted for publication July 1987)
• Main results:
  • The tumour removed from the right atrium measured 5 cm in greatest diameter
  • Parts of the main tumour showed a biphasic pattern: spindle cells mixed with a malignant epithelial (gland-forming) component
  • In the tumour's stalk (pedicle), the malignant component merged with a benign lesion made of glandular structures
  • The epithelial cells of both the benign lesion and the main tumour stained strongly for cytokeratin and epithelial membrane antigen; all parts of the tumour were negative for S-100, carcinoembryonic antigen and Factor VIII related antigen
  • Under electron microscopy, the benign lesion at the base of the stalk looked very similar to the epithelial component of the malignant tumour
  • The staining properties of the benign lesion were the opposite of those usually accepted for mesothelial tissue and suggested an endodermal origin
  • The authors stated that malignant mesothelioma was excluded by the ultrastructural and histochemical features
  • The patient died 6 months after the operation. Autopsy showed numerous lung metastases extending into the chest wall, no tumour outside the chest, and residual benign atrio-ventricular node lesion with no evidence of malignancy
• The authors' conclusion: The authors concluded that the case was an unusual example of a synovial sarcoma arising in a pre-existing benign lesion unrelated to any synovial structures. They also concluded that it was further evidence that synovial sarcoma does not arise directly from synovium or differentiate towards it.
• Limitations the authors state:
  • The authors stated that the nature of the so-called benign mesothelioma of the atrio-ventricular node remains in doubt
  • The authors considered whether the tumour could be a metastasis involving a pre-existing lesion. They reported that extensive investigation found no other possible primary site.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Synovial Sarcoma, Mesothelioma.

Related studies

• "Mesothelioma of the atrioventricular node" with long-standing complete heart block. Report of a case — I.R. Wanless, B.W. Mielke, et al. (1975)
• Mesothelioma of the atrioventricular node and congenital complete heart block — R. Subramanian, B. Flygenring (1989)
• Sudden death due to a cystic atrio-ventricular node tumour — G. Maujean, A. Tabib, et al. (2010)
• Congenital polycystic tumor of the atrioventricular node (endodermal heterotopia, mesothelioma): a histogenetic appraisal with evidence for its endodermal origin — G. Fine, U. Raju (1987)
• Mesothelioma of the atrioventricular node — K. Nishida, G. Kamijima, et al. (1985)
• Corpora amylacea in mesothelioma of the atrioventricular node — R. David, Y. Hiss (1978)

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