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Synovial Sarcoma
Synovial Sarcoma
Definition / General
Usually a deep seated mass present for years around large joints (80% in
knee and ankle) in young adults (age 20-40), 60% male; only 10% actually
involve the joint
Represent 10% of adult soft tissue tumors
5 year survival is 50 - 70%; 10 year survival 40%; recurs locally, 10 - 15%
metastasize to lung and pleura, bone, regional nodes
Rarely radiation associated (Mod Pathol 2002;15:998)
Minute (< 1 cm) tumors of hands and feet: 2/3 female, median age 29
years, 2/3 monophasic, 40% have microcalcifications; EMA+, keratin+;
have clinically favorable course if completely excised
Poor prognostic factors: high histologic grade (based on MIB1 index
and necrosis, (Hum Pathol 2001;32:257), SYT-SSX1 vs. SYT-SSX2
gene fusion
Micro Description
Biphasic, monophasic or undifferentiated
Biphasic have spindle cells resembling synoviocytes and plump epithelial
cells forming glands / cords
Monophasic lack the epithelial cells
Spindle cells are arranged in plump fascicles with hyalinization and distinct
lobulation accompanied by mast cells, occasional osseous or cartilaginous
metaplasia, focal whorling
May have hemangiopericytomatous vascular pattern
Poorly differentiated histology predicts poor outcome
___staghorn vessels___
biphasic tumor
Negative Stains
CD34 (94% monophasic fibrous, 100% poorly differentiated), desmin (98%
monophasic fibrous, 100% poorly differentiated), myogenin (Am J Surg
Pathol 2001;25:1150), h-caldesmon, CD141, WT1, FLI-1
Note: normal synovium is cytokeratin negative
Differential Diagnosis
Fibrous variant resembles other sarcomas
Metastatic adenocarcinoma: if primarily epithelial component
MPNST: usually negative for CK7 and CK19;negative for SYT-SSX fusion
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