Reply to Kawasaki et al. Comment on "Manole et al. Primary Pericardial Synovial Sarcoma: A Case Report and Literature Review. Diagnostics 2022, 12 , 158"

The translocation involves a fusion between one of the SSX genes (SSX1, SSX2, or SSX4) and the SS18 gene (SYT), with the fusion protein participating in the formation of the SWI/SNF and Polycomb complexes, playing a role in epigenetic gene regulation. In the described patient, the negative FISH test for this translocation did not allow for a clear differential diagnosis. [...]BCL-2 analysis was subsequently performed. The use of gene expression studies (RNAseq) is becoming useful for understanding the epigenetic mechanisms underlying synovial sarcoma and its prognosis and aggressiveness [4]. [...]we reiterate the significance of imaging in achieving an accurate diagnosis, particularly concerning the precise localization of pericardial tumors, including those of uncommon occurrence.