Top

Published in:

Open Access 01-12-2021 | Lung Cancer | Research

Usefulness of SS18-SSX antibody as a diagnostic marker for pulmonary metastatic synovial sarcoma

Authors: Kentaro Miura, Kimihiro Shimizu, Takashi Eguchi, Sachie Koike, Shunichiro Matsuoka, Tetsu Takeda, Kazutoshi Hamanaka, Takeshi Uehara

Published in: Diagnostic Pathology | Issue 1/2021

Abstract

Background

The novel SS18-SSX fusion-specific antibody is reported to have high sensitivity and specificity for the diagnosis of primary synovial sarcoma (SS), which often metastasizes to the lung. Thus far, no study has validated the diagnostic efficacy of SS18-SSX antibody for pulmonary metastatic SS. Therefore, we aimed to investigate the usefulness of the SS18-SSX antibody in the diagnosis of pulmonary metastatic SS.

Methods

We evaluated the immunohistochemistry of SS18-SSX fusion-specific antibody (E9X9V) in 10 pulmonary metastatic SS cases and the corresponding five primary sites (four limbs and one mediastinum) in five patients, for whom SS was already diagnosed and confirmed by fluorescence in-situ hybridization in the metastatic and primary sites, and in 93 clinical and histologic mimics including 49 non-SS, pulmonary metastatic sarcomas, 39 primary lung cancers, and five intrathoracic solitary fibrotic tumors. All specimens were surgically resected at Shinshu University Hospital during 2001–2019. For primary and metastatic SS, we also evaluated SS18-SSX immunohistochemistry using needle biopsy and touch imprint cytology specimens from the primary site.

Results

SS18-SSX staining was diffusely-strongly positive in all 10 pulmonary metastatic SS cases and the corresponding five primary sites; whereas, it was negative in all 93 clinical and histologic mimics (100% sensitivity and 100% specificity). Further, SS18-SSX staining was also sufficiently positive in the biopsy and cytology specimens.

Conclusions

Immunohistochemistry of the SS18-SSX fusion-specific antibody is useful for the differential diagnosis of pulmonary metastatic SS in clinical practice. This simple and reliable method has the potential to replace traditional genomic tests. However, further studies are warranted in this regard.

Shi W, Indelicato DJ, Morris CG, Scarborough MT, Gibbs CP, Zlotecki RA. Long-term treatment outcomes for patients with synovial sarcoma: a 40-year experience at the University of Florida. Am J Clin Oncol. 2013;36(1):83–8. https://doi.org/10.1097/COC.0b013e31823fe450.CrossRefPubMed

Sultan I, Rodriguez-Galindo C, Saab R, Yasir S, Casanova M, Ferrari A. Comparing children and adults with synovial sarcoma in the surveillance, epidemiology, and end results program, 1983 to 2005: an analysis of 1268 patients. Cancer. 2009;115(15):3537–47. https://doi.org/10.1002/cncr.24424.CrossRefPubMed

Thway K, Fisher C. Synovial sarcoma: defining features and diagnostic evolution. Ann Diagn Pathol. 2014;18(6):369–80. https://doi.org/10.1016/j.anndiagpath.2014.09.002.CrossRefPubMed

Baranov E, McBride MJ, Bellizzi AM, Ligon AH, Fletcher CDM, Kadoch C, et al. A novel SS18-SSX fusion-specific antibody for the diagnosis of synovial sarcoma. Am J Surg Pathol. 2020;44(7):922–33. https://doi.org/10.1097/PAS.0000000000001447.CrossRefPubMed

Bergh P, Meis-Kindblom JM, Gherlinzoni F, Berlin O, Bacchini P, Bertoni F, et al. Synovial sarcoma: identification of low and high risk groups. Cancer. 1999;85(12):2596–607. https://doi.org/10.1002/(SICI)1097-0142(19990615)85:12<2596::AID-CNCR16>3.0.CO;2-K.CrossRefPubMed

Stanelle EJ, Christison-Lagay ER, Wolden SL, Meyers PA, La Quaglia MP. Pulmonary metastasectomy in pediatric/adolescent patients with synovial sarcoma: an institutional review. J Pediatr Surg. 2013;48(4):757–63. https://doi.org/10.1016/j.jpedsurg.2012.09.042.CrossRefPubMed

Predina JD, Puc MM, Bergey MR, Sonnad SS, Kucharczuk JC, Staddon A, et al. Improved survival after pulmonary metastasectomy for soft tissue sarcoma. J Thorac Oncol. 2011;6(5):913–9. https://doi.org/10.1097/JTO.0b013e3182106f5c.CrossRefPubMed

Spillane AJ, A'Hern R, Judson IR, Fisher C, Thomas JM. Synovial sarcoma: a clinicopathologic, staging, and prognostic assessment. J Clin Oncol. 2000;18(22):3794–803. https://doi.org/10.1200/JCO.2000.18.22.3794.CrossRefPubMed

Lee K, Kang MC, Lee HW, Park JH, Baek HJ, Cho SJ, et al. Pulmonary metastasectomy in adult patients with synovial sarcoma: a single-center experience. Korean J Thorac Cardiovasc Surg. 2016;49(6):451–5. https://doi.org/10.5090/kjtcs.2016.49.6.451.CrossRefPubMedPubMedCentral

10.

Yamamoto Y, Kanzaki R, Kanou T, Ose N, Funaki S, Shintani Y, et al. Long-term outcomes and prognostic factors of pulmonary metastasectomy for osteosarcoma and soft tissue sarcoma. Int J Clin Oncol. 2019;24(7):863–70. https://doi.org/10.1007/s10147-019-01422-0.CrossRefPubMed

11.

dos Santos NR, de Bruijn DR, van Kessel AG. Molecular mechanisms underlying human synovial sarcoma development. Genes Chromosom Cancer. 2001;30(1):1–14. https://doi.org/10.1002/1098-2264(2000)9999:9999<::AID-GCC1056>3.0.CO;2-G.CrossRefPubMed

12.

Ladanyi M, Antonescu CR, Leung DH, Woodruff JM, Kawai A, Healey JH, et al. Impact of SYT-SSX fusion type on the clinical behavior of synovial sarcoma: a multi-institutional retrospective study of 243 patients. Cancer Res. 2002;62(1):135–40.PubMed

13.

Zaborowski M, Vargas AC, Pulvers J, Clarkson A, de Guzman D, Sioson L, et al. When used together SS18-SSX fusion-specific and SSX C-terminus immunohistochemistry are highly specific and sensitive for the diagnosis of synovial sarcoma and can replace FISH or molecular testing in most cases. Histopathology. 2020;77(4):588–600. https://doi.org/10.1111/his.14190.CrossRefPubMed

14.

Miettinen M, Limon J, Niezabitowski A, Lasota J. Calretinin and other mesothelioma markers in synovial sarcoma: analysis of antigenic similarities and differences with malignant mesothelioma. Am J Surg Pathol. 2001;25(5):610–7. https://doi.org/10.1097/00000478-200105000-00007.CrossRefPubMed

15.

Kosemehmetoglu K, Vrana JA, Folpe AL. TLE1 expression is not specific for synovial sarcoma: a whole section study of 163 soft tissue and bone neoplasms. Mod Pathol. 2009;22(7):872–8. https://doi.org/10.1038/modpathol.2009.47.CrossRefPubMed

16.

Ten Heuvel SE, Hoekstra HJ, Suurmeijer AJ. Diagnostic accuracy of FISH and RT-PCR in 50 routinely processed synovial sarcomas. Appl Immunohistochem Mol Morphol. 2008;16(3):246–50. https://doi.org/10.1097/PAI.0b013e31815349f5.CrossRefPubMed

17.

Vargas AC, Selinger C, Satgunaseelan L, Cooper WA, Gupta R, Stalley P, et al. FISH analysis of selected soft tissue tumors: diagnostic experience in a tertiary center. Asia Pac J Clin Oncol. 2019;15(1):38–47. https://doi.org/10.1111/ajco.12980.CrossRefPubMed

18.

Jagdis A, Rubin BP, Tubbs RR, Pacheco M, Nielsen TO. Prospective evaluation of TLE1 as a diagnostic immunohistochemical marker in synovial sarcoma. Am J Surg Pathol. 2009;33(12):1743–51. https://doi.org/10.1097/PAS.0b013e3181b7ed36.CrossRefPubMed

19.

Valente AL, Tull J, Zhang S. Specificity of TLE1 expression in unclassified high-grade sarcomas for the diagnosis of synovial sarcoma. Appl Immunohistochem Mol Morphol. 2013;21(5):408–13. https://doi.org/10.1097/PAI.0b013e318279f9ee.CrossRefPubMed

20.

Foo WC, Cruise MW, Wick MR, Hornick JL. Immunohistochemical staining for TLE1 distinguishes synovial sarcoma from histologic mimics. Am J Clin Pathol. 2011;135(6):839–44. https://doi.org/10.1309/AJCP45SSNAOPXYXU.CrossRefPubMed

21.

Matsuyama A, Hisaoka M, Iwasaki M, Iwashita M, Hisanaga S, Hashimoto H. TLE1 expression in malignant mesothelioma. Virchows Arch. 2010;457(5):577–83. https://doi.org/10.1007/s00428-010-0975-8.CrossRefPubMed

22.

Hartel PH, Fanburg-Smith JC, Frazier AA, Galvin JR, Lichy JH, Shilo K, et al. Primary pulmonary and mediastinal synovial sarcoma: a clinicopathologic study of 60 cases and comparison with five prior series. Mod Pathol. 2007;20(7):760–9. https://doi.org/10.1038/modpathol.3800795.CrossRefPubMed

23.

Tahara S, Kohara M, Honma K, Morii E. Detection of synovial sarcoma with an atypical fusion transcript by using SS18-SSX and SSX antibodies. Pathol Int. 2020;70(9):689–91. https://doi.org/10.1111/pin.12976.CrossRefPubMed

Title: Usefulness of SS18-SSX antibody as a diagnostic marker for pulmonary metastatic synovial sarcoma
Authors: Kentaro Miura
Kimihiro Shimizu
Takashi Eguchi
Sachie Koike
Shunichiro Matsuoka
Tetsu Takeda
Kazutoshi Hamanaka
Takeshi Uehara
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Lung Cancer
Fluorescence in Situ Hybridization
Metastasis
Lung Cancer
Soft Tissue Sarcoma
Sarcoma
Lung Cancer
Published in: Diagnostic Pathology / Issue 1/2021
Electronic ISSN: 1746-1596
DOI: https://doi.org/10.1186/s13000-021-01110-6

At a glance: The STEP trials

Springer Medicine

Usefulness of SS18-SSX antibody as a diagnostic marker for pulmonary metastatic synovial sarcoma

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Aurora-A kinase is differentially expressed in the nucleus and cytoplasm in normal Müllerian epithelium and benign, borderline and malignant serous ovarian neoplasms

Prognostic significance of the aberrant expression of neuroendocrine markers in melanomas

Accuracy of HPV E6/E7 mRNA examination using in situ hybridization in diagnosing cervical intraepithelial lesions

Metastases can occur in cirrhotic livers with patent portal veins

Clinicopathological significance of primitive phenotypes in early gastric cancer with differentiated histology

A case of Pseudomyxoma Peritonei of an unexpected origin