Soft tissue
Other tumors
Synovial sarcoma

Author: Vijay Shankar, M.D.

Revised: 25 April 2018, last major update November 2012

Copyright: (c) 2002-2018, PathologyOutlines.com, Inc.

PubMed Search: Synovial sarcoma [title] soft tissue

Related topics: Calcifying synovial sarcoma
Cite this page: Shankar, V. Synovial sarcoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/softtissuesynovialsarc.html. Accessed May 25th, 2018.
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 (Am J Surg Pathol 2006;30:721)
Radiology images

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Contributed by Mark R. Wick, M.D.

MRI

Foot

Prognostic factors
Case reports
Treatment
  • Wide local excision plus radiation
Gross description
  • Well circumscribed, firm, gray-pink
  • Focal calcifications on Xray
  • Rarely within major nerves
Gross images

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Contributed by Mark R. Wick, M.D.

Cystic changes



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14 cm mediastinal mass

Buttock mass

Mandibular region

Microscopic (histologic) 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
Microscopic (histologic) images

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Contributed by Mark R. Wick, M.D.

Monophasic synovial sarcoma H&E

Monophasic synovial sarcoma TLE1

Biphasic synovial sarcoma H&E

Biphasic synovial sarcoma TLE1



Contributed by Debra Zynger, M.D.

Monophasic synovial sarcoma H&E

Monophasic synovial sarcoma TLE1+



Contributed by Mark R. Wick, M.D.

Hemangiopericytoid

Nuclear palisading

Small cell

Monophasic epithelioid


Monophasic spindle cell


Biphasic

Intranuclear TLE1



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Epithelial islands

Spindled cells

Connective tissue

Buttock


Keratin+

Vimetin+

Positive stains
Negative stains
Electron microscopy description
  • Glandular formation of epithelioid tumor cells with sparse luminal microvilli
Electron microscopy images

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Contributed by Mark R. Wick, M.D.

Biphasic

Biphasic spindle cell

Molecular / cytogenetics description
Molecular / cytogenetics images

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Contributed by Mark R. Wick, M.D.

X18, in situ hybridization

Differential diagnosis