Abstract
BackgroundSoft-tissue sarcomas comprise a diverse group of sarcomas with characteristic histologic features. However, histology alone is not adequate for a definitive diagnosis for many tumors. In such cases, immunohistochemistry (IHC) plays a key role in determining the line of differentiation and exact characterization. Transducer-like enhancer of split 1 (TLE1) has been recently described as a novel marker for synovial sarcoma (SS). Its high sensitivity and specificity make it a potential marker that distinguishes SS from histologic mimics such as malignant peripheral nerve sheath tumor (MPNST), Ewing's sarcoma (ES), and fibrosarcomatous dermatofibrosarcoma protuberans (FS-DFSP). The objective of our study was to assess the frequency of TLE1 immunohistochemical expression on SS cases of various subtypes.MethodsThis cross-sectional study was conducted at the Department of Histopathology, Aga Khan University, Karachi, Pakistan from February 3, 2018 to February 10, 2019. Tissue samples of 89 SS cases were selected for this study. Tumor sections were stained with hematoxylin and eosin (H&E), cytokeratin AEI/AE3 (CKAE1/AE3), epithelial membrane antigen (EMA), and TLE1 immunohistochemical stain. TLE1 expression was assessed based on the Remmele scoring system.ResultsTissue samples of 89 SS cases were processed for the study. Mean (±) standard deviation (SD) of age was 25 (±7.36) years. Male:female ratio was 1.1:1. Of the 89 SS cases, 42 (47.2%) were monophasic, six (6.7%) were biphasic, and 41 (46.1%) were poorly differentiated. All the 89 cases showed positivity for TLE1 immunostain: 86 (96.6%) cases showed strong positivity, one (1.1%) case showed moderate expression, and two (2.2%) showed weak positivity.ConclusionThis study shows that TLE1 is a highly sensitive immunostain for SS irrespective of the histologic type. However, it may show weak-to-moderate staining in poorly differentiated types. No statistically significant association was seen with respect to age group, gender, or type of SS.
Highlights
Synovial sarcoma (SS) is the fourth most common sarcoma, comprising 10% of all soft-tissue sarcomas [1,2,3]
Tissue samples of 89 synovial sarcoma (SS) cases were processed for the study
No statistically significant association was seen with respect to age group, gender, or type of SS
Summary
Synovial sarcoma (SS) is the fourth most common sarcoma, comprising 10% of all soft-tissue sarcomas [1,2,3] It has a relatively higher occurrence in the 15-49 age group in Karachi [4]. Three histologic types of SS are known: monophasic (50-60%), which consists of monomorphic spindleshaped cells arranged in sheets or fascicles and rare mitosis with differentials of malignant peripheral nerve sheath tumor (MPNST), fibrosarcomatous dermatofibrosarcoma protuberans (FS-DFSP), etc.; biphasic (2030%), which consists of both spindle and epithelial components; and poorly differentiated SS (10-15%), which consists of diffuse sheets of small round blue cells with nuclear atypia, conspicuous nucleoli, and high mitotic rate with close differential of Ewing's sarcoma (ES) [7,8,9,10]. Its high sensitivity and specificity make it a potential marker that distinguishes SS from histologic mimics such as malignant peripheral nerve sheath tumor (MPNST), Ewing's sarcoma (ES), and fibrosarcomatous dermatofibrosarcoma protuberans (FS-DFSP). The objective of our study was to assess the frequency of TLE1 immunohistochemical expression on SS cases of various subtypes
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