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Synovial Sarcoma Case #07-2435

Synovial Sarcoma Case #07-2435. Michael W. Nolan, Anya C. Hawthorn and Bernard S. Jortner Department of Biomedical Sciences and Pathobiology Virginia-Maryland Regional College of Veterinary Medicine Virginia Polytechnic Institute and State University Blacksburg, VA 24061-0442. History.

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Synovial Sarcoma Case #07-2435

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  1. Synovial SarcomaCase #07-2435 Michael W. Nolan, Anya C. Hawthorn and Bernard S. Jortner Department of Biomedical Sciences and Pathobiology Virginia-Maryland Regional College of Veterinary Medicine Virginia Polytechnic Institute and State University Blacksburg, VA 24061-0442 Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  2. History • Adult dog • Mass at point of right hock • Surgically excised Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  3. Gross Findings • Pale solid mass • Several centimeters diameter • Found in close association with the distal calcaneal tendon Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  4. Histologic Description -H&E Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  5. Histologic Description -H&E Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  6. Histologic Description -Immunohistochemistry Cytokeratin Cytokeratin Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  7. Histologic Description -Immunohistochemistry Vimentin Vimentin Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  8. Histologic Description-Special Stains PAS Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  9. Histologic Description-Summary • Lined clefts • 2 cell populations • Epithelioid cells • Spindloid cells • Cytokeratin negative • Vimentin positive • PAS negative Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  10. Morphologic Diagnosis • Synovial cell sarcoma • biphasic Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  11. Discussion • Synovial Sarcoma • epithelial and/or mesenchymal • Classification • biphasic (epithelial and mesenchymal) • monophasic (epithelial or mesenchymal) • undifferentiated small cell sarcoma Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  12. Discussion • Are they really synovial in origin? • Anatomic location • Immunoreactivity for vimentin and cytokeratin • Production of basement membrane Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  13. Discussion • Are they really synovial in origin? • Anatomic location • many are para-articular • ~10% intra-articular • mediastinum, heart, lung, kidney, prostate, etc. Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  14. Discussion • Are they really synovial in origin? • Immunoreactivity for vimentin and cytokeratin • usually immunoreactive for vimentin • variably immunoreactive for cytokeratin Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  15. Discussion • Are they really synovial in origin? • Production of basement membrane • not a feature of normal synovium Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  16. Discussion • Are they really synovial in origin? • Arise from pleuripotent stem/progenitor cells • example = poorly differentiated synoviocyte Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  17. Discussion • So was this really a case of synovial sarcoma? • Extra-articular, in close association with joint • Immunoreactivity: vimentin (+), cytokeratin (-) • PAS (-) Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  18. Discussion • What is the biological behavior of synovial sarcoma? • Locally invasive • Non-metastatic Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  19. Discussion • Biological behavior guides treatment: • Wide excision and adjunct chemotherapy • Radical resection/limb amputation • Fair/good prognosis for survival Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  20. References Craig LE, Julian, ME, Ferracone JD (2002) The diagnosis and prognosis of synovial tumors in dogs: 35 cases. Veterinary Pathology 39: 66-73. Fairley R (2002) Letter to the editor. Veterinary Pathology 39(3): 413-414. Llomart-Bosch A, Lopez-Guerrero JA, Peydro-Olaya A (2002) Synovial sarcoma (ss): new perspectives supported by modern technology. Arkiv Patologii (Archives of Pathology Rus.) 3: 39-46. Suster S, Moran CA (2005) Primary synovial sarcomas of the mediastinum: a clinicopathologic, immunohistochemical, and ultrastructural study of 15 cases. American Journal of Surgical Pathology 29(5): 569-577. Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  21. Questions? mwnolan@vt.edu Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

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