Primary monophasic synovial sarcoma of the kidney: a case report and review of literature

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.

An Extremely Rare and Demanding Diagnosis of Primary Renal Synovial Sarcoma: A Case Report

Primary renal synovial sarcoma (PRSS) is an extremely rare malignancy. The diagnosis of PRSS is unforeseen due to the absence of clinical and radiological typical aspects. Here, we present a case of a 69-year-old male with complaints of hematuria and left lumbar pain. Abdominal-pelvic computed tomography scan with contrast injection showed a solid mass of 8cm diameter in the left kidney and renal vein tumor thrombus. The patient was further subjected to robotic-assisted left radical nephrectomy and renal vein thrombectomy. We concomitantly performed left adrenalectomy and paraaortic lymphadenectomy. Immunohistochemical and genetic analysis revealed PRSS. This entity is characterized by abnormal chromosomal translocation t(X;18)(p11.2; q11.2) and consequently the characteristic SYT-SSX fusion gene. Due to the disease's rarity and severity, diagnosis and management of PRSS rely upon a demanding and multidisciplinary approach.

Primary Synovial Sarcoma of the Kidney: Diagnostic Approach and Therapeutic Modalities for a Rare Nosological Entity

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.

Doxorubicin and ifosfamide for recurrent renal synovial sarcoma: The first case report in Indonesia

Introduction and importance

Synovial sarcoma (SS) is the fourth most common soft tissue sarcoma. The primary treatment for renal SS is radical surgical resection of the tumor. However, there are several stages of SS that need systemic treatment. The consensus regarding systemic treatment remains unclear. Therefore, we reported a case of an 18-year-old male with recurrent renal SS treated with doxorubicin and ifosfamide as systemic chemotherapy.

Case presentation

An 18-year-old male was admitted with a chief complaint of right flank pain for three months. He had a history of radical nephrectomy due to a suspicion of Wilms tumor. The histopathological and immunohistochemistry results showed a SS of the kidney. One year after the surgery, the patient came with a sign of a residual tumor. The diagnosis of recurrent renal SS was established after the physical examination, and Second-line chemotherapy was not administered because the patient refused any further treatment. However, the patient showed a partial response after the first chemotherapy session, indicating the benefit of the treatment.

Clinical discussion

The chemotherapy regimen is generally considered safe and can be widely used in clinical practice. Partial response was shown after six courses of treatment. Ifosfamide-based chemotherapy was also used in some reported cases. Most of the cases reported in the current literature were only managed by surgery without using chemotherapy. These cases had various RFS, ranging from 5 to 25 months.

Conclusion

Doxorubicin and ifosfamide are useful as first-line chemotherapy for recurrent renal synovial sarcoma.

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Synovial sarcoma is a rare tumor.

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There has not been any consensus on systemic treatment for synovial sarcoma.

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Partial response are apparent in patients after receiving six courses of Doxorubicin and Ifosfamide.

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The regimen has a potential role as systemic chemotherapy for recurrent renal synovial sarcoma.

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More trials are needed before the regimen can be used in daily practice.

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 cell sarcoma of the kidney: case report and review of the literature

Synovial cell sarcoma (SCS) of the kidney is a rare tumor entity with a poor prognosis. Morphologic and immunohistochemical characteristics may overlap with other more common neoplasms of the kidney. Therefore, the diagnosis of primary renal SCS not only requires the exclusion of similar tumor types, but also a confirmation of SYT-SSX gene fusion using molecular techniques. The treatment comprises radical surgery, and, depending on age and health status, adjuvant chemotherapy in selected patients. Here, we present an elderly SCS patient in whom straightforward radical surgical treatment resulted in a sustained complete remission; it allowed us to perform a literature survey focusing on current diagnostic tools for SCS.

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.