Synovial sarcoma–identification of favorable and unfavorable histologic types: A Scandinavian sarcoma group study of 104 cases

Skytting, Björn; Meis‐Kindblom, Jeanne M.; Larsson, Olle; Virolainen, Martti; Perfekt, Roland; Åkerman, Måns; Kindblom, Lars Gunnar

doi:10.3109/17453679908997840

Cited by 38 publications

(20 citation statements)

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“…Thus, at first glance, our older patients seemed to have a worse clinical course than that seen in other large series of synovial sarcomas, in which the metastasis‐free survival at 5 years was 68%, median survival interval after metastasis was 1.8 years, and overall 5‐year survival rate was 76% 2 . However, in the context of series which assessed outcome in cases of poorly differentiated or higher grade SS and those without such unfavourable histology, 2,7 , 23,33 , 34 the clinical outcome in our cases was not particularly worse. Large tumour size, poorly differentiated histology, high mitotic counts, and high Ki67/MIB‐1 proliferation index have all been shown to be strong negative prognostic factors in SS 35–38 .…”

Section: Discussionmentioning

confidence: 64%

Synovial sarcoma in older patients: clinicopathological analysis of 32 cases with emphasis on unusual histological features

2003

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Section: Discussionmentioning

confidence: 64%

Synovial sarcoma in older patients: clinicopathological analysis of 32 cases with emphasis on unusual histological features

2003

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“…12, 20, 21 6,16,17 Regarding survival, the unfavorable prognostic factors identified in our study were spontaneous necrosis over 25%, Some investigators have tried to establish high-and lowrisk groups based on histologic variables. Skitting et al 22 18 defined as favorable cases those presenting cellular atypia, no necrosis and a mitotic rate under 10/10 HPF. These cases had a survival rate of 83%, whereas the remaining patients had only a 31% survival rate.…”

Section: Discussionmentioning

confidence: 99%

Synovial Sarcoma of the Extremities: Prognostic Factors for 20 Nonmetastatic Cases and a New Histologic Grading System With Prognostic Significance

Baptista

Camargo

Croci

et al. 2006

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PURPOSE:To evaluate 20 cases of nonmetastatic synovial sarcoma of the extremities regarding prognostic factors, and to propose a histologic grading system with prognostic significance. METHODS:The cases of 20 patients (14 females and 6 males) with nonmetastatic synovial sarcomas of the extremities treated between 1985 and 1998, were retrospectively evaluated regarding prognostic factors. A histologic grading system with prognostic significance is proposed. RESULTS: The mean follow-up period was 48.4 months (range, 16-116 months). There was local recurrence in 3 cases (15%), microscopic surgical margin being the only prognostic factor identified. Seven patients (35%) died of the disease in a mean postoperative period of 31.7 months (range, 16-53 months), all with pulmonary or brain metastasis. The survival rate was 65% in 48.4 months of follow-up. CONCLUSION: The unfavorable prognostic factors identified regarding survival were high histologic grade, tumors proximal to the knee or elbow, and spontaneous tumor necrosis over 25%. Local recurrence did not have influence on survival in this study. The presence of mast cells appears to have a positive influence on survival, although statistical significance was not reached (P = 0.07). The oncologic and functional result was good in 6 cases (30%), regular in 7 (35%), and poor in 7 cases (35%).

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“…1,2 Poorly differentiated synovial sarcomas, showing a round cell pattern, account for o5% of synovial sarcoma, and may arise from either monophasic or biphasic synovial sarcomas. [3][4][5] Although the recognition of biphasic synovial sarcoma is typically straightforward, not requiring ancillary immunostains or molecular genetic tests, the differential diagnosis of monophasic and poorly differentiated synovial sarcoma may be more challenging. Although immunohistochemistry for markers such as cytokeratins, S100 protein, CD34, smooth muscle actin and desmin plays a valuable role in this differential diagnosis, there is overlap in the immunophenotypes of these various tumors, and a definitive diagnosis is not always possible with immunohistochemistry alone.…”

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confidence: 99%

TLE1 expression is not specific for synovial sarcoma: a whole section study of 163 soft tissue and bone neoplasms

2009

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TLE1, a transcriptional repressor essential in hematopoiesis, neuronal differentiation and terminal epithelial differentiation, has recently been shown in a single tissue microarray study to be a highly sensitive and relatively specific marker of synovial sarcomas. Expression of TLE1 has not, however, been studied in standard sections of soft tissue and bone tumors. We investigated TLE1 expression in a large series of well-characterized mesenchymal tumors, to more fully characterize the range of TLE1 expression. Standard sections of 163 bone and soft tissue tumors were immunostained for TLE1 (sc-9121, 1:100; Santa Cruz Biochemicals) using the Dako Dual Envision þ detection system. Nuclear positivity was scored as negative (o5% of cell positive), 1 þ (5-25% of cells positive), 2 þ (25-50% of cells positive), and 3 þ (450% of cells positive). Overall, TLE1 was expressed by 18 of 20 (90%) of synovial sarcoma, with 16 cases (89%) showing 2-3 þ positivity. However, TLE1 expression was also seen in 53 of 143 (37%) non-synovial sarcoma, with 36 such cases (25%) showing 2-3 þ positivity. TLE1 expression was commonly seen in peripheral nerve sheath tumors, including 33% of neurofibromas, 100% of schwannomas, and 30% of malignant peripheral nerve sheath tumors. Among non-neoplastic tissues, nuclear TLE1 expression was variably present in basal keratinocytes, adipocytes, perineurial cells, endothelial cells and mesothelial cells. Our study confirms the excellent sensitivity of TLE1 for synovial sarcoma. However, TLE1 expression is by no means specific for synovial sarcoma, being present in a number of tumors, which enter its differential diagnosis, in particular tumors of peripheral nerve sheath origin. Heterogeneity of TLE1 expression likely explains the differences between the present standard section study and the earlier TMA study. TLE1 may be of value in the differential diagnosis of synovial sarcoma, but should be used only in the context of a panel of antibodies. Morphology, ancillary immunohistochemistry for traditional markers such as cytokeratins and CD34, and molecular confirmation of synovial sarcoma-associated fusion genes should remain the 'gold standards' for this diagnosis.

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Synovial sarcoma–identification of favorable and unfavorable histologic types: A Scandinavian sarcoma group study of 104 cases

Cited by 38 publications

References 31 publications

Synovial sarcoma in older patients: clinicopathological analysis of 32 cases with emphasis on unusual histological features

Synovial sarcoma in older patients: clinicopathological analysis of 32 cases with emphasis on unusual histological features

Synovial Sarcoma of the Extremities: Prognostic Factors for 20 Nonmetastatic Cases and a New Histologic Grading System With Prognostic Significance

TLE1 expression is not specific for synovial sarcoma: a whole section study of 163 soft tissue and bone neoplasms

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