Immunohistochemical Staining for TLE1 Distinguishes Synovial Sarcoma From Histologic Mimics

Foo, Wai Chin; Cruise, Michael; Wick, Mark R.; Hornick, Jason L.

doi:10.1309/ajcp45ssnaopxyxu

Cited by 214 publications

(145 citation statements)

References 15 publications

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“…Biphasic examples of synovial sarcoma can be recognized by foci of epithelial/glandular differentiation. Synovial sarcoma shows positivity for TLE1 [24] and epithelial markers cytokeratin and EMA, even in the spindle cell component, but does not typically express SMA or HHF-35. Similar to prior studies [22,25], we observed frequent b-catenin expression in synovial sarcoma.…”

Section: Discussionmentioning

confidence: 99%

Nuclear β-Catenin Expression is Frequent in Sinonasal Hemangiopericytoma and Its Mimics

Fletcher

2016

Head and Neck Pathol

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Sinonasal hemangiopericytoma (HPC) is a tumor showing pericytic myoid differentiation and which arises in the nasal cavity and paranasal sinuses. CTNNB1 mutations appear to be a consistent aberration in sinonasal HPC, and nuclear expression of b-catenin has been reported. Our aim was to evaluate the frequency of b-catenin expression in sinonasal HPC and its histologic mimics in the upper aerodigestive tract. Cases were retrieved from the surgical pathology and consultation files. Immunohistochemical staining for b-catenin was performed on 50 soft tissue tumors arising in the sinonasal tract or oral cavity, and nuclear staining was recorded semiquantitatively by extent and intensity. Nuclear reactivity for b-catenin was present in 19/20 cases of sinonasal HPC; 17 showed moderate-to-strong multifocal or diffuse staining, and 2 had moderate focal nuclear reactivity. All solitary fibrous tumors (SFT) (10/10) showed focal-to-multifocal nuclear staining, varying from weak to strong in intensity. Most cases of synovial sarcoma (9/10) showed nuclear b-catenin expression in the spindle cell component, ranging from focal-weak to strong-multifocal. No cases of myopericytoma (0/10) showed any nuclear b-catenin expression. bcatenin expression is prevalent in sinonasal HPC, but is also frequent in SFT and synovial sarcoma. Our findings indicate that b-catenin is not a useful diagnostic tool in the evaluation of spindle cell tumors with a prominent hemangiopericytoma-like vasculature in the sinonasal tract and oral cavity, and that definitive diagnosis relies on the use of a broader immunohistochemical panel.

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Section: Discussionmentioning

confidence: 99%

Nuclear β-Catenin Expression is Frequent in Sinonasal Hemangiopericytoma and Its Mimics

Fletcher

2016

Head and Neck Pathol

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“…10,12,[29][30][31] TLE1 shows promise as a marker of synovial sarcoma, but weak and variable expression can be seen in malignant peripheral nerve sheath tumors. [32][33][34][35] Consequently, genetic and molecular tests to demonstrate t(X;18) rearrangement or SS18-SSX fusion, respectively, have become routine at many specialized centers to confirm the diagnosis of synovial sarcoma. Although some controversy existed in the past regarding the specificity of this genetic abnormality, 36,37 the current consensus among sarcoma pathologists is that SS18-SSX fusions are highly specific for synovial sarcoma.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic utility of SOX10 to distinguish malignant peripheral nerve sheath tumor from synovial sarcoma, including intraneural synovial sarcoma

et al. 2014

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Synovial sarcoma and malignant peripheral nerve sheath tumor pose a significant diagnostic challenge given similar histomorphology. The distinction is further complicated by similar immunophenotype and especially by occasional synovial sarcomas that present as intraneural tumors. Although the presence of a t(X;18) rearrangement or expression of TLE1 can help confirm the diagnosis of synovial sarcoma, negative results for these tests are not diagnostic of malignant peripheral nerve sheath tumor. The SOX10 transcription factor, a putative marker of neural crest differentiation, may have diagnostic utility in this differential, but immunohistochemical data are limited. The goal of the present study was to determine the diagnostic utility of SOX10 to discriminate between synovial sarcoma and malignant peripheral nerve sheath tumor. Forty-eight cases of malignant peripheral nerve sheath tumor, all from patients with documented neurofibromatosis, and 97 cases of genetically confirmed synovial sarcoma, including 4 intraneural synovial sarcomas, were immunohistochemically stained for SOX10. The stain was scored for intensity and fraction of cells staining. Thirty-two of 48 malignant peripheral nerve sheath tumors (67%) were SOX10-positive. The majority of malignant peripheral nerve sheath tumors showed Z2 þ staining, but staining did not correlate with grade. By contrast, only 7/97 (7%) synovial sarcomas were SOX10-positive. Only three synovial sarcomas showed Z2 þ staining but, importantly, two of these were intraneural synovial sarcoma. Therefore, SOX10 is a specific (93%), albeit not very sensitive (67%), diagnostic marker to support a diagnosis of malignant peripheral nerve sheath tumor over synovial sarcoma. Furthermore, the stain needs to be interpreted with caution in intraneural tumors in order to avoid a potential diagnostic pitfall. It remains to be determined whether SOX10-positive cells in intraneural synovial sarcoma represent entrapped Schwann cells, synovial sarcoma cells or both.

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“…94 By immunohistochemistry, TLE1 shows moderate-tostrong, diffuse nuclear staining in the majority of synovial sarcomas (80-90%) (Figure 14). [95][96][97][98] TLE1 is a relatively specific marker for synovial sarcoma that can be helpful in differential diagnosis, as it is only positive in a small subset of malignant peripheral nerve sheath tumors and solitary fibrous tumors (usually with only weak staining), and it is consistently negative in Ewing sarcomas (which can be mistaken for poorly differentiated synovial sarcomas). 95,97 MUC4 is a high-molecular-weight transmembrane glycoprotein expressed on the surface of some glandular epithelial cell types.…”

Section: Lineage-restricted Transcription Factorsmentioning

confidence: 99%

Novel uses of immunohistochemistry in the diagnosis and classification of soft tissue tumors

Hornick

2014

Modern Pathology

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Immunohistochemistry plays a key role in the diagnosis of soft tissue tumors. Until recently, however, the primary purpose of immunohistochemistry in this context was simply to attempt to demonstrate a line of differentiation. Unfortunately, most traditional markers (predominantly directed against cytoplasmic determinants) show relatively limited specificity. Over the last decade or so, much more specific immunohistochemical markers for soft tissue tumors have been developed. This review will provide an update of some of the most useful new diagnostic markers, which are significantly changing clinical practice for surgical pathologists, separated into three general categories: (1) lineage-restricted transcription factors, (2) protein correlates of molecular alterations, and (3) diagnostic markers identified by gene expression profiling.

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Immunohistochemical Staining for TLE1 Distinguishes Synovial Sarcoma From Histologic Mimics

Cited by 214 publications

References 15 publications

Nuclear β-Catenin Expression is Frequent in Sinonasal Hemangiopericytoma and Its Mimics

Nuclear β-Catenin Expression is Frequent in Sinonasal Hemangiopericytoma and Its Mimics

Diagnostic utility of SOX10 to distinguish malignant peripheral nerve sheath tumor from synovial sarcoma, including intraneural synovial sarcoma

Novel uses of immunohistochemistry in the diagnosis and classification of soft tissue tumors

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