Monophasic synovial sarcoma of spindle-cell type. Epithelial differentiation as revealed by ultrastructural features, content of prekeratin and binding of peanut agglutinin

A Role for SMARCB1 in Synovial Sarcomagenesis Reveals That SS18-SSX Induces Canonical BAF Destruction

Reduced protein levels of SMARCB1 (also known as BAF47, INI1, SNF5) have long been observed in synovial sarcoma. Here, we show that combined Smarcb1 genetic loss with SS18-SSX expression in mice synergized to produce aggressive tumors with histomorphology, transcriptomes, and genome-wide BAF-family complex distributions distinct from SS18-SSX alone, indicating a defining role for SMARCB1 in synovial sarcoma. Smarcb1 silencing alone in mesenchyme modeled epithelioid sarcomagenesis. In mouse and human synovial sarcoma cells, SMARCB1 was identified within PBAF and canonical BAF (CBAF) complexes, coincorporated with SS18-SSX in the latter. Recombinant expression of CBAF components in human cells reconstituted CBAF subcomplexes that contained equal levels of SMARCB1 regardless of SS18 or SS18-SSX inclusion. In vivo, SS18-SSX expression led to whole-complex CBAF degradation, rendering increases in the relative prevalence of other BAF-family subtypes, PBAF and GBAF complexes, over time. Thus, SS18-SSX alters BAF subtypes levels/balance and genome distribution, driving synovial sarcomagenesis. SIGNIFICANCE: The protein level of BAF component SMARCB1 is reduced in synovial sarcoma but plays a defining role, incorporating into PBAF and SS18-SSX-containing canonical BAF complexes. Reduced levels of SMARCB1 derive from whole-complex degradation of canonical BAF driven by SS18-SSX, with relative increases in the abundance of other BAF-family subtypes.See related commentary by Maxwell and Hargreaves, p. 2375.This article is highlighted in the In This Issue feature, p. 2355.

Glial FibriUary Acidic Protein (GFAP) Immunoreactivity in Peripheral Nerve Sheath Tumors

A spectrum of 24 benign and malignant nerve sheath tumors and 10 non-neural spindle-cell tumors were studied by light microscopy for the presence of glial fibrillary acidic protein (GFAP) immunoreactivity by the peroxidase-antiperoxidase (PAP) technique. In 8 cases, these results were compared to their electron microscopic appearances. Seventy percent (7 of 10) of benign schwannomas and 50% (4 of 8) of benign neurofibromas demonstrated focal to diffuse GFAP immunoreactivity. None of the malignant nerve sheath tumors nor any of the non-neural spindle-cell neoplasms contained demonstrable GFAP immunoreactivity. Similarly, no GFAP immunoreactivity could be detected in Schwann cells in normal peripheral nerves. The solitary benign schwannoma available for electron microscopic study demonstrated diffuse and abundant cytoplasmic intermediate filaments, and this tumor displayed diffuse and intense GFAP immunoreactivity. Two benign neurofibromas showed a more variable content of intermediate filaments ultrastructurally, and their GFAP immunoreactivity was variable. All five malignant nerve sheath tumors studied by electron microscopy displayed a variable complement of intermediate filaments; however, none of these tumors possessed GFAP immunoreactivity, suggesting that these intermediate filaments are either members of a different class of intermediate filaments or may perhaps represent "altered" GFAP not recognized by these antisera.

Differential Ki67 and bcl-2 immunoexpression in solid-glandular and spindle cell components of biphasic synovial sarcoma: a double immunostaining assessment with cytokeratin and vimentin

AIMS

Synovial sarcoma is a malignant soft tissue of uncertain histogenesis that may show a biphasic (spindle and solid/glandular components) or a monophasic histological appearance. In previous studies, we demonstrated that the solid/glandular component possesses higher proliferation rates than the spindle cell component of biphasic synovial sarcomas and that the spindle cell component may exhibit a progressive transition from or to the solid-glandular component in biphasic synovial sarcoma. To evaluate this hypothesis further, we designed a novel approach to correlate immunoexpression of Ki67, bcl-2 and bax in the spindle cell and in the solid-glandular component of biphasic synovial sarcomas. We also performed a double-immunohistochemical assessment of the Ki67 proliferative indices and the immunoexpression of anti-apoptotic protein bcl-2 in neoplastic cells expressing either vimentin or cytokeratin.

METHODS AND RESULTS

Immunohistochemistry for vimentin (10 cases), bcl-2 (10 cases), Ki67(10 cases), cytokeratin (10 cases), and bax (eight cases), and double-immunostaining for vimentin/Ki67 (10 cases), vimentin/bcl-2 (nine cases), cytokeratin/Ki67 (10 cases), and cytokeratin/bcl-2 (10 cases) assays were performed in 10 cases of primary biphasic synovial sarcoma. Semiquantitative assessment was adopted for each case in both components. Statistical analysis was performed using Fisher's exact test or chi2 test. On conventional immunohistochemistry, the solid/glandular component revealed more expression of Ki67, bax and cytokeratin than the spindle cell component (P=0.0004, P=0.082, and P < 0.0001, respectively); on the other hand, the latter showed higher expression of bcl-2 and vimentin than the former (P=0.0281 and P=0.059, respectively). Double immunohistochemistry analysis revealed higher co-expression levels of cytokeratin/Ki67 and cytokeratin/bcl-2 than the spindle cell component (P=0.015 and P < 0.0001, respectively); conversely, the latter presented higher co-expression of vimentin/bcl-2 than the former (P=0.0007). All cases showed no more than 10% of cells coexpressing cytokeratin/bcl-2, cytokeratin/Ki67, and no case revealed cells coexpressing vimentin/Ki67.

CONCLUSION

Our findings indicate that in biphasic synovial sarcoma the acquisition of epithelial phenotype (solid/glandular component) is associated with a high expression of pro-apoptotic proteins and a high proliferative differentiation status, and conversely, mesenchymal phenotype (spindle cell component) is associated with a high expression of apoptosis-inhibitor bcl-2 and a low proliferative terminal-type differentiation status.

Capacity for epithelial differentiation in synovial sarcoma: analysis of a new human cell line

AIM

To analyse the capacity for epithelial differentiation in synovial sarcoma using a new human cell line.

METHODS

A new human cell line, KU-SS-1, was established from a monophasic, spindle cell type of synovial sarcoma by grafting those cells on to severe combined immunodeficient (SCID) mice and then transferring them to in vitro culture systems. The KU-SS-1 cells were characterised by light and electron microscopy, and by immunohistochemical, flow cytometric, and cytogenetic analysis.

RESULTS

Primary tumour and cultured cells at passage 20 showed a positive reaction for vimentin, which is a mesenchymal marker. After 40 passages, subcultured cells were injected into SCID mice to induce further tumours. These advanced subcultured cells and the tumour cells that they induced were positive for cytokeratin, an epithelial marker, and exhibited epithelial ultrastructural features such as intermediate junctions. Furthermore, two colour immunofluorescent analysis for proliferating nuclear cell antigen (PCNA) and intermediate filaments showed that a large number of PCNA expressing cells were positive for vimentin, and that part of this fraction also expressed cytokeratin. The existence of cells with reactivity for these three markers indicated that, in this cell line, a fraction with high proliferating capacity had both mesenchymal and epithelial markers. In addition, cytogenetically, this cell line expressed the SYT-SSX chimaeric transcript as a result of the t(X;18) (p11;q11) translocation.

CONCLUSIONS

A human synovial sarcoma cell line was established and stably maintained in cell culture for more than 70 passages. In addition, this cell line showed epithelial differentiation, which supports the hypothesis that synovial sarcoma is a carcinosarcoma like tumour with true epithelial differentiation. This cell line will be a useful tool for investigating the nature of this tumour and will contribute to clinical studies.

Detection of chromosome 18 rearrangement in synovial sarcoma by fluorescence in situ hybridization

Fluorescence in situ hybridization (FISH) evaluations of chromosome 18 were performed in synovial sarcoma, hemangiopericytoma, and mesothelioma. Each case was evaluated with centromeric and whole chromosome paint probes. The synovial sarcomas had t(X;18) cytogenetically, but the FISH evaluator was blinded to the cytogenetic results and to the histopathologic diagnosis. The FISH analyses were consistent with chromosome 18 translocation in 6 of 7 synovial sarcomas, 0 of 3 hemangiopericytomas, and 0 of 1 mesothelioma. These findings support the use of FISH in the diagnosis of synovial sarcoma.

A synovial sarcoma with a complex t(X;18;5;4) and a break in the ornithine aminotransferase (OAT)L1 cluster on Xp11.2

The initial cytogenetic analysis of a biphasic synovial sarcoma revealed complex anomalies involving six different chromosomes: 46,Y,t(X;18;5;4)(p11;q11;p13;q12),t(2;5)(q35;q11). After fluorescence in situ hybridization (FISH) analysis, using chromosome X-specific plasmid library and YAC probes, the situation appeared to be even more complex, with an insertion of part of the X chromosome short arm into the der(5)t(5;18). In spite of these complex chromosomal rearrangements, the Xp11 breakpoint could be mapped to within the ornithine aminotransferase (OAT)L1 cluster, very similar to that reported previously for the standard t(X;18)(p11;q11) in synovial sarcomas. These findings suggest common pathogenetic pathways in these cytogenetically different but morphologically similar tumors.

Distinct Xp11.2 breakpoint regions in synovial sarcoma revealed by metaphase and interphase FISH: relationship to histologic subtypes

Fluorescence in situ hybridization (FISH) and molecular analyses of synovial sarcomas with cytogenetically similar (X;18)(p11.2;q11.2) translocations have revealed two alternative breakpoint regions in Xp11.2, one residing in the ornithine aminotransferase-like 1 (OATL1) region and the other one in the related but distinct OATL2 region. As these results were obtained by different groups, we set out to evaluate an extended series of tumors with special emphasis on the two possible X-related breakpoint regions. Together, seven synovial sarcomas were identified with a break in the OATL1 region and six with a break near OATL2, thereby confirming the actual existence of the two alternative Xp breakpoint regions. We speculate that there seems to be a relationship between the occurrence of these breakpoint regions and the histologic phenotype of the tumors, with a predominance of OATL1-related breakpoints in the classical biphasic tumors and of OATL2-related breakpoints in the monophasic fibrous tumors.

Immunohistochemical profile of synovial sarcoma with emphasis on the epithelial-type differentiation. A study of 49 primary tumours, recurrences and metastases

The relationship between biphasic (BSS) and monophasic (MSS) subtypes of synovial sarcoma (SS) as well as the relationship between cells of solid/glandular areas and the spindle cells of BSS remain controversial. In order to further evaluate the immunohistochemical phenotype of SS we studied 34 primary tumours (15 BSS; 19 MSS), 7 recurrences (4 from primary BSS; 3 from primary MSS) and 8 metastases (7 BSS; one MSS), using several antibodies (EMA, CEA, keratins 1, 4, 5/6, 7, 8, 13, 18, 19, 20, vimentin, collagen IV and laminin) that work in paraffin-embedded material. Spindle cells outside solid/glandular areas of BSS and in MSS showed immunoreactivity for keratins 5/6, 7, 8, 18 and 19. The transition of solid/glandular areas to surrounding spindle cells also showed keratin staining and failed to show a distinct separation regarding the immunoreactivity for laminin and collagen IV. Peripheral cells of solid/glandular areas were immunoreactive for vimentin. No major differences were observed between immunophenotypical cell profiles of BSS and MSS, apart from the exclusive immunostaining of solid/glandular areas of BSS for keratin 13 and CEA. Downgrading of keratin and extracellular matrix antigens immunoreactivity was observed when primary tumours were compared to recurrent and/or metastatic tumours of both subtypes (MSS and BSS). We conclude that SS should be regarded as carcinomas of soft tissues with an immunohistochemical phenotype depending on the degree of epithelial differentiation: spindle cells (MSS and BSS) predominantly expressing simple keratins, and poorly differentiated (solid/glandular) as well as well-differentiated (glandular) areas (BSS) expressing, in addition, complex epithelial-type keratins.

Identification of a yeast artificial chromosome (YAC) spanning the synovial sarcoma-specific t(X;18)(p11.2;q11.2) breakpoint

A somatic cell hybrid containing the synovial sarcoma-associated t(X;18)(p11.2;q11.2) derivative (der(X)) chromosome was used to characterize the translocation breakpoint region on the X chromosome. By using Southern hybridization of DNA from this der(X) hybrid in conjunction with Xp-region specific radiation reduced cell hybrids and probes, it was found that this breakpoint maps within the ornithine aminotransferase (OAT) L1 cluster. A yeast artificial chromosome (YAC) clone (OAT YAC2) which hybridizes to a human OAT cDNA probe and is known to contain part of the OATL1 cluster was selected and used to confirm these results both by fluorescence in situ hybridization on synovial sarcoma patient material and by hybridization of its end-clones to the der(X) containing hybrid cells. It was found that indeed the human Xp sequences contained within this YAC are split as a consequence of the (X;18) translocation. Therefore, we conclude that OAT YAC2 spans the synovial sarcoma-specific translocation breakpoint and, as such, may serve as an ideal starting point from which the gene(s) involved in the development of this soft tissue tumor can be isolated.

The ultrastructural spectrum of synovial sarcomas: a study of the epithelial type differentiation of primary tumors, recurrences, and metastases

Synovial sarcomas (SS) are malignant soft tissue tumors of unknown origin. Their classification as carcinomas (monophasic synovial sarcomas, MSS) or carcinosarcomas (biphasic synovial sarcomas, BSS) still raises controversy. In an attempt to settle this controversy, an ultrastructural study was undertaken of 25 primary SS (12 BSS and 13 MSS), 5 recurrences (3 BSS and 2 MSS), and 2 metastases (2 BSS) based upon precise selection of different aspects of BSS and MSS on numerous semithin sections from each case. Ultrastructural markers of epithelial type differentiation of neoplastic cells were found in every type of cellular component of SS regardless of the tumoral pattern (biphasic or not). No major differences were found between MSS and the nonglandular areas of BSS (not even regarding the presence of abortive glandular lumina). Cytoarchitectural transitions were frequently observed; these included spindle to epithelioid cell types and fascicular to solid (MSS and BSS) or fascicular to glandular (BSS) patterns. These findings support the assumption that spindle cells of SS are neoplastic and may evolve to glandular cells in SS. Based on the cytogenetic data pointing to a common pathogenesis of both phenotypes (BSS and MSS), SS may represent true carcinomas of soft tissues with a biphasic and/or monophasic pattern depending on the degree of differentiation.

Synovial sarcoma. A clinicopathological study of 31 cases

Thirty-one surgically treated cases of synovial sarcoma were reviewed. The mean age of the patients at primary surgery was 37 years (range 10-78 years). Twenty-nine of the tumors were of the biphasic type and two were monophasic. Currently a monophasic synovial sarcoma can be considered as a specific entity. In contrast to other soft-tissue sarcomas, synovial sarcomas present the characteristics of a carcinosarcoma. The 5-year survival rate in this study was 55% and the 6-year survival rate 50%; after 6 years there were no recurrences. The primary treatment should follow the same guidelines that are currently given for other soft-tissue sarcomas: wide and radical excisional margins should be aimed at. Excisional treatment even of repeated pulmonary recurrences may be rewarding.

Synovial sarcoma. Inter-relationship of the biphasic and monophasic subtypes

In order to assess minimum diagnostic criteria for synovial sarcoma, particularly the monophasic variety, and the inter-relationship between the monophasic and biphasic types, 32 examples were studied histologically, immunohistochemically (26 cases), and ultrastructurally (13 cases). Of the six biphasic synovial sarcomas examined by electron microscopy, the spindle cell component did not show evidence of epithelial differentiation or resemble the epithelial phase, but did appear fibroblastic; no tumor cells transitional between the spindle and epithelial component were evident. In contrast, all of the seven monophasic lesions had ultrastructural growth patterns and some cellular features approximating the epithelial cells of the biphasic variant. In 11 biphasic synovial sarcomas, epithelial membrane antigen was detected in the glandular epithelium of all cases and cytokeratins in eight cases; in no case were these antigens detected in the spindle cell regions of biphasic lesions. Of the 15 monophasic synovial sarcomas, two were positive for cytokeratins and four for epithelial membrane antigen. Thus, the detection of epithelial markers either immunohistochemically or by electron microscopy (or both) should be the minimal diagnostic criteria for monophasic synovial sarcomas. Based on these findings, it is suggested that monophasic synovial sarcomas do not represent the spindle cell or "stromal" phase of biphasic synovial sarcomas, but are a poorly differentiated variant of the latter. As others have suggested, these tumors are, in fact, carcinosarcomas and carcinomas of the soft tissues and the designation synovial sarcoma is inappropriate for this tumor class.

Synovial sarcoma: a review and update, with emphasis on the ultrastructural characterization of the nonglandular component

Classic biphasic synovial sarcoma is usually not a problem in identification, whereas the monophasic spindle cell form continues to be a challenge in the differential diagnosis of spindle cell neoplasms. Most synovial sarcomas do not arise from a joint or tendon sheath, and by electron microscopy and immunohistochemistry they differ in several ways from nonneoplastic synovium. The cell of origin of synovial sarcoma is unknown, but certain features are rather consistently observed in the biphasic tumors and are useful in identifying monophasic samples. These features are apparent by immunohistochemistry and electron microscopy, both of which indicate early epithelial differentiation in the nonglandular component of the neoplasm. With immunohistochemistry, some of these cells stain for keratin. By electron microscopy, a gradient of differentiation from unclassifiable spindle cells to fully differentiated epithelial lining cells is demonstrable. A review and illustration of the ultrastructural characteristics in this spectrum of intermediate cells constitute the main emphasis of the article. The cells tend to be oval and polygonal; to be arranged in clusters surrounded by basal lamina or flocculent matrix; to have junctions, including tight junctions, and to form villuslike filopodia, true microvilli, canaliculi, and microlumina. This range of ultrastructural features is usually diagnostic of the nonglandular phase of synovial sarcoma.

Synovial sarcoma: an immunohistochemical and ultrastructural study

Thirty-nine primary synovial sarcomas (15 biphasic, 24 monophasic), and 19 metastatic synovial sarcomas were studied with a battery of antibodies directed to keratin, epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), vimentin, desmin, muscle-specific actin, smooth muscle actin, S-100 protein, Leu-7, chromogranin A, laminin, collagen IV, Ulex europaeus agglutinin I (UEAI), and the HMB-45 antimelanoma antibody. Twenty-two primary and 18 metastatic synovial sarcomas were also examined by electron microscopy. Epithelial and/or spindle cells in every biphasic tumor, primary and metastatic, reacted for keratin and EMA, but only six primary tumors (five biphasic and one monophasic) showed weak reactivity for CEA which, in the biphasic tumors, was confined to the epithelial component. Of the monophasic tumors, 15 primary (63%) and four metastatic (25%) stained for keratin, whereas seven primary (29%) and two metastatic (13%) tumors reacted for EMA. Only one primary monophasic synovial sarcoma stained for CEA. Tumors that stained for EMA or CEA also stained for keratin which is, therefore, the most useful epithelial marker. Immunostaining for epithelial markers, UEAI, collagen IV, and laminin serves to delineate the epithelial component when it is obscure in routine sections. Electron microscopy facilitates the diagnosis when epithelial markers are not expressed and aids in separating monophasic synovial sarcomas from other sarcomas that they resemble by light microscopy.

Epithelial differentiation in synovial sarcoma. Correlation with histology and immunophenotypic expression

The epithelial properties of the cells in six cases of synovial sarcoma, five biphasic and one monophasic, were examined. Epithelial cells formed well demarcated glandular nests with a multi- or single-layered lining, poorly defined nest-like clusters, or appeared as scattered single plump cells in a spindle-cell stroma. Keratinization was seen in multi-layered epithelia, and was suggested in single-layered epithelia from the presence of some enlarged eosinophilic cells. Immunohistochemically, epithelia lining glands showed reactivity for both low- and high-molecular-weight (MW) cytokeratins, and the reactions for both were strongest in keratinized cells. Clustered or single plump cells showed low-MW cytokeratin reactivity. All epithelial cells were negative for the largest cytokeratin (no. 1), and occasionally stained positively for vimentin. Spindle-shaped stromal cells usually stained positively for vimentin only. Type IV collagen was distributed linearly around well circumscribed epithelia, but not around poorly defined epithelia or plump cells. Epithelial membrane antigen was distributed linearly along glandular spaces and irregularly or granularly in clustered plump cells. The immunophenotypic epithelialization in synovial sarcoma was restricted, but showed considerable correlation with the histological grade of differentiation.

Epithelial markers in synovial sarcoma. An immunohistochemical study on paraffin embedded tissues

Immunohistochemical studies on synovial sarcomas have proved the potentiality of these neoplasm for epithelial and mesenchymal differentiation and antibodies detecting epithelial cells have been found to be helpful in determining the histological types. In this study different epithelial markers directed against various cytokeratins, HMFG-2 and EMA were investigated on paraffin embedded tissues of 13 cases of synovial sarcomas, with regard to their reliability in unmasking the epithelial components demonstrable in this type of neoplasm. The results lead to three conclusions: firstly, synovial sarcomas possess the capacity for generating different epithelial cell types with uncommon compositions of intermediate filaments as well as of membrane proteins, secondly, these features may be expressed in a heterogenous pattern even within the same tumour and finally, the use of wide range anti-cytokeratin antibodies covering the spectrum of basic as well as acidic type proteins seems to be necessary for the detection of all epithelial components demonstrable in synovial sarcomas.

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

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.

Analysis of differentiation and transformation of cells by lectins

During differentiation cells are known to change their biological behavior according to their genotype. This is thought to be accompanied by a modulation of cell surface determinants expressed on the outer cell membrane. Vice versa, cell surface molecules are suggested to mediate extracellular signals to the genome. Most of these molecules integrated in the cell membrane have been proven to be glycoconjugates. The carbohydrate moieties of these molecules can be detected by means of lectins that are characterized by their ability to react specifically with distinct terminal sugar sequences. Thus, lectins have been used as appropriate tools for studying the modulation of functionally important membrane-associated molecules during the differentiation of cells, in particular of B- and T-lymphocytes. Moreover, lectins have been proven to distinguish between differentiated cells and malignant cell clones, according to the hypothesis that transformed cells possess a glycoconjugate profile that corresponds to the stage of differentiation at which they are arrested. Since lectins, like monoclonal antibodies, make it possible to study functionally important molecules that are associated with differentiation and malignancy, they might be of value for diagnostic purposes and, moreover, for analyzing malignant transformation.

Cytokeratins in certain endothelial and smooth muscle cells of two taxonomically distant vertebrate species, Xenopus laevis and man

Using immunolocalization techniques, electron microscopy, and gel electrophoresis combined with immunoblotting, we have noted remarkable interspecies differences in the expression of cytokeratins in certain nonepithelial cells. In the present study we describe, in two taxonomically distant vertebrate species, the African clawed toad Xenopus laevis and man, endothelial and smooth muscle cells which express cytokeratin intermediate filaments (IFs), in addition to vimentin and/or desmin IFs. In Xenopus, all endothelia seem to produce both vimentin and cytokeratin IFs. As well, certain smooth muscle bundles located in the periphery of the walls of the esophagus and the urinary bladder produce small amounts of cytokeratin IFs in addition to IFs containing vimentin or desmin or both. The amphibian equivalents of human cytokeratins 8 and 18 have been identified in these nonepithelial tissues. In human endothelial cells, immunocytochemical reactions with certain cytokeratin antibodies are restricted to a rare subset of blood vessels. Vessels of this type were first noted in synovial and submucosal tissues, but also occur in some other locations. Cytokeratins have also been detected in certain groups of smooth muscles, such as those present in the walls of some blood vessels in synovial tissue and umbilical cord. Here, the synthesis of low levels of cytokeratins 8 and 18, sometimes with traces of cytokeratin 19, has been demonstrated in smooth muscle cells by colocalization with myogenic marker proteins, such as desmin and/or the smooth-muscle-specific isoform of alpha-actin. Possible reasons for the differences in cytokeratin expression between adjacent endothelia in man, and smooth-muscle structures in both species, as well as biologic and histodiagnostic implications of these findings, are discussed.

Immunoprofile of benign and malignant fibrohistiocytic tumors

Formalin-fixed, paraffin-embedded tissue sections from 26 malignant fibrous histiocytomas (MFH) and 61 benign fibrohistiocytic proliferations (BFHP) were evaluated immunohistochemically. An avidinbiotin-peroxidase technique was used to determine immunoreactivity for alpha-1 antichymotrypsin, muramidase, HLA-DR, leucocyte common antigen, S-100 protein, vimentin, desmin, and keratin. MFHs were consistently positive for ACT and vimentin and inconsistently reactive for the other antigens. MFHs were negative for LCA suggesting a mesenchymal origin for these lesions. In the MFH histologic subtypes, antigen expression was not significantly different to be useful in their classification. Also no distinctive pattern emerged relative to immunoreactivity and tumor location. The benign lesions, giant cell tumor of tendon sheath, dermatofibroma, and oral benign fibrous histiocytoma differed from the MFHs in that they were often LCA positive, suggesting origin from hematopoetic mononuclear-macrophages. The immunoprofiles of peripheral fibromas and "giant cell" fibromas were felt to be consistent with origin from mesenchymal cells. Several of the antigens studied could be used to differentiate the benign lesions studied from other benign neoplasms. The antigens were, however, of little value in separation of benign and malignant lesions.

Monophasic and biphasic synovial sarcoma. An immunohistochemical study

Seven cases of synovial sarcoma (SS), two with biphasic and five with monophasic histology, were studied immunohistochemically using monoclonal antibodies to intermediate filaments, keratin, and vimentin. Slender spindle cells and plump cells were constant components of all the tumors. Epithelioid cells were present only in biphasic SS. Epithelioid cells and plump cells were positively stained by both keratin and vimentin. Slender spindle cells were stained positive for vimentin and negative for keratin. Staining manner of each cell type was similar irrespective of monophasic or biphasic pattern. Present immunohistochemical studies suggested that monophasic or biphasic patterns in SS should be regarded as a different expression of the same disease. In addition, immunohistochemistry proved to be a useful tool to detect plump cells which were difficult to find on routine staining.

Expression of intermediate filament proteins in normal and diseased thyroid glands

A total of 67 samples from normal and pathological thyroid glands were stained (as formalin fixed paraffin sections) with a panel of monoclonal antibodies directed against intermediate filament proteins. The study confirmed previous reports of cytokeratin and vimentin coexpression in primary thyroid carcinomas, but coexpression was also detected in normal thyroid and in a range of benign conditions including follicular adenomas, Hashimoto's thyroiditis, and diffuse hyperplasia (thyrotoxicosis). Prekeratin expression was found (using antibodies recognising higher molecular weight cytokeratins) predominantly in areas of squamous change, independent of the underlying thyroid pathology. This study does not therefore support previous findings that prekeratin expression provides a reliable means of distinguishing follicular pattern papillary carcinoma from follicular carcinoma with its poorer prognosis or that it helps distinguish benign from malignant papillary lesions. No evidence of desmin or neurofilament expression was seen, and in particular, neurofilaments could not be detected in any of the cases of medullary carcinoma studied.

Synovial sarcoma: ultrastructural study and immunohistochemical analysis by a combined peroxidase-antiperoxidase/avidin-biotin-peroxidase complex procedure

To analyze the purportedly epithelial features of synovial sarcoma, the antigenic profiles of 20 of these neoplasms (including 12 of the monophasic type) were studied by three different immunohistochemical techniques, and the results were correlated with ultrastructural observations in 10 cases. All of the biphasic tumors were immunoreactive for the epithelial markers epithelial membrane antigen (EMA) and cytokeratin (CK) and also had ultrastructural features of epithelial differentiation. In contrast, only one of five monophasic tumors had electron microscopic features suggestive of epithelial differentiation, but eight of the 12 were immunoreactive for CK or EMA by a procedure combining the peroxidase-antiperoxidase and avidin-biotin-peroxidase complex methods. It is concluded that synovial sarcoma, including the monophasic variant, is a mesenchymal tumor with epithelial features. Immunohistochemical studies are more sensitive than ultrastructural analysis for documenting epithelial differentiation.

Synovial sarcoma: ultrastructural and immunohistochemical features of epithelial differentiation in monophasic and biphasic tumors

Nineteen synovial sarcomas, six biphasic and 13 monophasic tumors, were examined by light and electron microscopy and immunohistochemically for the presence of the epithelial markers keratin and epithelial membrane antigen (EMA). Ultrastructurally, intercellular spaces with processes are present to varying degrees in the spindle cell component of all synovial sarcomas, and junctional specializations occur in most cases. Tumors of the two types differ in their content of external (basal) lamina, which encloses the epithelial component of all biphasic tumors and is detectable in the spindle cell component of two thirds of them, but is absent from the majority of monophasic tumors. Keratin and EMA were demonstrated in both components of all six biphasic tumors. Of the 13 monophasic tumors, keratin was present in nine, EMA in eight, and at least one epithelial marker in ten. Synovial sarcoma is regarded as a distinctive soft tissue tumor with variable epithelial-like differentiation. The use of electron microscopy can increase the specificity of immunohistochemical studies of soft tissue sarcomas and allow more accurate differentiation of monophasic synovial sarcoma from other spindle cell tumors, particularly those that do not express markers.

Immunohistochemical and ultrastructural observations on adenoid cystic carcinoma of salivary glands. With special reference to intermediate filaments and proteoglycan particles

In adenoid cystic carcinoma (ACC) of salivary gland origin, intermediate filaments of tumour cells were investigated by immunohistochemical techniques and complex carbohydrates within the pseudocysts by ultrastructural methods. The intermediate filament proteins vimentin and cytokeratin were found in most neoplastic cells. The pseudocysts of the tumours were found to contain proteoglycan particles stainable after glutaraldehyde fixation--but not after osmium fixation alone. Ruthenium red (cationic dye) enhanced the staining whereas periodic acid-chromic acid-silver methenamine staining or phosphotungstic acid staining did not visualize the proteoglycan particles mainly containing acid proteoglycans which are normally produced by mesenchymal tissue. The cells of adenoid cystic carcinoma thus have an intermediate filament content and produce complex carbohydrates characteristic of both epithelial and mesenchymal tissue. Hence, an origin in an undifferentiated pluripotential cell seems plausible.

Ultrastructural and immunohistochemical aspects of carcinoma in mixed tumors

Four cases of malignant mixed tumor (carcinoma in pleomorphic adenomas) were studied for ultrastructural appearance and for the presence of cytokeratins and vimentin. Ultrastructurally, both squamous and glandular epithelial differentiation were found not only in the same tumor but also within the same cell. One tumor showed mainly mesenchymal differentiation with fibroblast-like cells. The intermediate filament expression of benign mixed tumors (i.e., both cytokeratin and vimentin content) were found in two of the three malignant tumors investigated. In the third tumor, only cytokeratins were found. Thus, the filament content of mixed tumors may change when the tumor becomes malignant. This change does not always parallel a change in morphology. Although one tumor was clearly epithelial ultrastructurally and another mostly mesenchymal, both did contain both cytokeratins and vimentin.

Coexpression of keratin and desmin in a carcinosarcoma involving the maxillary alveolar ridge

Immunohistochemical determination of the class of intermediate filaments (keratins, vimentin, desmin, neurofilaments, and glial fibrillary acidic protein) expressed by tumors has become an important diagnostic procedure for the histogenetic classification of neoplasms. A case of a poorly differentiated malignant neoplasm of the maxillary alveolar ridge which coexpressed keratin and desmin types of intermediate filaments is reported. These intermediate filaments have been associated with epithelial and muscle cell differentiation, respectively. The morphologic features of the tumor plus the expression of both these intermediate filaments indicate that this neoplasm represents a true carcinosarcoma.

Application of markers in the diagnosis of soft tissue tumours

In this review we describe the application of markers which are useful for the diagnosis of soft tissue tumours in paraffin sections. Detection of intermediate filament proteins appears to be most useful for first screening of these neoplasms because all, except neuroblastomas, express vimentin; cytokeratin is expressed in synovial sarcomas, epithelioid sarcomas and mesotheliomas; desmin in myogenic tumours and glial fibrillary acidic protein in astrocytomas and gliomas. Tissue-specific markers are: factor VIII--related antigen-endothelial cells; myoglobulin and skeletal muscle myosin--skeletal muscle cells; neuron specific enolase--neurons and cells of the APUD systems; and leukocyte-associated antigen--leukocytes. Markers which are present in a variety of cell types and therefore do not serve as tissue-specific markers are; S-100 proteins, alpha-1-antichymotrypsin, creatine kinase M and actin. The S-100 antigens have been detected in melanomas, granular cell tumours, chondrosarcomas and in some schwannomas and liposarcomas. Alpha-1-antichymotrypsin has been found in fibrohistiocytic and 'true' histiocytic tumours and creatine kinase M and actin in myogenic tumours. No specific markers have, as yet, been described for fibrosarcomas, Ewing's sarcomas and hemangiopericytomas.

Smooth and skeletal muscle myosins in spindle cell tumors of soft tissue. An immunohistochemical study

Histological localization of myosins of the smooth and skeletal muscles was investigated in comparison with that of myoglobin by immunoperoxidase technique using the antibody against each of them in surgical specimens from spindle cell tumors and tumor-like lesions of the soft tissue. Skeletal muscle myosin was demonstrated in all of the cases of rhabdomyosarcoma, whereas myoglobin was found in 75% of the examined cases. Smooth muscle myosin was widely distributed not only in the tumor cells of smooth muscle origin such as leiomyosarcoma and angioleiomyoma, but also in the tumor cells showing myofibroblastic differentiation such as malignant fibrous histiocytoma and in the epithelial components of synovial sarcoma. The results showed that skeletal muscle myosin can be regarded as an excellent marker in the diagnosis of rhabdomyosarcoma and that smooth muscle myosin is a useful marker of leiomyosarcoma and leiomyomas, and of tumors with myofibroblastic differentiation.

Antibodies to intermediate filament proteins in the diagnosis and classification of human tumors

Immunohistochemistry of intermediate filaments (IF) is a new and important way to evaluate the epithelial, mesenchymal, muscular, glial, or neural differentiation in tumors. This is based on the stable cell-type-specific expression of IF proteins in normal and neoplastic tissues. Immunohistochemical studies with antibodies to intermediate filaments have also given new perspectives in the histogenesis and biologic nature of many tumors. This article reviews both the recent findings and the authors' experience in the use of intermediate filament antibodies in tumor diagnosis and classification.