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Monophasic synovial sarcoma: a cytologic spectrum.

C Alexander Ewing¹, Maureen F Zakowski, Oscar Lin

¹Memorial Sloan-Kettering Cancer Center, Department of Pathology, New York, New York, USA. aewing@solarishs.org

Diagnostic Cytopathology

|December 30, 2003

Summary

Monophasic synovial sarcoma (MSS) can present with varied cytologic findings, not just spindle cells. Some MSS cases show cell types typically seen in biphasic synovial sarcoma, complicating diagnosis.

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Area of Science:

Oncology
Cytopathology
Surgical Pathology

Background:

Synovial sarcoma (SS) is a high-grade sarcoma.
Certain diagnosis of SS in cytology typically requires a biphasic pattern.
Monophasic SS (MSS) presents diagnostic challenges due to its uniform spindle cell population.

Purpose of the Study:

To evaluate the cytologic presentation of monophasic synovial sarcoma (MSS).
To identify the spectrum of cytologic findings in histologically confirmed MSS cases.

Main Methods:

Review of 21 fine-needle aspiration (FNA) specimens from patients with confirmed MSS.
Morphologic analysis of cellular characteristics, nuclear features, and growth patterns.

Main Results:

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Specimens showed scant granular cytoplasm, medium-sized nuclei, and coarse chromatin.
A monotonous spindle pattern with comma-shaped nuclei was observed in 5 cases.
Sixteen cases exhibited oval and spindled nuclei; 8 had round nuclei.
Five of these cases displayed prominent nucleoli and cohesive clusters, mimicking biphasic SS.

Conclusions:

Monophasic synovial sarcoma exhibits a diverse range of cytologic findings.
Cytologic evaluation of MSS should consider variations that may resemble biphasic SS.
Recognizing this spectrum aids in accurate MSS diagnosis in cytology.