SURGICAL PATHOLOGY CONSULT REPORT

Study Result

Narrative

FLAMM, ERIC S Age: 55 years 
Collected Date: 3/26/2021 08:50 PDT 
ADM Consult
CONSULT DIAGNOSIS
Left lung mass, biopsy (Mayo No. CR-21-19309):
- Metastatic synovial sarcoma.
ANCILLARY STUDIES
Immunohistochemistry for TLE1 shows nuclear expression in the spindled cells but not in glands.
Report electronically signed by: Andrew L. Folpe, M.D.
Mayo Clinic Laboratories, Department of Pathology
200 First Street SW, Rochester, MN 55905
04/06/2021 10:25 Mitchell R Ryan, MD
MTM/MRR (Electronic Signature)
.
.
Consult Comment
I have reviewed the slides representing a biopsy of a left lung mass from the above patient
with a history of a reportedly monophasic synovial sarcoma of the retropharynx and entirely agree with you that this specimen shows metastatic synovial sarcoma. It is somewhat difficult to say whether this represents a monophasic synovial sarcoma with a very exuberant proliferation of non-neoplastic epithelium or a biphasic synovial sarcoma. I would somewhat favor biphasic synovial sarcoma on morphologic grounds although TLE1 expression in biphasic synovial sarcomas is usually confined to the epithelium, in contrast to what is seen here. Ultimately, the distinction between monophasic and biphasic synovial sarcoma is really of no clinical concern, as there are no known differences in behavior or response to therapy in monophasic versus biphasic tumors or in synovial sarcomas having different fusion subtypes.
Thank you for sharing this case with me. If you have any questions, please do not hesitate to
reach me by calling Mayo Clinic Laboratories at 1-800-533-1710.
Material Received
A. SG-21-0001608: Left lung mass
1 stained slide, 1 block
1 CD
Surgical Pathology Report
DIAGNOSIS
Diagnosis After Microscopic Examination:
Left lung mass, needle core biopsy:
- Diagnosis PENDING outside consultation.
- See Comments.
03/29/2021 14:00 Mitchell R Ryan, MD
MJC/MRR (Electronic Signature)
.
.
Pathology processing and professional performed at Legacy Central Lab,
services
1225 NE Second Ave Portland, OR unless otherwise specified.
Cytology and HPV technical and professional performed at Legacy Central Lab,
services
1225 NE Second Ave Portland, OR unless otherwise specified.
FLAMM, ERIC S Age: 55 years MRN: 800048-83-73
Collected Date: 3/26/2021 08:50 PDT Case Number: SG-21-0001608
Comments
We understand this patient had a monophasic synovial sarcoma excised from the retropharynx in
2005 (surgical pathology case SE-05-2796). We also understand the patient had a noninvasive
high-grade, urothelial carcinoma of the bladder diagnosed in 2019 (surgical pathology case
SG-19-3978). The current biopsy shows a biphasic neoplasm with spindled and epithelioid
components, and extensive necrosis. The histology resembles biphasic synovial cell sarcoma.
Given the limited material present to work with, and that genetic studies may be required
for definitive diagnosis, material will be referred for expert consultative opinion, with the
consultant's diagnosis and findings to be reported in an addendum.
MR/mjc
Microscopic
Provision of Service: Professional Services Provided by Cascade Pathology Services, 24800 SE
Stark Street, Gresham, OR 97030.
Specimen
Left lung mass
Clinical Information
Lung mass. History of bladder cancer and sarcoma
Gross Description
Received in formalin labeled " Flamm, Eric" and "left lung mass" are multiple tan-gray to
tan-pink
needle core fragments ranging in size from less than 0.1 up to 0.6 cm in greatest
dimension.
TE1A,1B.
MDM/bb
Pathology processing and professional performed at Legacy Central Lab,
services
1225 NE Second Ave Portland, OR unless otherwise specified.
Cytology and HPV technical and professional performed at Legacy Central Lab,
services
1225 NE Second Ave Portland, OR unless otherwise specified.