Ossifying synovial sarcoma

Pathol Res Pract. 2009;205(3):195-8. doi: 10.1016/j.prp.2008.10.003. Epub 2008 Nov 28.

Abstract

Although intralesional calcification is a common finding of synovial sarcoma, ossification is an unusual phenomenon in such a soft tissue sarcoma. Here we report a case of ossifying synovial sarcoma arising in the back of a young adult man. Microscopically, the tumor was composed of spindle or oval cells together with foci of atypical polygonal cells in small nests or cord-like structures, displaying an epithelial appearance. In addition, extensive osteoid or woven bone formation was present in the tumor, resembling extraskeletal osteosarcoma. However, an SS18-SSX1 fusion gene transcript was detected by reverse transcription-polymerase chain reaction, supporting the diagnosis of biphasic synovial sarcoma. The osteogenic phenotype of the tumor cells was further demonstrated by an intense immunohistochemical expression of Runx2, a key transcription factor involved in the regulation of osteoblastic differentiation. The current case suggests the diagnostic utility of the molecular detection of a tumor type-specific fusion gene and expands the phenotypic plasticity of the soft tissue sarcoma of uncertain differentiation.

MeSH terms

  • Adult
  • Base Sequence
  • Humans
  • Immunohistochemistry
  • Male
  • Oncogene Proteins, Fusion
  • Ossification, Heterotopic / genetics*
  • Ossification, Heterotopic / pathology*
  • Reverse Transcriptase Polymerase Chain Reaction
  • Sarcoma, Synovial / genetics*
  • Sarcoma, Synovial / metabolism
  • Sarcoma, Synovial / pathology*
  • Soft Tissue Neoplasms / genetics*
  • Soft Tissue Neoplasms / metabolism
  • Soft Tissue Neoplasms / pathology*
  • Tomography, X-Ray Computed

Substances

  • Oncogene Proteins, Fusion
  • SYT-SSX fusion protein