Evaluating the clinico-pathological features including the immunohistochemical and molecular landscape of synovial sarcoma cases from a tertiary care cancer referral centre in India

Figures

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  Fig. 1. Kaplan Meier curve depicting PFS and OS

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  Fig. 2. Radiology and Gross specimens A MRI shows a well-defined soft tissue mass involving the right thigh without any underlying bone erosion B Cross sectional image of the same mass, which was hypointense on T1, and heterogeneously hyperintense on T2 C Gross photograph of the thigh mass shows a solid, lobulated, grey-white tumor with areas of hemorrhage. D MRI of right forearm shows a large well-defined soft tissue mass involving the dorsal aspect of the forearm, measures approximately 10.4 × 10.3 × 12 cm. E Gross picture of the forearm mass shows a large tumor with extensive areas of necrosis. F Below-knee amputation specimen of left lower leg shows a huge lobulated tumor involving the medial aspect of foot with overlying skin ulceration. G Gross photograph of a left foot with a solid tumor involving the heel

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  Fig. 3. Histomorphological features A Low power view shows the Herring Bone pattern of arrangement of the tumor cells, H&E, 20X. B Higher magnification shows the cells have spindled, elongated nuclei and scanty cytoplasm, H&E, 40X. C Round cell morphology of the tumor cells along with brisk mitosis is seen, H&E, 40X. D Hemangiopercytomatous pattern of blood vessels are seen., H&E, 20X. E Thick collagen bundles were noted amidst the tumor cells, H&E, 20X. F Microsection shows thin ropey collagen in few of the cases, H&E, 40X. G Sclerotic stroma in noted in focal areas in some of the cases. H Areas of calcification are noted. I Epithelioid morphology of the tumor cells is seen in one of the cases, H&E, 40X. I Cytoplasmic clearing is seen in the tumor cells. J Bcl 2 is positive, H&E, 40X. K Diffuse nuclear positivity of SS18 is seen, H&E, 20X

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  Fig. 4. Biphasic synovial sarcoma cases with highlighted epithelial glandular component (arrow heads). A A biphasic tumor with the epithelial component arranged in glandular pattern. Stromal nodule is highlighted by star, H&E, 40X. B Pan-CK highlights the epithelial glandular components of the same case, with the adjacent spindle cell component being negative, H&E, 40X. C Tumor cells show diffuse nuclear positivity for TLE-1, H&E, 20X. D Biphasic tumor showing eosinophilic secretions inside the glandular components, H&E, 40X. E EMA is positive in the epithelial components of the same case, H&E, 40X. F Diffuse nuclear positivity of SS18:SSX is seen. G Biphasic tumor showing periglandular arrangement of the spindle cell component, H&E, 40X. H Pan-CK highlights the epithelial glandular components I Fluorescent in situ Hybridization depicting SS18:SSX translocation

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  Fig. 5. Paratesticular synovial sarcoma case A Gross photograph of the paratesticular mass showing areas of hemorrhage and necrosis. B Scanner power view shows the normal testicular structures at the lower end and infiltrating tumor nests at the right upper corner (arrows), H&E, 4X. C Higher power view of the tumor nest along with the normal epididymal tubules, H&E, 20X. D Extensive lymphovascular invasion was noted (arrow heads), H&E, 20X. E Numerous dilated and congested vascular channels are noted throughout the tumor, H&E, 20X. F Extensive areas of necrosis (star) and calcification (arrow heads) were noted amidst the tumor cells, H&E, 20X. G Microsection shows the round cell morphology of the tumor cells having clear cytoplasm and brisk mitosis, resembling Ewing sarcoma, H&E, 40X. H On immunohistochemistry, tumor cells are diffusely positive for TLE-1. I CD56 is diffusely and strongly expressed by the tumor cells, the adjacent testicular tubules being negative (arrow heads)