Spectrum of Synovial Sarcoma-clinicopathological and Immunohistochemical Correlation
Keywords:
Synovial sarcoma, Ewing Sarcoma, Schwannoma, Vimentin
Abstract
Background: Synovial sarcoma is the common adult soft tissue sarcomas affects the lower extremities. In poor resource settings, characterization by molecular methods may not be feasible always. This study is aimed to evaluate Sensitivity and Specificity of Transducin-like enhancer of split 1 (TLE1) immunohistochemical expression in Synovial sarcomas (SS) and its histological mimics and to study the clinicopathological features of Synovial sarcoma. Method: A prospective study of two years duration from September 2013 to September 2015 conducted at the Department of Pathology, MNJ Institute of Oncology and Regional Cancer Centre, Redhills, Hyderabad. Total number of Synovial sarcomas was 30. All original H & E section of the tumor are reviewed and Immunohistochemistry (IHC) analysis was carried out on TLE1 mouse monoclonal antibody (TMA) blocks using TLE1 Antibody. Results: The Median age was 30 years. The most common site of involvement was lower limbs. The most common mode of presentation was painless swelling. The most common variant of Synovial sarcoma was monophasic Spindle in 19 cases. Total number of TLE1 positive cases of Synovial sarcoma was 93.3%. Total number of SS mimics showing TLE1 positivity was30%. TLE1 showed Sensitivity 93.3% and Specificity- 73.3%. In the present study negative predictive value is 91.6% and the positive predictive value is 77.7%. Conclusion: All small round blue cell tumors should be kept in mind while diagnosing poorly differentiated SS. TLE1 is a very sensitive marker for synovial sarcoma.TLE 1 is a highly sensitive marker for synovial sarcoma, but is less specific because of its positive expression in other mesenchymal tumors.References
1. Dimitriadis E, Rontogianni D, Kyriazoglou A, Takou A, Frangia K, Pandis N, et al. Novel SYT-SSX fusion transcript variants in synovial sarcoma. Cancer Genet Cytogenet. 2009;195(1):54-8.
2. Fletcher, Christopher DM, K. Krishnan Unni, and Fredrik Mertens, eds. Pathology and genetics of tumours of soft tissue and bone. Vol. 4. Chapter ix. IARC Press: Lyon, 2002. page: 200-204.
3. Baek D, Barbieri A, Ayala AG, Lee KM, Ju MJ, Ro JY. Monophasic epithelial synovial sarcoma initially diagnosed as metastatic adenocarcinoma of unknown primary. Human Pathology: Case Reports. 2019;17: 200307.
4. Thway K, Fisher C. Synovial sarcoma: defining features and diagnostic evolution. Ann Diagn Pathol. 2014;18(6):369-80.
5. Pop DL, Folescu R, Deleanu BN, Iacob M, VERMEŞ Prejbeanu R, et al. The role of immunohistochemistry in the diagnosis and management of synovial sarcoma. Rom J Morphol Embryol. 2018;59(2):569-72.
6. Shooshtarizadeh P, Helness A, Vadnais C, Brouwer N, Beauchemin H, Chen R, Bagci H, Staal FJ, Coté JF, Möröy T. Gfi1b regulates the level of Wnt/β-catenin signaling in hematopoietic stem cells and megakaryocytes. Nat Commun. 2019;10(1):1-6.
7. Foo WC, Cruise MW, Wick MR, Hornick JL. Immunohistochemical staining for TLE1 distinguishes synovial sarcoma from histologic mimics. Am J Clin Pathol. 2011;135(6):839-44.
8. Rekhi B, Basak R, Desai SB, Jambhekar NA. Immunohistochemical validation of TLE1, a novel marker, for synovial sarcomas. Indian J Med Res. 2012;136 (5):766-75.
9. Okcu MF, Munsell M, Treuner J, et al. Synovial sarcoma of childhood and adolescence: a multicenter, multivariate analysis of outcome. J Clin Oncol. 2003;21:1602-1611.
10. Segal NH, Pavlidis P, Antonescu CR, et al. Classification and subtype sprediction of adult soft tissue sarcoma by functional genomics. Am J Pathol. 2003;163:691–700.
11. Al-Mohrej OA, Al-Jarallah SA, Al-Dakhil Allah HH, Pant R, Al-Zayed ZS. Synovial sarcoma presenting as an intra-articular mass in a pediatric patient: a case report. BMC Musculoskelet Disord 2020;21: 21, 1-5.
12. Chhabra A, Ashikyan O, Slepicka C, Dettori N, Hwang H, Callan A, et al. Conventional MR and diffusion-weighted imaging of musculoskeletal soft tissue malignancy: correlation with histologic grading. Eur Radiol. 2019;29:4485–94.
13. Rose L, Grignon D, Cheng L, Fan R, Zhang S, Alruwaii F, Chen S. Primary renal synovial Sarcomas: PAX 8 immunostaining and unusual molecular findings. APPL IMMUNOHISTO M M. 2020;28(3):221-8.
14. Rekhi B, Shetty O, Ramadwar M, Rangarajan V, Bajpai J. Role of fine needle aspiration cytology in the diagnosis of a rare case of a poorly differentiated synovial sarcoma with “Rhabdoid” features, including treatment implications. Diagn Cytopathol. 2017;45(7):662-7.
15. Argani P, Faria PA, Epstein JI, Reuter VE, Perlman EJ, Beckwith JB, et al. Primary renal synovial sarcoma: molecular and morphologic delineation of an entity previously included among embryonal sarcomas of the kidney. Am J Surg Pathol. 2000;24(8):1087-96.
16. Pukhalskaya T, Smoller BR. TLE1 expression fails to distinguish between synovial sarcoma, atypical fibroxanthoma, and dermatofibrosarcoma protuberans. J. Cutan. Pathol. 2020;47(2):135-8.
17. Kosemehmetoglu K, Vrana JA, Folpe AL. TLE1 expression is not specific for synovial sarcoma: a whole section study of 163 soft tissue and bone neoplasms. Mod Pathol. 2009;22(7):872-8.
18. Terry J, Saito T, Subramanian S, Ruttan C, Antonescu CR, Goldblum JR, et al. TLE1 as a diagnostic immunohistochemical marker for synovial sarcoma emerging from gene expression profiling studies. Am J Surg Pathol. 2007;31(2):240-6.
19. Jagdis A, Rubin BP, Tubbs RR, Pacheco M, Nielsen TO. Prospective evaluation of TLE1 as a diagnostic immunohistochemical marker in synovial sarcoma. Am J Surg Pathol. 2009;33(12):1743-51.
2. Fletcher, Christopher DM, K. Krishnan Unni, and Fredrik Mertens, eds. Pathology and genetics of tumours of soft tissue and bone. Vol. 4. Chapter ix. IARC Press: Lyon, 2002. page: 200-204.
3. Baek D, Barbieri A, Ayala AG, Lee KM, Ju MJ, Ro JY. Monophasic epithelial synovial sarcoma initially diagnosed as metastatic adenocarcinoma of unknown primary. Human Pathology: Case Reports. 2019;17: 200307.
4. Thway K, Fisher C. Synovial sarcoma: defining features and diagnostic evolution. Ann Diagn Pathol. 2014;18(6):369-80.
5. Pop DL, Folescu R, Deleanu BN, Iacob M, VERMEŞ Prejbeanu R, et al. The role of immunohistochemistry in the diagnosis and management of synovial sarcoma. Rom J Morphol Embryol. 2018;59(2):569-72.
6. Shooshtarizadeh P, Helness A, Vadnais C, Brouwer N, Beauchemin H, Chen R, Bagci H, Staal FJ, Coté JF, Möröy T. Gfi1b regulates the level of Wnt/β-catenin signaling in hematopoietic stem cells and megakaryocytes. Nat Commun. 2019;10(1):1-6.
7. Foo WC, Cruise MW, Wick MR, Hornick JL. Immunohistochemical staining for TLE1 distinguishes synovial sarcoma from histologic mimics. Am J Clin Pathol. 2011;135(6):839-44.
8. Rekhi B, Basak R, Desai SB, Jambhekar NA. Immunohistochemical validation of TLE1, a novel marker, for synovial sarcomas. Indian J Med Res. 2012;136 (5):766-75.
9. Okcu MF, Munsell M, Treuner J, et al. Synovial sarcoma of childhood and adolescence: a multicenter, multivariate analysis of outcome. J Clin Oncol. 2003;21:1602-1611.
10. Segal NH, Pavlidis P, Antonescu CR, et al. Classification and subtype sprediction of adult soft tissue sarcoma by functional genomics. Am J Pathol. 2003;163:691–700.
11. Al-Mohrej OA, Al-Jarallah SA, Al-Dakhil Allah HH, Pant R, Al-Zayed ZS. Synovial sarcoma presenting as an intra-articular mass in a pediatric patient: a case report. BMC Musculoskelet Disord 2020;21: 21, 1-5.
12. Chhabra A, Ashikyan O, Slepicka C, Dettori N, Hwang H, Callan A, et al. Conventional MR and diffusion-weighted imaging of musculoskeletal soft tissue malignancy: correlation with histologic grading. Eur Radiol. 2019;29:4485–94.
13. Rose L, Grignon D, Cheng L, Fan R, Zhang S, Alruwaii F, Chen S. Primary renal synovial Sarcomas: PAX 8 immunostaining and unusual molecular findings. APPL IMMUNOHISTO M M. 2020;28(3):221-8.
14. Rekhi B, Shetty O, Ramadwar M, Rangarajan V, Bajpai J. Role of fine needle aspiration cytology in the diagnosis of a rare case of a poorly differentiated synovial sarcoma with “Rhabdoid” features, including treatment implications. Diagn Cytopathol. 2017;45(7):662-7.
15. Argani P, Faria PA, Epstein JI, Reuter VE, Perlman EJ, Beckwith JB, et al. Primary renal synovial sarcoma: molecular and morphologic delineation of an entity previously included among embryonal sarcomas of the kidney. Am J Surg Pathol. 2000;24(8):1087-96.
16. Pukhalskaya T, Smoller BR. TLE1 expression fails to distinguish between synovial sarcoma, atypical fibroxanthoma, and dermatofibrosarcoma protuberans. J. Cutan. Pathol. 2020;47(2):135-8.
17. Kosemehmetoglu K, Vrana JA, Folpe AL. TLE1 expression is not specific for synovial sarcoma: a whole section study of 163 soft tissue and bone neoplasms. Mod Pathol. 2009;22(7):872-8.
18. Terry J, Saito T, Subramanian S, Ruttan C, Antonescu CR, Goldblum JR, et al. TLE1 as a diagnostic immunohistochemical marker for synovial sarcoma emerging from gene expression profiling studies. Am J Surg Pathol. 2007;31(2):240-6.
19. Jagdis A, Rubin BP, Tubbs RR, Pacheco M, Nielsen TO. Prospective evaluation of TLE1 as a diagnostic immunohistochemical marker in synovial sarcoma. Am J Surg Pathol. 2009;33(12):1743-51.
Published
2020-09-09
Issue
Section
Original Article
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).
