Primary synovial sarcoma of the kidney: corroboration with in situ polymerase chain reaction

Synovial Sarcoma of the Kidney: Diagnostic Pitfalls in a Case with Myxoid Monophasic Differentiation and No Epithelial Biomarkers Expression

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.

Primary Renal Synovial Sarcoma and Clinical and Pathological Findings: a Systematic Review

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.

Primary synovial sarcoma of the kidney: a case report of complete pathological response at a Lebanese tertiary care center

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.

Primary synovial sarcoma of the kidney: A case report

Synovial sarcoma (SS) is a soft-tissue tumor with a unique t(X;18)(p11.2;q11.2) chromosomal translocation that can be identified by polymerase chain reaction in tissue homogenates. Generally, the tumor occurs in the proximity of the joints. The current study presents the case of a 54-year-old female with primary SS (PSS) of the right kidney; this is an extremely rare tumor accounting for <2% of malignant renal carcinomas. The patient presented with an interrupted right flank pain of 20 years duration, with a precipitating factor of a hematuria of 8 days. Abdominal computerized tomography (CT) scan revealed a heterogeneous, unclear-marginated soft tissue arising in the upper pole of the right kidney with solid, necrotic components and heterogeneous enhancement. Renal cell carcinoma was diagnosed pre-operatively. A right nephrectomy was performed, and the patient is currently free of metastasis 12 months after the surgery. The current treatment for renal SS includes surgical resection and ifosfamide-based chemotherapy. To the best of our knowledge, <50 cases have been reported in the English literature. Urologists should be aware of the possibility of malignancy in cystic renal masses and consider a diagnosis of SS. Along with the case report, the current study presents a literature review on the diagnosis and treatment of PSS.

Synovial sarcoma of the kidney in a young patient with a review of the literature

Synovial sarcoma (SS) is a soft tissue, generally deep seated neoplasms that occurs generally in the proximity of large joints. We report of a case of a 33-year-old man who was diagnosed with primary SS of the kidney which is an extremely rare tumor that accounts for less than 2% of malignant renal tumors. Contemporary management of renal synovial sarcoma includes surgical resection and ifosfamide-based chemotherapy and they remain the mainstay of therapy of synovial sarcoma, which is often applied, combined as part of an aggressive treatment approach. Fewer than 50 patients have been described in the English literature. Physicians should be aware of the possibility of malignancy in cystic renal masses and raise the suspicion of synovial sarcoma, especially when patients with renal masses are young adults. Along with the case report a literature review on primary synovial sarcomas of the kidney is provided with focus on the renal tumors' differential diagnosis.

The value of immunohistochemistry in diagnosing primary renal synovial sarcoma: a case report and literature review

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.

Primary synovial sarcoma of the kidney

Synovial Sarcoma (SS) is a soft tissue neoplasm that occurs generally in the proximity of large joints. Here, we report a case of a 45-year-old man who was diagnosed with Primary SS of the kidney which is an extremely rare tumor that accounts for less than 2% of malignant renal tumors. We also review the literature on primary synovial sarcomas of the kidney and focus especially on the renal tumors' differential diagnosis.

Primary renal synovial sarcoma

Primary synovial sarcoma (SS) of kidney is very rare and difficult to diagnose. Here, we present a case of a 21-year-old female clinically diagnosed as renal cell carcinoma. Right nephrectomy specimen showed a cystic tumor in the upper pole of kidney with areas of hemorrhage and solid growth. Histologically, it showed poorly differentiated cells with hemangiopericytoma-like vascular pattern. Morphologic and immunohistochemical features were compatible with the diagnosis of poorly differentiated SS of kidney. Primary renal SS is a recently described entity. To the best of our knowledge, approximately 34 cases have been reported till date and this is the eighth documented case of poorly differentiated variant. Most of the time, poorly differentiated SS of kidney exhibits hemangiopericytoma like histology. Reverse transcriptase-polymerase chain reaction analysis to demonstrate SYT-SSX fusion gene transcript helps to confirm the diagnosis.

Primary synovial sarcoma of kidney: A rare tumor with an atypical presentation

Synovial sarcoma (SS) is a tumor of the soft tissues with a unique chromosomal translocation t(X;18)(p11.2;q11.2) that can be detected by polymerase chain reaction in tissue homogenates. Here we present a case of a 20-year-old female presenting PSS of the left kidney with caval thrombus. The diagnosis was corroborated by reverse transcription polymerase chain reaction (RT-PCR). Similar cases of PSS of kidney with tumor extension in the inferior vena cava are extremely rare and to date, approximately three cases have been reported in the literature.

Pediatric and adult primary sarcomas of the kidney: a cross-sectional imaging review

There is a wide pathological spectrum of kidney sarcomas that show characteristic histology, ontogeny, and clinical-biological behavior. While leiomyosarcomas commonly arise from the capsule, solitary fibrous tumors and clear cell sarcomas typically show renal sinus and medullary epicenter, respectively. Although distribution and imaging findings of some sarcomas may be characteristic, definitive diagnosis warrants histopathological examination following surgery. Renal sarcomas manifest advanced disease at presentation and portend poor prognosis.