Immunocytochemistry as an Ancillary Technique in the Cytologic Diagnosis of Synovial Sarcoma: Lock With Cell Block

Synovial Sarcoma -Lock With Cell Block

Authors

  • Aarti Ashok Dani GMC Nagpur
  • Meharbano M Kamal GMC Nagpur
  • Swati Swati Kalantri GMC Nagpur

DOI:

https://doi.org/10.21276/apalm.3153

Keywords:

Cell block, Immunocytochemistry, TLE 1, Synovial sarcoma cytology

Abstract

Introduction: Synovial sarcomas are rare tumors accounting for approximately 5-10% of soft tissue sarcomas. For synovial sarcomas that arise at unusual locations, cytologic diagnosis is challenging despite characteristic cytomorphologic features.

Material and Methods: The use of ancillary diagnostic procedures such as immunocytochemistry (ICC) using cell blocks and molecular genetic techniques using aspirated material help in the confirmation of diagnosis. During the period of 18 months from Nov 16 to Feb 18 we reported three cases of SS that occurred in rare locations with the help of ICC on cell blocks in 2 cases and IHC in the third case.

Results: Cells arranged in bundles, perivascular arrangement, tight clusters, acini & singly. Cells are elongated, oval to spindle, presence of uni or bipolar cytoplasmic processes with mildly pleomorphic , hyperchromatic nuclei & fine granular chromatin. TLE1 was positive in all 3 cases.

Conclusion: TLE1 marker is an extremely useful marker that distinguishes SS from other cytological & histological mimics.

The objective of the present study was to call attention and also highlight the variable cytology of synovial sarcoma arising at rare locations. Furthermore, we discuss use of adjunctive ICC on cell blocks that help to lock the diagnosis.

References

Song W, van Hemel BM, Suurmeijer AJH. Suitability of the CellientTM cell block method for diagnosing soft tissue and bone tumors. Diagnostic Cytopathology. 2018;46:299–305.

Srinivasan R, Gautam U, Gupta R, Rajwanshi A, Vasistha RK. Synovial sarcoma: diagnosis on fine-needle aspiration by morphology and molecular analysis. Cancer. 2009 Apr 25;117(2):128-36.

Pai S, Chinoy RF, Pradhan SA, D'cruz AK, Kane SV, Yadav JN. Head and neck synovial sarcomas. Journal of Surgical Oncology. 1993;54(2):82–86.

Hirsch RJ, Yousem DM, Loevner LA, Montone KT, Chalian AA, Hayden RE, et al. Synovial sarcomas of the head and neck: MR findings. AJR Am J Roentgenol. 1997;169:1185–1188.

Singh HK, Kilpatrick SE, Silverman JF. Fine needle aspiration biopsy of soft tissue sarcomas: Utility and diagnostic challenges. Advances in Anatomic Pathology. 2004;11:24–37.

Kottu R, Prayaga AK. Synovial sarcoma with relevant immunocytochemistry and special emphasis on the monophasic fibrous variant. J Cytol. 2010 Apr;27(2):47-50.

Eilber FC, Dry SM. Diagnosis and management of synovial sarcoma. J Surg Oncol. 2008;97(4):314–320.

Ferrari A, Gronchi A, Casanova M, et al. Synovial sarcoma: a retrospective analysis of 271 patients of all ages treated at a single institution. Cancer. 2004;101(3):627–634.

Holla P, Hafez GR, Slukvin I, Kalayoglu M. Synovial sarcoma, a primary liver tumor--a case report. Pathology Research and Practice. 2006;202:385–387.

Ishiki H, Miyajima C, Nakao K, Asakage T, Sugasawa M, Motoi T. Synovial sarcoma of the head and neck: rare case of cervical metastasis. Head Neck. 2009 Jan;31(1):131-5.

Jang KS, Min KW, Jang SH, Paik SS, Tae K, Jang SJ, et al. Primary synovial sarcoma of the thyroid gland. J Korean Med Sci. 2007;22(Suppl):S154–S158.

Smith CJ, Ferrier AJ, Russell P, Danieletto S. Primary synovial sarcoma of the ovary: first reported case. Pathology. 2005;37:385–387.

Yaseen SB, Mustafa F, Rafiq D, Makhdoomi R, Chanda N. Primary pulmonary synovial sarcoma: Diagnosis on squash smears. J Cytol. 2015 Jan-Mar;32(1):56-8.

Jernstrom P. Synovial sarcoma of the pharynx: report of a case. American Journal of Clinical Pathology. 1954;24(8):957–961.

Gautam AD, Jain S, Ravi Sankar M, Jain N. Primary synovial sarcoma of parotid gland with intravenous extension into the heart. BJR Case Reports. 2020 Jul 2;6(4):20200080.

Barkan GA, El-Naggar AK. Primary synovial sarcoma of the parotid gland. Annals of Diagnostic Pathology. 2004 Aug;8(4):233-6.

Ouansafi I, Klein M, Sugrue C, Morgenstern N, Frank D, Wasserman P. Monophasic parapharyngeal synovial sarcoma diagnosed by cytology, immunocytochemistry, and molecular pathology: case report and review of the literature. Diagn Cytopathol. 2010 Nov;38(11):822-7.

Mohaidat ZM, Saleh AA, Al-Gharaibeh S, Yousef IR. Case report: synovial sarcoma of the axilla with brachial plexus involvement. World Journal of Surgical Oncology. 2018 Aug 13;16(1):166.

Agarwal A, Chinoy RF. Cytohistologic spectrum of 13 synovial sarcomas. J Cytol. 2006;23(2):71-74.

Akerman M, Ryd W, Skytting B; Scandinavian Sarcoma Group. Fine-needle aspiration of synovial sarcoma: criteria for diagnosis: retrospective reexamination of 37 cases, including ancillary diagnostics. Diagn Cytopathol. 2003 May;28(5):232-8.

Viguer JM, Jiménez-Heffernan JA, Vicandi B, López-Ferrer P, Gamallo C. Cytologic features of synovial sarcoma with emphasis on the monophasic fibrous variant. Cancer. 1998;84:50–6.

Kilpatrick SE, Teot LA, Stanley MW, Ward WG, Savage PD, Geisinger KR. Fine-needle aspiration biopsy of synovial sarcoma. A cytomorphologic analysis of primary, recurrent, and metastatic tumors. American Journal of Clinical Pathology. 1996 Dec;106(6):769-75.

Klijanienko J, Caillaud JM, Lagacé R, Vielh P. Cytohistologic correlations in 56 synovial sarcomas in 36 patients: the Institut Curie experience. Diagn Cytopathol. 2002 Aug;27(2):96-102.

Domanski HA. Fine-needle aspiration cytology of soft tissue lesions: diagnostic challenges. Diagn Cytopathol. 2007 Dec;35(12):768-73.

Akerman M, Domanski HA. The complex cytological features of synovial sarcoma in fine needle aspirates, an analysis of four illustrative cases. Cytopathology. 2007 Aug;18(4):234-40.

Bose A, Pradhan P, Dash K, Senapati U, Sahoo SR, Parida S. Inguinal lymph node metastasis in a case of recurrent biphasic synovial sarcoma – A cytologic diagnosis. J Cytol [serial online] 2021 [cited 2021 Jun 14];38:110-1. Available from: https://www.jcytol.org/text.asp?2021/38/2/110/315769.

Foo WC, Cruise MW, Wick MR, Hornick JL. Immunohistochemical staining for TLE1 distinguishes synovial sarcoma from histologic mimics. Am J Clin Pathol. 2011;135(6):839-44.

Rekhi B, Basak R, Desai SB, Jambhekar NA. Immunohistochemical validation of TLE1, a novel marker, for synovial sarcomas. Indian J Med Res. 2012 Nov;136(5):766-75.

Cagle LA, Mirra JM, Storm FK, Roe DJ, Eilber FR. Histologic features relating to prognosis in synovial sarcoma. Cancer. 1987 May 15;59(10):1810-4.

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Published

03-07-2023

How to Cite

1.
Dani AA, Kamal MM, Swati Kalantri S. Immunocytochemistry as an Ancillary Technique in the Cytologic Diagnosis of Synovial Sarcoma: Lock With Cell Block: Synovial Sarcoma -Lock With Cell Block. Ann of Pathol and Lab Med [Internet]. 2023 Jul. 3 [cited 2024 Dec. 27];10(3):C21-28. Available from: https://pacificejournals.com/journal/index.php/apalm/article/view/3153

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Case Report