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Presented by Dr. P. Argani and prepared by Dr. A. McCuiston.
Case 1: This is a 54 year old male with multiple pleural masses.
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Question 1 of 1
1. Question
This is a 54 year old male with multiple pleural masses.
BCL-2
Correct
Answer: Synovial sarcoma
Histology: This is a highly cellular but non-pleomorphic spindle cell neoplasm. Spindle cells are arranged in short fascicles, and focally there is cystic change within the tumor. The cells have variably prominent nucleoli, and have a plump spindle cell shape. The cytoplasm is minimal and largely clear. By immunohistochemistry, the tumor is immunoreactive for BCL2 but not for CD34. Molecular analysis revealed evidence of the SYT-SSX 2 gene fusion, supporting the diagnosis of synovial sarcoma.
Differential Diagnosis: Solitary fibrous tumor would be typically less cellular and associated with more collagen production. Malignant solitary fibrous tumors exist; however, these lesions would typically label for CD34 and would not have the SYT-SSX gene fusion of synovial sarcoma. Sarcomatoid malignant mesothelioma is typically more pleomorphic, and would demonstrate diffuse immunoreactivity for cytokeratin (unlike the typical focal immunoreactivity for cytokeratin in synovial sarcoma of spindle cell type). Leiomyosarcoma would typically demonstrate more pleomorphism, would have more eosinophilic cytoplasm, and would label desmin.
Synovial sarcoma may present in the pleura as a primary neoplasm in this site, though metastasis should be excluded clinically.
Incorrect
Answer: Synovial sarcoma
Histology: This is a highly cellular but non-pleomorphic spindle cell neoplasm. Spindle cells are arranged in short fascicles, and focally there is cystic change within the tumor. The cells have variably prominent nucleoli, and have a plump spindle cell shape. The cytoplasm is minimal and largely clear. By immunohistochemistry, the tumor is immunoreactive for BCL2 but not for CD34. Molecular analysis revealed evidence of the SYT-SSX 2 gene fusion, supporting the diagnosis of synovial sarcoma.
Differential Diagnosis: Solitary fibrous tumor would be typically less cellular and associated with more collagen production. Malignant solitary fibrous tumors exist; however, these lesions would typically label for CD34 and would not have the SYT-SSX gene fusion of synovial sarcoma. Sarcomatoid malignant mesothelioma is typically more pleomorphic, and would demonstrate diffuse immunoreactivity for cytokeratin (unlike the typical focal immunoreactivity for cytokeratin in synovial sarcoma of spindle cell type). Leiomyosarcoma would typically demonstrate more pleomorphism, would have more eosinophilic cytoplasm, and would label desmin.
Synovial sarcoma may present in the pleura as a primary neoplasm in this site, though metastasis should be excluded clinically.
