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Biphasic Synovial Sarcoma With Neuroendocrine Differentiation: A Case Report.

Nicholas Phillipow¹, Brian Hong², Kaitlin Vanderbeck¹

¹Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada ; and.

The American Journal of Dermatopathology

|January 16, 2026

Summary

Synovial sarcoma can mimic carcinoma, posing diagnostic challenges. This case highlights a rare superficial biphasic synovial sarcoma with neuroendocrine features, emphasizing the need for molecular testing to confirm diagnosis.

Keywords:

gene fusion immunohistochemistry neuroendocrine pitfall synovial sarcoma

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Area of Science:

Oncology
Pathology
Dermatopathology

Background:

Synovial sarcoma is a soft tissue neoplasm that can be misdiagnosed as carcinoma.
Accurate diagnosis is challenging in small or superficial biopsies due to overlapping histological and immunohistochemical features.

Purpose of the Study:

To report a rare case of superficial biphasic synovial sarcoma with neuroendocrine differentiation.
To highlight a potential diagnostic pitfall in dermatopathology.
To emphasize the importance of molecular testing in diagnosing challenging soft tissue neoplasms.

Main Methods:

Histological and immunohistochemical examination of a superficial soft tissue biopsy.
Surgical resection and subsequent pathological analysis.
Molecular testing to detect specific genetic fusions (SS18::SSX).

Main Results:

A superficial biphasic synovial sarcoma with significant neuroendocrine differentiation was identified.
Initial biopsy was misinterpreted as poorly differentiated carcinoma due to cytokeratin and neuroendocrine marker expression.
Molecular testing confirmed the SS18::SSX fusion, establishing the diagnosis of synovial sarcoma.

Conclusions:

Superficial synovial sarcoma can exhibit neuroendocrine differentiation, mimicking carcinoma.
Diagnostic challenges necessitate careful pathological evaluation and confirmatory molecular testing.
Molecular analysis is crucial for definitive diagnosis when sarcoma and carcinoma are differential diagnoses.