151
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Bisceglia M, Bacchi CE. Mixed epithelial-stromal tumor of the kidney in adults: two cases from the Arkadi M. Rywlin slide seminars. Adv Anat Pathol 2003; 10:223-33. [PMID: 12826829 DOI: 10.1097/00125480-200307000-00006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M Bisceglia
- Servizio di Anatomia Patologica, IRCCS-Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy.
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152
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McCahon E, Sorensen PHB, Davis JH, Rogers PCJ, Schultz KR. Non-resectable congenital tumors with the ETV6-NTRK3 gene fusion are highly responsive to chemotherapy. MEDICAL AND PEDIATRIC ONCOLOGY 2003; 40:288-92. [PMID: 12652616 DOI: 10.1002/mpo.10272] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Recently, the ETV6-NTRK3 gene fusion has been identified in both infantile fibrosarcoma and cellular mesoblastic nephroma. For both these tumors standard curative treatment has been primarily surgical with wide local excision. This has frequently involved radical and even mutilating surgery. PROCEDURE This report discusses three infants with congenital tumors, two congenital fibrosarcomas, and one atypical congenital mesoblastic nephroma, not easily amenable to surgical intervention. RESULTS All three were treated with pre-operative chemotherapy with excellent responses negating the need for amputation in two patients. In each patient, the ETV6-NTRK3 gene fusion was identified by reverse transcriptase-polymerase chain reaction (RT-PCR) in the tumor specimens. CONCLUSIONS Our findings suggest that the ETV6-NTRK3 gene fusion may underlie the distinctive biological properties of these tumors and may also indicate tumor chemosensitivity. In this group of patients pre-operative chemotherapy may abrogate the need for morbid surgical procedures.
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Affiliation(s)
- Emma McCahon
- Oncology Department, The Children's Hospital Westmead, New South Wales, Australia
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153
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Willi N, Lohri A, Hailemariam S. Pathologic quiz case: a renal tumor in a 62-year-old woman. Arch Pathol Lab Med 2003; 127:245-7. [PMID: 12562248 DOI: 10.5858/2003-127-245-pq] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Niels Willi
- Cantonal Institute of Pathology, Kantonsspital Liestal, Switzerland
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154
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Pelmus M, Guillou L, Hostein I, Sierankowski G, Lussan C, Coindre JM. Monophasic fibrous and poorly differentiated synovial sarcoma: immunohistochemical reassessment of 60 t(X;18)(SYT-SSX)-positive cases. Am J Surg Pathol 2002; 26:1434-40. [PMID: 12409719 DOI: 10.1097/00000478-200211000-00005] [Citation(s) in RCA: 142] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Diagnosing monophasic fibrous and poorly differentiated synovial sarcoma (SS) on morphology alone is often a source of problems for pathologists. SS bear the t(X;18)(p11.2,q11.2) translocation, which proved to be specific for this tumor type and is currently considered one of the most reliable diagnostic criteria. To evaluate the sensitivity of immunohistochemical techniques in diagnosing monophasic fibrous SS (MFSS) and poorly differentiated SS (PDSS), we examined 60 t(X;18)(SYT-SSX)-positive cases (47 MFSS and 13 PDSS) for cytokeratin AE1/AE3, cytokeratin KL1, epithelial membrane antigen, E-cadherin, CD34, S-100 protein, alpha-smooth muscle actin, desmin, h-caldesmon, CD99, bcl2, and C-kit (CD117) antibodies. Of the four epithelial markers tested, epithelial membrane antigen proved to be the most sensitive, reacting with 100% of MFSS and 92% of PDSS, followed by cytokeratin AE1/AE3 (70% of MFSS, 46% of PDSS), cytokeratin KL1 (49% of MFSS, 38% of PDSS), and E-cadherin (47% of MFSS, 54% of PDSS). A staining for cytokeratin AE1/AE3 and/or E-cadherin was observed in 79% of MFSS and 69% of PDSS, and a staining for cytokeratin KL1 and/or E-cadherin was observed in 74% of MFSS and 62% of PDSS. S-100 protein was positive in 38% of MFSS and 23% of PDSS, and alpha-smooth muscle actin in 21% of MFSS and 8% of PDSS. Tumor cells were rarely positive for CD34 (6% of MFSS, 0% of PDSS) and desmin (2% of MFSS, 0% of PDSS). Most SS were strongly positive for bcl-2 (91% of MFSS, 92% of PDSS) and CD99 (91% of MFSS, 100% of PDSS). A weak and focal cytoplasmic reactivity for CD117 was observed in 11% of MFSS (only one case had a strong immunoreactivity) and 8% of PDSS. Staining with h-caldesmon was consistently negative. In conclusion, in keeping with literature data, our results show that reactivity for epithelial membrane antigen, cytokeratin AE1/AE3, and E-cadherin, in combination with CD34 negativity, are the most useful and sensitive markers for diagnosing monophasic fibrous and poorly differentiated t(X;18)-positive SS. They also support the fact that about one third of MFSS and one fourth of PDSS are positive for S-100 protein, a finding of diagnostic relevance when considering their distinction from other spindle to round cell sarcomas, especially malignant peripheral nerve sheath tumors.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/metabolism
- Child
- Chromosomes, Human, Pair 18
- Chromosomes, Human, X
- DNA, Neoplasm/analysis
- Female
- Humans
- Immunoenzyme Techniques
- Male
- Middle Aged
- Neoplasm Proteins/metabolism
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- Sarcoma, Synovial/genetics
- Sarcoma, Synovial/metabolism
- Sarcoma, Synovial/pathology
- Soft Tissue Neoplasms/genetics
- Soft Tissue Neoplasms/metabolism
- Soft Tissue Neoplasms/pathology
- Translocation, Genetic/genetics
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155
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156
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Bella AJ, Winquist EW, Perlman EJ. Primary synovial sarcoma of the kidney diagnosed by molecular detection of SYT-SSX fusion transcripts. J Urol 2002; 168:1092-3. [PMID: 12187231 DOI: 10.1016/s0022-5347(05)64583-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Anthony J. Bella
- From the Divisions of Urology and Medical Oncology, University of Western Ontario, London, Ontario, Canada, and The Johns Hopkins Hospital and National Wilms Tumor Study Group Pathology Center, Baltimore, Maryland
| | - Eric W. Winquist
- From the Divisions of Urology and Medical Oncology, University of Western Ontario, London, Ontario, Canada, and The Johns Hopkins Hospital and National Wilms Tumor Study Group Pathology Center, Baltimore, Maryland
| | - Elizabeth J. Perlman
- From the Divisions of Urology and Medical Oncology, University of Western Ontario, London, Ontario, Canada, and The Johns Hopkins Hospital and National Wilms Tumor Study Group Pathology Center, Baltimore, Maryland
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157
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Magro G, Cavallaro V, Torrisi A, Lopes M, Dell'Albani M, Lanzafame S. Intrarenal solitary fibrous tumor of the kidney report of a case with emphasis on the differential diagnosis in the wide spectrum of monomorphous spindle cell tumors of the kidney. Pathol Res Pract 2002; 198:37-43. [PMID: 11866209 DOI: 10.1078/0344-0338-00182] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Solitary fibrous tumor (SFT) is a neoplasm that can occur in the urogenital tract, and is also reported occurring in the spermatic cord, seminal vesicles, urinary bladder, prostate, and kidney. Furthermore, it is most important to consider its existence in the kidney, because it is usually diagnosed as renal cell carcinoma pre-operatively. To our knowledge, only 10 cases of SFT have been reported in the kidney to date. We report the clinico-pathological features of an intrarenal SFT occurring in a 31-year-old woman. The tumor, measuring 8.6 cm in its greatest diameter, completely replaced the cortex and the medulla of the middle region of the right kidney, compressing the pelvis. Radiological imaging was consistent with a renal cell carcinoma. Histologically, the tumor was composed of a proliferation of bland-looking vimentin+, CD34+, bcl2+ and CD99+ spindle cells exhibiting a haphazard to storiform growth pattern, pushing borders, and a low mitotic rate (2 mitoses x 10 HPF). We placed emphasis on the differential diagnostic problems, i.e., its differentiation from other primary monomorphous benign and malignant spindle cell tumors of the kidney, such as fibroma, benign fibrous histiocytoma, hemangiopericytoma, inflammatory myofibroblastic (pseudo-)tumor, leiomyoma, angiomyolipoma with predominant spindle cell smooth muscle component, benign peripheral nerve sheath tumors, renal mixed epithelial/stromal tumors, adult type mesoblastic nephroma, fibrous type monophasic synovial sarcoma, malignant peripheral nerve sheath tumors, fibrosarcoma, and low-grade fibromyxoid sarcoma.
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Affiliation(s)
- Gaetano Magro
- Institute of Anatomic Pathology, University of Catania, Italy.
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158
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Sandberg AA, Bridge JA. Updates on the cytogenetics and molecular genetics of bone and soft tissue tumors. Synovial sarcoma. CANCER GENETICS AND CYTOGENETICS 2002; 133:1-23. [PMID: 11890984 DOI: 10.1016/s0165-4608(01)00626-4] [Citation(s) in RCA: 121] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Avery A Sandberg
- Department of DNA Diagnostics, St. Joseph's Hospital and Medical Center, 350 West Thomas Road, Phoenix, AZ 85013, USA.
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159
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Bijwaard KE, Fetsch JF, Przygodzki R, Taubenberger JK, Lichy JH. Detection of SYT-SSX fusion transcripts in archival synovial sarcomas by real-time reverse transcriptase-polymerase chain reaction. J Mol Diagn 2002; 4:59-64. [PMID: 11826189 PMCID: PMC1906970 DOI: 10.1016/s1525-1578(10)60681-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Synovial sarcomas comprise approximately 5% of soft tissue sarcomas and occur primarily in young adults. The t(X;18) (p11.2;q11.2) has been demonstrated to be highly characteristic of synovial sarcomas, and the resulting SYT-SSX fusion transcripts have been shown to be useful diagnostic markers. We have developed a real-time, reverse transcriptase-polymerase chain reaction (RT-PCR) multiplex assay for the identification of the primary fusion transcript types (SYT-SSX1 and SYT-SSX2) from formalin-fixed, paraffin-embedded (FFPE) tissues. Twenty-nine of 30 (96.7%) histologically diagnosed FFPE synovial sarcomas were positive for the presence of either the SYT-SSX1 or SYT-SSX2 fusion transcripts. Ten of 16 (62.5%) and five of 16 (31.25%) monophasic fibrous synovial sarcomas were positive for SYT-SSX1 and SYT-SSX2, respectively. One of 16 (6.25%) monophasic fibrous synovial sarcomas was negative for either SYT-SSX fusion transcript. Twelve of 14 (85.7%) and 2 of 14 (14.3%) biphasic synovial sarcomas were positive for SYT-SSX1 and SYT-SSX2, respectively. All 13 non-synovial sarcomas tested were negative for SYT-SSX1 and SYT-SSX2 fusion transcripts. This method is a relatively simple and rapid procedure for the detection of the t(X;18)(p11.2;q11.2).
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MESH Headings
- Biomarkers, Tumor/genetics
- Chromosomes, Human, Pair 18
- DNA Primers/chemistry
- DNA, Neoplasm/analysis
- Diagnosis, Differential
- Humans
- Neoplasm Proteins/genetics
- Oncogene Proteins, Fusion/genetics
- Prognosis
- RNA, Messenger/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- Sarcoma, Synovial/genetics
- Sarcoma, Synovial/pathology
- Soft Tissue Neoplasms/genetics
- Soft Tissue Neoplasms/pathology
- Translocation, Genetic
- Tumor Cells, Cultured
- X Chromosome
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Affiliation(s)
- Karen E Bijwaard
- Division of Molecular Pathology, the Department of Cellular Pathology and Genetics, Armed Forces Institute of Pathology, Washington, DC, USA.
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160
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Chen S, Bhuiya T, Liatsikos EN, Alexianu MD, Weiss GH, Kahn LB. Primary synovial sarcoma of the kidney: a case report with literature review. Int J Surg Pathol 2001; 9:335-9. [PMID: 12574853 DOI: 10.1177/106689690100900414] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We describe a case of primary renal synovial sarcoma (SS) in a 48-year-old man. The patient presented with hematuria and was found to have a large tumor in his left kidney on computed tomography scan. Histology revealed a highly cellular spindle cell neoplasm with minimal pleomorphism. The major differential diagnoses included leiomyosarcoma, hemangiopericytoma, and SS. The presence of focal areas with a biphasic pattern, uniformly positive immunostain for bcl-2, focally positive immunostains for epithelial membrane antigen and cytokeratin, and negative immunostains for CD-34, smooth muscle actin and S-100 established the diagnosis. This was subsequently confirmed by molecular testing for t(X;18) translocation. Since the existence of primary SS in the kidney was first suggested in 1999, to the best of our knowledge a total of 19 cases including the present case have been reported to date. Although primary renal SS is rare, these findings indicate that it should be included in the differential diagnosis of spindle cell tumors of the kidney.
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MESH Headings
- Biomarkers, Tumor/analysis
- Diagnosis, Differential
- Hemangiopericytoma/pathology
- Hematuria/etiology
- Humans
- Immunohistochemistry
- Kidney Neoplasms/complications
- Kidney Neoplasms/genetics
- Kidney Neoplasms/metabolism
- Kidney Neoplasms/pathology
- Leiomyosarcoma/pathology
- Male
- Middle Aged
- Oncogene Proteins, Fusion/genetics
- RNA, Messenger/analysis
- Reverse Transcriptase Polymerase Chain Reaction
- Sarcoma, Synovial/complications
- Sarcoma, Synovial/genetics
- Sarcoma, Synovial/metabolism
- Sarcoma, Synovial/pathology
- Tomography, X-Ray Computed
- Translocation, Genetic
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Affiliation(s)
- S Chen
- Department of Pathology, Long Island Jewish Medical Center, The Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, NY 11040, USA
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161
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Wang J, Arber DA, Frankel K, Weiss LM. Large solitary fibrous tumor of the kidney: report of two cases and review of the literature. Am J Surg Pathol 2001; 25:1194-9. [PMID: 11688580 DOI: 10.1097/00000478-200109000-00011] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Solitary fibrous tumors are spindle cell neoplasms frequently arising in the serosal surface as well as a variety of other sites. We report two cases of large solitary fibrous tumor arising in the kidney, clinically thought to be renal cell carcinoma, in 41- and 72-year-old men. Although large in size (13.0 and 14.0 cm in greatest dimension, respectively), both lesions were well circumscribed and composed of a mixture of spindle cells and dense collagenous bands with no areas of necrosis or cystic changes noted macroscopically or microscopically. Immunohistochemical studies revealed reactivity for vimentin, CD34, collagen IV, and bcl-2 protein in both cases, with no staining for keratin, S-100 protein, or muscle markers, confirming the diagnosis of solitary fibrous tumor of the kidney. Solitary fibrous tumor of the kidney is rare but may present as a large mass that may be clinically confused with carcinoma or sarcoma.
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Affiliation(s)
- J Wang
- Department of Pathology and Laboratory Medicine, Loma Linda University Medical Center, California 92354, USA
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162
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Primary renal neoplasms with the ASPL-TFE3 gene fusion of alveolar soft part sarcoma: a distinctive tumor entity previously included among renal cell carcinomas of children and adolescents. THE AMERICAN JOURNAL OF PATHOLOGY 2001; 159:179-92. [PMID: 11438465 PMCID: PMC1850400 DOI: 10.1016/s0002-9440(10)61684-7] [Citation(s) in RCA: 436] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The unbalanced translocation, der(17)t(X;17)(p11.2;q25), is characteristic of alveolar soft part sarcoma (ASPS). We have recently shown that this translocation fuses the TFE3 transcription factor gene at Xp11.2 to ASPL, a novel gene at 17q25. We describe herein eight morphologically distinctive renal tumors occurring in young people that bear the identical ASPL-TFE3 fusion transcript as ASPS, with the distinction that the t(X;17) translocation is cytogenetically balanced in these renal tumors. A relationship between these renal tumors and ASPS was initially suggested by the cytogenetic finding of a balanced t(X;17)(p11.2;q25) in two of the cases, and the ASPL-TFE3 fusion transcripts were then confirmed by reverse transcriptase-polymerase chain reaction. The morphology of these eight ASPL-TFE3 fusion-positive renal tumors, although overlapping in some aspects that of classic ASPS, more closely resembles renal cell carcinoma (RCC), which was the a priori diagnosis in all cases. These tumors demonstrate nested and pseudopapillary patterns of growth, psammomatous calcifications, and epithelioid cells with abundant clear cytoplasm and well-defined cell borders. By immunohistochemistry, four tumors were negative for all epithelial markers tested, whereas four were focally positive for cytokeratin and two were reactive for epithelial membrane antigen (EMA) (one diffusely, one focally). Electron microscopy of six tumors demonstrated a combination of ASPS-like features (dense granules in four cases, rhomboid crystals in two cases) and epithelial features (cell junctions in six cases, microvilli and true glandular lumens in three cases). Overall, although seven of eight tumors demonstrated at least focal epithelial features by electron microscopy or immunohistochemistry, the degree and extent of epithelial differentiation was notably less than expected for typical RCC. We confirmed the balanced nature of the t(X;17) translocation by fluorescence in situ hybridization in all seven renal tumors thus analyzed, which contrasts sharply with the unbalanced nature of the translocation in ASPS. In summary, a subset of tumors previously considered to be RCC in young people are in fact genetically related to ASPS, although their distinctive morphological and genetic features justify their classification as a distinctive neoplastic entity. Finally, the finding of distinctive tumors being associated with balanced and unbalanced forms of the same translocation is to our knowledge, unprecedented.
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163
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Koyama S, Morimitsu Y, Morokuma F, Hashimoto H. Primary synovial sarcoma of the kidney: Report of a case confirmed by molecular detection of the SYT-SSX2 fusion transcripts. Pathol Int 2001; 51:385-91. [PMID: 11422798 DOI: 10.1046/j.1440-1827.2001.01203.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We describe an unusual case of primary synovial sarcoma of the kidney. A 47-year-old woman had a tumor massively replacing the right kidney. There were no primary extrarenal neoplastic lesions. Microscopically, the tumor was composed of a cellular proliferation of relatively uniform spindle-shaped cells having atypical spindle or oval nuclei arranged in fascicles with tumor necrosis, without epithelial areas. Immunohistochemically, a small number of the tumor cells were positive for epithelial markers such as cytokeratin and epithelial membrane antigen. The SYT-SSX2 fusion transcripts were detected by a reverse transcription-polymerase chain reaction (RT-PCR) using RNA extracted from formalin-fixed, paraffin-embedded tissue. ETV6-NTRK3 fusion gene transcripts that result from t(12; 15)(p13;q25), which is characteristic of cellular congenital mesoblastic nephroma, were not demonstrated. To our knowledge, this is the ninth case of primary renal synovial sarcoma. This case report indicates that synovial sarcoma should be taken into account for the differential diagnosis of renal spindle cell tumors and the molecular assay detecting the SYT-SSX fusion transcripts is useful for the final diagnosis of synovial sarcoma arising in an unusual location.
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Affiliation(s)
- S Koyama
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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