1
|
Cho EB, Lee SK, Kim JY, Kim Y. Synovial Sarcoma in the Extremity: Diversity of Imaging Features for Diagnosis and Prognosis. Cancers (Basel) 2023; 15:4860. [PMID: 37835554 PMCID: PMC10571652 DOI: 10.3390/cancers15194860] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/15/2023] [Accepted: 10/02/2023] [Indexed: 10/15/2023] Open
Abstract
Synovial sarcomas are rare and highly aggressive soft-tissue sarcomas, primarily affecting adolescents and young adults aged 15-40 years. These tumors typically arise in the deep soft tissues, often near the large joints of the extremities. While the radiological features of these tumors are not definitely indicative, the presence of calcification in a soft-tissue mass (occurring in 30% of cases), adjacent to a joint, strongly suggests the diagnosis. Cross-sectional imaging characteristics play a crucial role in diagnosing synovial sarcomas. They often reveal significant characteristics such as multilobulation and pronounced heterogeneity (forming the "triple sign"), in addition to features like hemorrhage and fluid-fluid levels with septa (resulting in the "bowl of grapes" appearance). Nevertheless, the existence of non-aggressive features, such as gradual growth (with an average time to diagnosis of 2-4 years) and small size (initially measuring < 5 cm) with well-defined margins, can lead to an initial misclassification as a benign lesion. Larger size, older age, and higher tumor grade have been established as adverse predictive indicators for both local disease recurrence and the occurrence of metastasis. Recently, the prognostic importance of CT and MRI characteristics for synovial sarcomas was elucidated. These include factors like the absence of calcification, the presence of cystic components, hemorrhage, the bowl of grape sign, the triple sign, and intercompartmental extension. Wide surgical excision remains the established approach for definitive treatment. Gaining insight into and identifying the diverse range of presentations of synovial sarcomas, which correlate with the prognosis, might be helpful in achieving the optimal patient management.
Collapse
Affiliation(s)
- Eun Byul Cho
- Department of Radiology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu 11765, Republic of Korea
| | - Seul Ki Lee
- Department of Radiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jee-Young Kim
- Department of Radiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Yuri Kim
- Department of Radiology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| |
Collapse
|
2
|
Challa B, Mohanty SK, Jha S, Sampat NY, Sardana R, Lobo A, Sharma S, Arora S, Rath D, Munjal G, Pattnaik N, Jain D, Jain E, Dewan A, Dixit M, Malik V, Shinde S, Balzer BL, Parwani A. SS18-SSX Expression in a Contemporary Cohort of Primary Renal Synovial Sarcoma: A Multi-Institutional Experience of Fourteen Patients. Int J Surg Pathol 2023; 31:1232-1243. [PMID: 36591871 DOI: 10.1177/10668969221143481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Primary renal synovial sarcoma is a rare aggressive mesenchymal neoplasm of the kidney that accounts for less than 1% of renal sarcomas. Herein, we describe the clinicopathologic and molecular findings of 14 renal synovial sarcoma patients in one of the largest case series to date and to our knowledge, the only renal synovial sarcoma series to use novel SS18-SSX IHC. Clinicopathologic, IHC, molecular, management, and follow-up data were reviewed and analyzed. Macroscopically, the tumors had either homogeneous, tan-white, and solid (n = 10), variegated and solid (n = 3), or variegated and solid-cystic (n = 1) cut surfaces. Spindle cell (n = 10), round cell (n = 3), and round to epithelioid morphologies (n = 1) were observed. SS18-SSX IHC was positive in all 14 tumors (diffuse, n = 10; multifocal, n = 2; focal, n = 2). All the tumors harbored SS18::SSX1/2 gene rearrangement. Metastases to the liver, brain, and lung (n = 1); liver and bone (n = 1); liver and diaphragm (n = 1) were identified. Adjuvant chemotherapy was administered in 11/12 patients. Follow-up was available for 10 patients (time period range: 5 to 24 months). Four patients died of disease, and six patients are alive with no recurrence or metastasis. As SS18-SSX IHC showed an excellent concordance with the FISH results, this may reliably be used in the IHC panel of spindle/round cell sarcomas of the kidney and as a molecular surrogate for renal synovial sarcoma, particularly in a resource-limited setting. Also, the tumors with focal SS18-SSX expression had lower break apart signals in the FISH assay (19% and 23% in two tumors with focal SS18-SSX IHC positivity).
Collapse
Affiliation(s)
- Bindu Challa
- Departments of Pathology and Laboratory Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sambit K Mohanty
- Departments of Pathology and Laboratory Medicine, Advanced Medical and Research Institute, Bhubaneswar, India
- Departments of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Shilpy Jha
- Departments of Pathology and Laboratory Medicine, Advanced Medical and Research Institute, Bhubaneswar, India
| | - Nakul Y Sampat
- Departments of Pathology and Laboratory Medicine, Advanced Medical and Research Institute, Bhubaneswar, India
| | - Ruhani Sardana
- Departments of Pathology and Laboratory Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Anandi Lobo
- Departments of Pathology and Laboratory Medicine, Kapoor Center of Urology and Pathology, Raipur, India
| | - Shivani Sharma
- Departments of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Samriti Arora
- Departments of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Debadarshi Rath
- Departments of Pathology and Laboratory Medicine, Advanced Urology Maxport Hospital, Bhubaneswar, India
| | - Gauri Munjal
- Departments of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Niharika Pattnaik
- Departments of Pathology and Laboratory Medicine, Advanced Medical and Research Institute, Bhubaneswar, India
| | - Deepika Jain
- Departments of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Ekta Jain
- Departments of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Aditi Dewan
- Departments of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Mallika Dixit
- Departments of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Vipra Malik
- Departments of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Sayali Shinde
- Departments of Pathology and Laboratory Medicine, CORE Diagnostics, Gurgaon, India
| | - Bonnie L Balzer
- Departments of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Anil Parwani
- Departments of Pathology and Laboratory Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA
| |
Collapse
|
3
|
Calleja M, Afzaal Q, Saifuddin A. The safety of primary surgical excision of small deep indeterminate musculoskeletal soft tissue masses. Br J Radiol 2021; 94:20200713. [PMID: 33095649 DOI: 10.1259/bjr.20200713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the suitability of primary excision of small indeterminate deep soft tissue masses presenting to a tertiary musculoskeletal oncology service. METHODS AND MATERIALS Review of all patients referred to a specialist musculoskeletal oncology service over a 20-month period with a deep indeterminate soft tissue mass by non-contrast MRI criteria that was recommended for primary surgical excision due to relatively small size (<30 mm). Data collected included age, gender, site and maximal size of the lesion, and final histological diagnosis for excised lesions. RESULTS 85 patients were included, mean lesion size being 12 mm (range 5-29 mm). Primary surgical resection had been undertaken in 69 cases (81.2%) by the conclusion of data collection, 36 males and 33 females with mean age of 45.6 years (range 11-80 years). Of these, 11 cases (15.9%) were non-neoplastic, 53 (76.8%) were benign, 1 (1.4%) was intermediate grade, while 4 (5.8%) were malignant including 3 synovial sarcomas. Two of these were treated with re-excision of the tumour bed showing no residual disease, with no evidence of local recurrence at a mean of 10.7 months post-excision. CONCLUSION Primary surgical excision of small deep soft tissue masses that are indeterminate by non-contrast MRI criteria is considered a safe procedure when undertaken in a specialist musculoskeletal oncology service, with only 4 of 69 cases (5.8%) being malignant. ADVANCES IN KNOWLEDGE Small indeterminate deep soft tissue masses can safely be treated with primary excision in the setting of a specialist musculoskeletal oncology service.
Collapse
Affiliation(s)
- Michèle Calleja
- Department of Radiology, Royal National orthopaedic Hospital, Brockley Hill, Stanmore, London, UK
| | - Qasim Afzaal
- Department of Urology, Northampton General Hospital, Cliftonville, Northampton, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National orthopaedic Hospital, Brockley Hill, Stanmore, London, UK
| |
Collapse
|