Primary Renal Synovial Sarcoma- A Diagnostic Challenge
Dr. Ranjana Shashidhar Ranade,
Assistant Professor, Department of Pathology, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India.
|Synovial sarcoma arising primarily in kidney is very rare, accounting for <2% of all malignant renal neoplasms. This tumour poses diagnostic dilemma as it mimics histologically with many other commonly presenting kidney tumours. Here, a 32-year-old female is reported who presented with gross haematuria and flank pain for three months. She complained recent increase in frequency of micturition, poor stream and incomplete emptying of bladder. Clinical possibility of urinary tract infection, urolithiasis, and renal neoplasm were considered. Right lower pole renal mass lesion of soft tissue density measuring 7.2x8.1x6.4 cm was found on radiologic examination. Grossly, fairly well circumscribed fleshy friable tumour with microcystic and haemorrhagic areas were noted. Monotonous small blue round cells arranged in sheets and in peritheliomatous pattern was noted upon microscopic examination. Histopathological differentials included were Ewing sarcoma, adult Wilm tumour, Non-Hodgkin Lymphoma (NHL) and rhabdomyosarcoma. A remote possibility of synovial sarcoma was also considered. Immunohistochemistry (IHC) revealed positivity with CD99, CD56, Bcl2 and TLE1. Characteristic histomorphology aided by typical immunohistochemical findings unravelled a diagnostic surprise of a rare renal tumour Primary Renal Synovial Sarcoma (PRSS).|
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