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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.
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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
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Mastoraki A, Schizas D, Karavolia DM, Smailis A, Machairas N, Vailas M, Michalinos A, Tsapralis D, Anastasiou I, Agrogiannis G. Primary Synovial Sarcoma of the Kidney: Diagnostic Approach and Therapeutic Modalities for a Rare Nosological Entity. J Pers Med 2022; 12:jpm12091450. [PMID: 36143235 PMCID: PMC9504314 DOI: 10.3390/jpm12091450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/27/2022] [Accepted: 08/31/2022] [Indexed: 11/29/2022] Open
Abstract
Synovial sarcoma (SS) is a rare mesenchymal entity that represents 5–10% among soft tissue sarcomas (STS). Primary renal synovial sarcoma (PRSS) is an uncommon, rapidly growing tumor, with potential metastatic dissemination. The main prognostic factors of PRSS include tumor size and histologic grade, while translocation t (X; 18) (p11.2; q11.2) (fusion of SYT gene -chromosome 18- with SSX genes (1, 2 or 4)-chromosome X) is the most common pathognomonic sign. Aggressive surgical resection of the tumor along with concomitant regional lymphadenectomy is the treatment of choice for PRSS, while additional en bloc resection of the adjacent affected organs is often performed. To date, the role of preoperative or postoperative chemotherapy remains equivocal. The prognosis of patients with PRSS is poor, as the 5-year survival rate is only 20–30% and further deteriorates when a high mitotic activity is detected. Local recurrence even after complete R0 surgical excision remains the most frequent cause of death. The aim of this review was to meticulously discuss clinical features, histogenesis, and morphological and immunochemical findings of PRSS, while the role of current diagnostic and therapeutic management of this aggressive neoplasm was emphasized.
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Affiliation(s)
- Aikaterini Mastoraki
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Despoina Maria Karavolia
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Antonios Smailis
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - Nikolaos Machairas
- Second Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-6972-300265
| | - Michail Vailas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | | | - Dimitrios Tsapralis
- Department of Surgery, General Hospital of Ierapetra, 72200 Ierapetra, Greece
| | - Ioannis Anastasiou
- First University Urology Clinic, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece
| | - George Agrogiannis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
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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.
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Affiliation(s)
- Leandro Blas
- Hospital Aleman de Buenos Aires, Buenos Aires, Argentina
| | - Javier Roberti
- National Scientific and Technical Research Council - CONICET, Buenos Aires, Argentina.
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Paediatric Renal Synovial Sarcoma: Another Diagnostic Pathological Dilemma. Indian J Surg Oncol 2019; 11:138-141. [PMID: 32205983 DOI: 10.1007/s13193-019-00989-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022] Open
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Wang S, Song R, Sun T, Hou B, Hong G, Mallampati S, Sun H, Zhou X, Zhou C, Zhang H, Cheng Z, Li J, Ma H, Sun H. Survival changes in Patients with Synovial Sarcoma, 1983-2012. J Cancer 2017; 8:1759-1768. [PMID: 28819372 PMCID: PMC5556638 DOI: 10.7150/jca.17349] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 05/02/2017] [Indexed: 12/16/2022] Open
Abstract
Background: Synovial sarcoma (SyS) is a rare malignancy that typically invades the extremities and occurs predominantly in adolescents. Studies on incidence and survival in SyS that were based on a large population had not been reported yet. Methods: To evaluate changes in incidence and survival in SyS over three decades, we accessed data on SyS cases in each decade between 1983 and 2012 (1983-1992, 1993-2002, and 2003-2012) from the Surveillance, Epidemiology, and End Results (SEER) database. The survival difference between decades, age groups, sexes, race, pathologic types, sites, stages and socioeconomic status (SES) over three decades were accessed by comparing Kaplan-Meier curves. Results: We located 2,070 SyS cases in 18 SEER registry regions between 1983 and 2012. Our study demonstrated that the incidence of SyS per 1,000,000 continued to increase from 0.906 to 1.348 to 1.548 in the total population and in most age groups and that the age of incidence peak was 15-29 years in three decades. But, the survival of patients with SyS did not significantly improve throughout the three decades, with 5-year survival rates of 69.4%, 61.1% and 60.5% respectively (p > 0.05). Interestingly, the widening survival gaps among races, sexes, pathological types and various SES over time were observed, with narrowing p values. Conclusions: This study demonstrated the increasing incidence and unimproved survival rates across three decades in a large sample, indicating the urgency for further development of diagnosis, improving health care providers' awareness of SyS and lead to the development of novel treatments.
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Affiliation(s)
- Shuncong Wang
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Rongfeng Song
- Department of Gastroenterology, Cancer Hospital of Jiangxi Province, Nanchang, Jiangxi 330029, China
| | - Tiantian Sun
- Department of Hematology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Bingzong Hou
- Department of Gastrointestinal Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Guobin Hong
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Saradhi Mallampati
- Department of Laboratory Medicine and the Center for Stem Cell and Developmental Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Hongliu Sun
- Department of pathology, University of Michigan, Ann Arbor, MI 48201, USA
| | - Xiuling Zhou
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Cuiling Zhou
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Hongyu Zhang
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Zhibin Cheng
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Jie Li
- Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Haiqing Ma
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Huanhuan Sun
- Department of Oncology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
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Xu P, Chen J. Primary Synovial Sarcoma of the Orbit. OPHTHALMOLOGY AND EYE DISEASES 2017; 9:1179172117701732. [PMID: 28469480 PMCID: PMC5397295 DOI: 10.1177/1179172117701732] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/31/2017] [Indexed: 12/17/2022]
Abstract
Purpose: To describe the clinical, pathological, and immunohistochemical characteristics and therapies of a rare case of primary synovial sarcoma in the orbit. Design: Retrospective interventional case report. Participant: A 6-year-old girl with pathologically proven synovial sarcoma in the orbit. The diagnosis was confirmed by immunohistochemistry. Methods: The patient was treated with right lateral orbital and right temporal tumor resection, followed by chemotherapy. She was followed up every 3 months for 1 year. Results: The tumor was excised, and the patient received 5 courses of chemotherapy. She did well during the initial first-year follow-up with no recurrent signs. Conclusions: We reported the sixth case of primary synovial sarcoma in the orbit and the first case of a 6-year-old girl.
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Affiliation(s)
- Pei Xu
- Department of Ophthalmology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, People's Republic of China.,Department of Ophthalmology & Visual Sciences, University of Texas Medical Branch, Galveston, TX, USA.,Department of Neuroscience and Cell biology, University of Texas Medical Branch, Galveston, TX, USA
| | - Jianbin Chen
- Department of Ophthalmology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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Primary Intracranial Synovial Sarcoma. Case Rep Neurol Med 2016; 2016:5608315. [PMID: 27247811 PMCID: PMC4876212 DOI: 10.1155/2016/5608315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 04/20/2016] [Indexed: 12/31/2022] Open
Abstract
Background. Synovial sarcoma is an aggressive soft tissue sarcoma with uncertain histological origin. The pathology frequently presents as a localized disease, especially near large joints around the knee and thigh. Intracranial disease, which is rare, has been reported as metastasis from synovial sarcoma. We report a case with no obvious primary extracranial pathology, suggesting primary intracranial disease; this has not been reported in the literature. Case Description. A 21-year-old male, with a prior right skull lesion resection for atypical spindle cell neoplasm, presented with headaches, gait instability, left arm weakness, and left homonymous hemianopsia. CT of head demonstrated a right parietal hemorrhagic lesion with mass effect, requiring surgical decompression. Histopathology revealed synovial sarcoma. FISH analysis noted the existence of the t(X;18)(p11.2;q11.2) chromosomal translocation. PET scan did not show other metastatic disease. He underwent stereotactic radiotherapy and adjuvant chemotherapy. At 2-year follow-up, he remained nonfocal without recurrence. Conclusion. We report the first known case of primary intracranial synovial sarcoma. Moreover, we stress that intracranial lesions may have a tendency for hemorrhage, requiring urgent lifesaving decompression.
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