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Primary orbital synovial sarcoma: A clinicopathologic review with a differential diagnosis and discussion of molecular genetics.

Abstract
Synovial sarcoma is a soft-tissue sarcoma of the extremities developing in young adults that has rarely been reported in the orbit. Synovial sarcoma is associated with a unique translocation, resulting in an SYT-SSX fusion gene. We analyze 7 published periocular cases, together with the current one, to gain a better appreciation of the features of the tumor in this location and to compare the findings with those derived from nonophthalmic studies. An inferior orbital mass developed in a 31-year-old woman after experiencing periorbital and hemifacial pain for more than a decade. Radiographically, the mass was circumscribed and displayed coarse internal calcifications. A large but subtotal excision with histopathologic examination disclosed a primitive tumor composed of spindled and ovoid cells. Immunohistochemistry demonstrated positivity for nuclear transducin-like enhancer of split 1 and membranous CD99, typical for synovial sarcoma. Fluorescence in situ hybridization identified a (X,18) translocation in the tumor cells. The patient underwent postoperative adjuvant proton beam radiotherapy with a good response that has been maintained during 1 year of follow-up. Orbital soft-tissue tumors of all types are increasingly identified by their distinctive genetic signatures that offer more specificity than standard immunohistochemical tests.
AuthorsAnna M Stagner, Frederick A Jakobiec, Aaron Fay
JournalSurvey of ophthalmology (Surv Ophthalmol) 2017 Mar - Apr Vol. 62 Issue 2 Pg. 227-236 ISSN: 1879-3304 [Electronic] United States
PMID27697479 (Publication Type: Case Reports, Journal Article, Review)
CopyrightCopyright © 2016 Elsevier Inc. All rights reserved.
Chemical References
  • Biomarkers, Tumor
  • Oncogene Proteins, Fusion
  • SYT-SSX fusion protein
Topics
  • Adult
  • Biomarkers, Tumor (genetics, metabolism)
  • Biopsy
  • Diagnosis, Differential
  • Female
  • Humans
  • Molecular Biology (methods)
  • Oncogene Proteins, Fusion (genetics, metabolism)
  • Orbital Neoplasms (diagnosis, genetics)
  • Sarcoma, Synovial (diagnosis, genetics)
  • Tomography, X-Ray Computed

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