Vesoulis Zissis, Rahmeh Tarek, Nelson Rick, Clarke Raymond, Lu You, Dankoff Joseph
Department of Pathology, Summa Health System, 525 East Market Street, Akron, Ohio 44304, USA.
Acta Cytol. 2003 Jul-Aug;47(4):668-72. doi: 10.1159/000326586.
Primary renal synovial sarcoma is a relatively recently described and characterized neoplasm, formerly designated embryonal sarcoma of the kidney, and has not been diagnosed before by fine needle aspiration biopsy cytology. We describe the cytologic features of a malignant biphasic neoplasm of the kidney that was subsequently diagnosed at nephrectomy and confirmed with molecular genetic analysis as a biphasic renal synovial sarcoma.
A 38-year-old male presented with acute abdominal pain. Computed tomography (CT) demonstrated a 4.7-cm mass in the left kidney. No soft tissue or extrarenal masses were identified. A CT-guided fine needle aspiration biopsy revealed a malignant biphasic tumor characterized by minimally atypical tubular epithelium, immature spindle cells and foci of coagulative tumor necrosis. At nephrectomy, a necrotic, pseudo-encapsulated synovial sarcoma of the upper pole of the left kidney was identified and was additionally evaluated with immunohistochemistry and molecular genetic studies. The case is unique since biphasic synovial sarcomas have yet to be reported to occur in the kidney and fine needle aspiration biopsy findings of this renal neoplasm have never been reported to our knowledge.
Synovial sarcoma should be a diagnostic consideration particularly in a young adult with a malignant spindle cell neoplasm of the kidney. The list of differential diagnoses should include sarcomatoid renal cell carcinoma, sarcomatoid transitional cell carcinoma of the renal pelvis, angiomyolipoma and monophasic or biphasic synovial sarcoma.
原发性肾滑膜肉瘤是一种相对较新描述和特征化的肿瘤，以前称为肾胚胎肉瘤，细针穿刺活检细胞学检查此前尚未诊断出该肿瘤。我们描述了一例肾脏恶性双相性肿瘤的细胞学特征，该肿瘤随后在肾切除术中被诊断，并经分子遗传学分析确认为双相性肾滑膜肉瘤。
一名38岁男性因急性腹痛就诊。计算机断层扫描（CT）显示左肾有一个4.7厘米的肿块。未发现软组织或肾外肿块。CT引导下细针穿刺活检显示为恶性双相性肿瘤，其特征为轻度非典型管状上皮、未成熟梭形细胞和凝固性肿瘤坏死灶。肾切除术中，在左肾上极发现一个坏死、假包膜的滑膜肉瘤，并进行了免疫组织化学和分子遗传学研究。该病例独特，因为双相性滑膜肉瘤尚未报道发生于肾脏，据我们所知，该肾肿瘤的细针穿刺活检结果也从未有过报道。
滑膜肉瘤应作为一种诊断考虑，特别是在患有肾脏恶性梭形细胞瘤的年轻成年人中。鉴别诊断应包括肉瘤样肾细胞癌、肾盂肉瘤样移行细胞癌、血管平滑肌脂肪瘤以及单相或双相性滑膜肉瘤。
