Synovial sarcoma is a rare renal neoplasm that is not easy to diagnose unless SYT-SSX fusion transcripts are identified. We report here on a case of primary renal synovial sarcoma in a 35-year-old woman. A mass was discovered by accident in the lower part of the right kidney when ultrasonography was performed, and it was removed via radical nephrectomy. Grossly, the tumor was a homogeneously tan-brown soft mass that measured 4.5x3.2x3.0 cm, and it was encircled by a well-defined cystic space. The lesion exhibited hypercellularity of the oval or short spindle cells that were arranged in various solid sheets or intersecting fascicles. Immunohistochemically, the tumor showed diffuse positivity for vimentin, bcl-2 and CD99, and it showed focal positivity for epithelial membrane antigen.
The SYT-SSX fusion transcripts were detected by reverse transcription-polymerase chain reaction (RT-PCR). Synovial sarcoma should be considered in the differential diagnosis when a spindle cell neoplasm is encountered in the kidney.
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Primary Renal Synovial Sarcoma and Clinical and Pathological Findings: a Systematic Review Leandro Blas, Javier Roberti Current Urology Reports.2021;[Epub] CrossRef
BACKGROUND Several cancer-testis antigen genes or gene families have been isolated to date, including Melanoma Antigen Gene (MAGE) and Synovial Sarcoma on X chromosome (SSX). This study attempted to investigate the possibility of immunotherapy for ovarian cancer and to explore the prevalence of the expression of MAGE and SSX. METHODS The fresh tissue samples were obtained from 5 cases of normal ovaries, 6 cases of non-neoplastic disease, 21 cases of benign ovarian tumors, and 12 cases of malignant ovarian tumors. The expression of MAGE A1-6 and SSX 1-9 was detected by nested reverse transcriptionpolymerase chain reaction using each common primers sets for MAGE A1-6 and SSX 1-9. RESULTS The expression rate of MAGE 1-6 mRNA was 23.0% (5/21) for the benign ovarian tumors and 91.7% (11/12) for the malignant ovarian tumor, whereas the normal ovaries (0/5) and non-neoplastic ovarian tissues (0/6) did not express MAGE (p<0.05). The expression rate of SSX was 40.0% (2/5) for the normal ovaries, 23.0% (5/21) for the benign ovarian tumors, and 33.3% (4/12) for the malignant ovarian tumors, while the non-neoplastic ovarian tissues showed no expression of SSX (p>0.05). A relationship between the two genes was not observed (kappa coefficient=0.32). CONCLUSION These results suggest that the gene products of MAGE and SSX can be useful for the immunotherapy of ovarian cancer patients and that MAGE can be a more promising target than SSX from the viewpoint of applicability and cancer-specificity.