1
|
Pagliuca F, Carraturo E, De Chiara A, Vallese S, Giovannoni I, Alaggio R, Cannella L, Tafuto S, Franco R. Synovial Sarcoma of the Kidney: Diagnostic Pitfalls in a Case with Myxoid Monophasic Differentiation and No Epithelial Biomarkers Expression. Int J Mol Sci 2024; 25:7382. [PMID: 39000489 PMCID: PMC11242046 DOI: 10.3390/ijms25137382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 06/28/2024] [Accepted: 06/30/2024] [Indexed: 07/16/2024] Open
Abstract
Synovial sarcomas are soft tissue tumours of uncertain origin, most commonly found in the upper or lower extremities. They are characterised by distinctive chromosomal rearrangements involving the gene SS18. Synovial sarcomas can occasionally arise also in visceral sites, but retroperitoneal SSs are very unusual. Among them, a few primary renal synovial sarcomas have been described in the scientific literature. Primary renal synovial sarcomas tend to be monophasic and often show cystic changes. Histologically, they can closely resemble other primary kidney tumours, mainly paediatric tumours such as nephroblastoma and clear cell sarcoma of the kidney. In the current work, a primary synovial sarcoma of the kidney with unusual morphological features (extensively myxoid stroma and immunohistochemical positivity for BCOR) is described. Molecular analysis, through targeted RNA sequencing, was of invaluable help in reaching the correct diagnosis. Despite locally advanced disease at presentation, the patient showed an unexpectedly brilliant response to chemotherapy.
Collapse
Affiliation(s)
| | - Emma Carraturo
- Pathology Unit, Vanvitelli University Hospital, 80138 Naples, Italy
| | - Anna De Chiara
- Histopathology of Lymphomas and Sarcomas SSD, Istituto Nazionale Tumori-IRCCS-Fondazione "G. Pascale", 80131 Naples, Italy
| | - Silvia Vallese
- Pathology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | | | - Rita Alaggio
- Pathology Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy
| | - Lucia Cannella
- S.C. Sarcomas and Rare Tumors, Istituto Nazionale Tumori-IRCCS-Fondazione "G. Pascale", 80131 Naples, Italy
| | - Salvatore Tafuto
- S.C. Sarcomas and Rare Tumors, Istituto Nazionale Tumori-IRCCS-Fondazione "G. Pascale", 80131 Naples, Italy
| | - Renato Franco
- Pathology Unit, Vanvitelli University Hospital, 80138 Naples, Italy
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| |
Collapse
|
2
|
Blas L, Roberti J. Primary Renal Synovial Sarcoma and Clinical and Pathological Findings: a Systematic Review. Curr Urol Rep 2021; 22:25. [PMID: 33704587 DOI: 10.1007/s11934-021-01038-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW To update epidemiological, diagnostic, and therapeutic information on primary synovial sarcoma of the kidney. RECENT FINDINGS A total of 96 studies were analyzed; age at presentation was 38.6±14.2 years, predominant location of tumor was right kidney; frequent reported symptoms at diagnosis were hematuria and pain. For definitive diagnosis, cytogenetic technique was used. Detected oncogene was available in 37.8% cases with fusion of SS18-SSX in most patients. Surgery is treatment of choice, with adjuvant chemotherapy; most frequently ifosfamide-based associated with doxorubicin or epirubicin. Overall median survival was 34 months. Mortality was 29% of the cases which reported death and the recurrence rate was 39.8%. Risk of death was increased in patients with metastases at diagnosis Primary RSS occurs more often in young men. RSS often presents with symptoms and in an advanced stage. Surgical treatment is the most commonly used and chemotherapy for advanced or recurrent treatment.
Collapse
Affiliation(s)
- Leandro Blas
- Hospital Aleman de Buenos Aires, Buenos Aires, Argentina
| | - Javier Roberti
- National Scientific and Technical Research Council - CONICET, Buenos Aires, Argentina.
| |
Collapse
|
3
|
El Chediak A, Mukherji D, Temraz S, Nassif S, Sinno S, Mahfouz R, Shamseddine A. Primary synovial sarcoma of the kidney: a case report of complete pathological response at a Lebanese tertiary care center. BMC Urol 2018; 18:40. [PMID: 29751751 PMCID: PMC5948733 DOI: 10.1186/s12894-018-0358-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 05/03/2018] [Indexed: 12/17/2022] Open
Abstract
Background Primary synovial sarcoma of the kidney is a rare type of soft tissue sarcoma. Its presenting features can resemble those of other renal tumors; rendering its early diagnosis, a dilemma. Several cases of renal synovial sarcoma have been reported in the literature with varying treatment options and outcomes. This article describes a rare case of primary renal synovial sarcoma and reviews all cases in the literature. Case presentation A 26-year-old male presented with flank pain and hematuria. Initially diagnosed with Wilm’s tumor, revision of pathology and histology, along with the immunohistochemical profile, confirmed, nevertheless, the diagnosis of primary monophasic synovial sarcoma of the kidney with the SYT-SSX2 fusion transcript. Follow-up, post nephrectomy, revealed recurrence within the lungs and at the surgical bed. Surgical resection followed by adjuvant chemotherapy regimen constituting of Doxorubicin and Ifosfamide, achieved complete pathological response. Conclusion In this case report, we emphasize the need for accurate diagnosis and prompt treatment. We propose multimodality treatment approach including surgery along with anthracycline-based chemotherapy to induce complete remission.
Collapse
Affiliation(s)
- Alissar El Chediak
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut - Medical Center, P.o.Box: 11-0236, Riad El Solh, Beirut, 110 72020, Lebanon
| | - Deborah Mukherji
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut - Medical Center, P.o.Box: 11-0236, Riad El Solh, Beirut, 110 72020, Lebanon
| | - Sally Temraz
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut - Medical Center, P.o.Box: 11-0236, Riad El Solh, Beirut, 110 72020, Lebanon
| | - Samer Nassif
- Department of Pathology and Laboratory Medicine, American University of Beirut - Medical Center, Beirut, Lebanon
| | - Sara Sinno
- Department of Pathology and Laboratory Medicine, American University of Beirut - Medical Center, Beirut, Lebanon
| | - Rami Mahfouz
- Department of Pathology and Laboratory Medicine, American University of Beirut - Medical Center, Beirut, Lebanon
| | - Ali Shamseddine
- Department of Internal Medicine, Division of Hematology/Oncology, American University of Beirut - Medical Center, P.o.Box: 11-0236, Riad El Solh, Beirut, 110 72020, Lebanon.
| |
Collapse
|
4
|
The value of immunohistochemistry in diagnosing primary renal synovial sarcoma: a case report and literature review. Int Surg 2014; 97:177-81. [PMID: 23102085 DOI: 10.9738/cc57.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Primary synovial sarcoma of the kidney is rare and difficult to diagnose with 100% accuracy without the use of up-to-date histopathologic methods. Immunohistochemical procedures are well established and are continuously expanding and improving. Currently, these methods are successful in up to 90% of tumor identification. The remaining cases will ultimately benefit by combining immunohistochemistry with tumor-specific genetic marker identifiers, the latter of which are increasing in availability for tumor diagnosis. The principal immunohistochemical methods enlisted in establishing a diagnosis of primary renal synovial sarcoma are summarized.
Collapse
|
5
|
Iacovelli R, Altavilla A, Ciardi A, Urbano F, Manai C, Gentile V, Cortesi E. Clinical and pathological features of primary renal synovial sarcoma: analysis of 64 cases from 11 years of medical literature. BJU Int 2012; 110:1449-54. [PMID: 22452647 DOI: 10.1111/j.1464-410x.2012.11105.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To describe, for the first time, the clinical characteristics of primary renal synovial sarcoma (SS) and to examine the association of histological features with the expression of immunohistochemical markers. PATIENTS AND METHODS We collated published data on all cases of primary renal SS, from its first description in 2000 to September 2011. Data on clinical and pathological characteristics were extracted and used to create a database. Disease-free survival (DFS) and overall survival (OS) rates were estimated using the Kaplan-Meier method with Rothman's 95% confidence intervals (CIs) and compared across the groups using the log-rank test. The associations between tumour extension and histological features were evaluated using the non-parametric Spearman rank test. A chi-squared test was used to assess the differences between groups. RESULTS In the overall cohort, the median OS was 48 months (95% CI, 14.1-81.9). Cox analysis showed that the risk of death at diagnosis was greatly increased in patients with metastatic disease compared with those with non-metastatic disease (hazard ratio [HR]: 343.9, 95% CI, 2.8-42,000; P= 0.017). The median DFS was 33.0 months (95% CI, 16.8-49.2), and patients who develop metastatic disease have a very poor prognosis with a median survival of 6 months (95% CI, 5.1-6.9). Microscopic features were monophasic, biphasic and poorly differentiated synovial sarcoma in 76, 16 and 8% of patients, respectively. Significant differences in expression of immunohistochemical markers or genetic mutation were found between different subtypes. CONCLUSIONS Despite its retrospective nature, this study shows that renal SS comprises different histological subtypes, which are characterized by specific immunohistochemical stains and by specific translocations. When diagnosed at metastatic stage, the prognosis was very poor compared with that for non-metastatic disease, even though one out of three patients with non-metastatic disease had disease relapse. Cooperative efforts and publication of cases with adequate follow-up are necessary to better define prognosis and therapeutic strategies for this rare disease.
Collapse
Affiliation(s)
- Roberto Iacovelli
- Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Sapienza University of Rome, Italy.
| | | | | | | | | | | | | |
Collapse
|
6
|
Moch H. [Cystic renal neoplasms. New entities and molecular findings]. DER PATHOLOGE 2010; 31 Suppl 2:239-43. [PMID: 20652265 DOI: 10.1007/s00292-010-1317-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Renal neoplasms with dominant cysts represent a broad spectrum of known as well as novel renal tumor entities. Established renal tumors with dominant cysts include cystic nephroma, mixed epithelial and stromal tumor, synovial sarcoma and multilocular cystic renal cancer (WHO classification 2004). Novel tumor types have recently been reported, which are also characterized by marked cyst formation. Examples are tubulocystic renal cancer and renal cancer in end-stage renal disease. These tumors are very likely to be included in a future WHO classification due to their characteristic phenotype and molecular features. Cysts and clear cell renal cell carcinoma frequently coexist in the kidneys of patients with von Hippel-Lindau disease. Cysts are also a component of many sporadic clear cell renal cell carcinomas. Multilocular cystic renal cell carcinoma is composed almost exclusively of cysts and is regarded as a specific subtype of clear cell renal cancer. Recent molecular findings suggest that clear cell renal cancer may develop via a cyst-dependent mechanism in von Hippel-Lindau syndrome as well as via cyst-independent molecular pathways in sporadic clear cell renal cancer.
Collapse
MESH Headings
- Adolescent
- Adult
- Basic Helix-Loop-Helix Leucine Zipper Transcription Factors/genetics
- Carcinoma, Renal Cell/classification
- Carcinoma, Renal Cell/genetics
- Carcinoma, Renal Cell/pathology
- Cell Transformation, Neoplastic/genetics
- Cell Transformation, Neoplastic/pathology
- Child
- Child, Preschool
- Gene Expression Regulation, Neoplastic/genetics
- Humans
- Kidney/pathology
- Kidney Neoplasms/classification
- Kidney Neoplasms/genetics
- Kidney Neoplasms/pathology
- Neoplasm Staging
- Polycystic Kidney Diseases/classification
- Polycystic Kidney Diseases/genetics
- Polycystic Kidney Diseases/pathology
- Sarcoma, Synovial/classification
- Sarcoma, Synovial/genetics
- Sarcoma, Synovial/pathology
- Translocation, Genetic/genetics
- Von Hippel-Lindau Tumor Suppressor Protein/genetics
- Young Adult
- von Hippel-Lindau Disease/classification
- von Hippel-Lindau Disease/genetics
- von Hippel-Lindau Disease/pathology
Collapse
Affiliation(s)
- H Moch
- Institut für Klinische Pathologie, UniversitätsSpital Zürich, Schmelzbergstr. 12, 8091, Zürich, Schweiz.
| |
Collapse
|
7
|
Abstract
Cystic renal neoplasms and renal epithelial stromal tumors are diagnostically challenging and represent some novel tumor entities. In this article, clinical and pathologic features of established and novel entities are discussed. Predominantly cystic renal tumors include cystic nephroma/mixed epithelial and stromal tumor, synovial sarcoma, and multilocular cystic renal cell carcinoma. These entities are own tumor entities of the 2004 WHO classification of renal tumors. Tubulocystic carcinoma and acquired cystic disease-associated renal cell carcinoma are neoplasms with an intrinsically cystic growth pattern. Both tumor types should be included in a future WHO classification as novel entities owing to their characteristic features. Cysts and clear cell renal cell carcinoma frequently coexist within the kidneys of patients with von Hippel-Lindau disease. Sporadic clear cell renal cell carcinomas often contain cysts, usually as a minor component. Some clear cell renal cell carcinomas have prominent cysts, and multilocular cystic renal cell carcinoma is composed almost exclusively of cysts. Recent molecular findings suggest that clear cell renal cancer may develop through cyst-dependent and cyst-independent molecular pathways.
Collapse
|
8
|
Park MJ, Baek TH, Kim JH, Kang DW, Lee HK, Son HJ. Primary Synovial Sarcoma of the Kidney: A Case Report and Literature Review. KOREAN JOURNAL OF PATHOLOGY 2009. [DOI: 10.4132/koreanjpathol.2009.43.3.274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Mee-Ja Park
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Tae-Hwa Baek
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Joo-Heon Kim
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Dong-Wook Kang
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Hye-Kyung Lee
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| | - Hyun-Jin Son
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
| |
Collapse
|
9
|
Paláu L MA, Thu Pham T, Barnard N, Merino MJ. Primary synovial sarcoma of the kidney with rhabdoid features. Int J Surg Pathol 2007; 15:421-8. [PMID: 17913954 DOI: 10.1177/1066896907302421] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Synovial sarcoma is a soft tissue sarcoma with clearly defined histologic, immunophenotypic, and molecular features. It occurs predominantly in the extremities of young adults but has been reported in many other anatomic sites. Histologically, it is classified as biphasic, monophasic, and poorly differentiated. The latter category, which includes tumors with a rhabdoid morphology, has been associated with a more aggressive behavior. Generally, the biphasic variant does not pose any diagnostic problem because of its typical histologic appearance; in contrast, the monophasic and poorly differentiated variants may represent a diagnostic challenge because their microscopic features can be confused with those of other spindle cell tumors with rhabdoid features. The application of molecular techniques, such as reverse transcriptase polymerase chain reaction to detect the fusion transcript associated with the characteristic t(X;18) translocation of synovial sarcoma, has enabled the confirmation of this diagnosis, even in cases of unusual localization, such as the one we present here.
Collapse
Affiliation(s)
- Mauricio A Paláu L
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | | | | | | |
Collapse
|
10
|
Moch H, Schürch LV, Sulser T, Terracciano L. [Mixed epithelial and stromal tumor of the kidney]. DER PATHOLOGE 2005; 25:356-61. [PMID: 15127227 DOI: 10.1007/s00292-004-0690-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We describe a case of mixed epithelial and stromal tumor of the kidney. The tumor was identified in a 63 years old woman and retroperitoneoscopically resected. Immunohistochemistry, electron microscopy and fluorescence in situ hybridization were performed. Grossly, the tumor was well-circumscribed with a diameter of 8 cm and consisted of solid and cystic components. Microscopically, the spindle cell component ranged in appearance from scar-like fibrous tissue to leiomyoma-like fascicles. Epithelial elements were composed of tubules with variable lining. The tubules were focally transformed into large cysts. Estrogen and progesteron receptors were detected in the nuclei of the spindle cells. Electron microscopy confirmed a smooth-muscle differentiation of the spindle cells. Previously, such tumors were published as adult mesoblastic nephroma or cystic hamartoma of the renal pelvis. Its predominance in females with a history of long-term estrogen replacement or the history of long-term sex-steroid use in a male patient, combined with the expression of estrogen und progesteron receptors in the spindle cells suggest that hormonal influence is relevant for the development of these tumors.
Collapse
Affiliation(s)
- H Moch
- Institut für Klinische Pathologie/Departement Pathologie, Universitätsspital Zürich.
| | | | | | | |
Collapse
|