CONCLUSION
Primary pericardial synovial sarcomas are exceedingly uncommon. Complete surgical resection is critical to prolong long-term survival. Technical surgical guidance for complex tumors is lacking. This report describes the successful resection of an extensive and invasive pericardial synovial sarcoma using a modified autotransplantation technique with adjuvant radiation for microscopic positive margins. Surgical technical aspects are described. Our case can be of benefit to cardiac surgeons embracing challenging cases. Overall, careful patient selection, a thorough surgical plan and understanding of anatomy and physiology, expertise in transplantation, and availability of skilled, senior cardiothoracic surgeons at a center of excellence are critical for success. The modification of resection as required may help improve outcomes.