I think that this is a metastatic synovial sarcoma. Because of the wrong diagnosis, the patient's lung nodule got resected and did NOT go for the appropriate chemotherapy. But, we need to respect other pathologist's opinion. It will be not responsible to just sign this case out without doing any further studies. So, I did two more immunostaines on the block:

1) CK19, which should be positive for synovial sarcoma; 2) TLE-1: we use that a lot for our soft tissue service to diagnose synvial sarcoma (Terry et al. TLE1 as a diagnostic marker for synovial sarcoma emerging from gene profile study. American Journal of Surgical pathology, 31:240-6, 2007): this stain should be nuclear staining. I also did FISH study on the cell block and it is POSITIVE for SYT gene.
Final diagnosis: metastatic synovial sarcoma.

Note: synovial sarcoma can be focally positive for Synaptophysin, when you do immunostains, be careful to interprete immunostains, your diagnosis should not be solely depend on 1 or 2 positive immunostains, it has to be correlate with morphology and clinical presentation.

re:FNA of lung mass 肺包块细针抽吸活检

I think that this is a metastatic synovial sarcoma.我认为本例为转移性滑膜肉瘤。 Because of the wrong diagnosis, the patient's lung nodule got resected and did NOT go for the appropriate chemotherapy.由于误诊，患者做了肺部包块切徐，并且没有做适当的化疗， But, we need to respect other pathologist's opinion. 但是，我们还是应该尊重其医生的意见。It will be not responsible to just sign this case out without doing any further studies.如果本例不做什么工作，直接发出这样的病理报告，是一种不负责任的行为。 So, I did two more immunostaines on the block:所发以我建议再做点免疫组化。

1) CK19, which should be positive for synovial sarcoma; 1) CK19滑膜肉瘤是阳性， 2) TLE-1: we use that a lot for our soft tissue service to diagnose synvial sarcoma (Terry et al. TLE1 as a diagnostic marker for synovial sarcoma emerging from gene profile study.     2) TLE-1:我们也常用于做为软组织肿瘤，也用于诊断滑膜肉瘤的诊断性标记（美国外科病理杂志） American Journal of Surgical pathology, 31:240-6, 2007): this stain should be nuclear staining. 这种染色是核着色。I also did FISH study on the cell block and it is POSITIVE for SYT gene. 我也用切片做了FISH研究，并且SYT gene基因也是阳性
Final diagnosis: metastatic synovial sarcoma.最后诊断：转移性滑膜肉瘤。

Note: synovial sarcoma can be focally positive for Synaptophysin, when you do immunostains, 注意：滑膜肉瘤免疫组化Synaptophysin阳性，be careful to interprete immunostains, your diagnosis should not be solely depend on 1 or 2 positive immunostains, it has to be correlate with morphology and clinical presentation.一定要认真的去解释免疫组化结果。你的诊断不应该单独依赖于1-2种阳性的免疫组化，必需使临床和形态密切联系。

 谢谢陈博士！

报神经内分泌癌信心不足，Syn(+),而CgA（—），（CgA在类癌中表达率>80%，在小细胞神经内分泌癌中仅达32%，吴秉铨，刘彦仿.免疫组织化学病理诊断.北京科学技术出版社.2007.10.472），需加做NCAM。

梭形细胞滑膜肉瘤：常 AE1/AE3 不连续表达，EMA常表达，CEA阴性，CD99可阳性，Bcl-2 强阳性。

如果我发报告我还是发转移性滑膜肉瘤。用一个诊断比二个诊断合适。

OK. I got the outside slides (2001) from this patient's previous soft tissue mass, it is synovial sarcoma. The pictures are shown here. The outside pathologist called this lung mass "neuroendocrine carcinoma, favor atypical carcinoid tumor". They did immunohistochemistry on the current lung nodule (I did not get the IHX slides), it is positive for cytokeratin AE1/AE3 and synaptophisin. the tumor cells are negative for Chromogranin.

Is this metastatic synovial sarcoma or a second primary lung neuroendocrine tumor? What extra-immuno or test you would do to support your diagnosis? or you are so confident that you just want to sign out this case. I ordered some extra tests and will keep you posted tomorrow. 

 前三张细胞图片：细胞小圆形或短梭形，胞浆少，淡红，可见核仁。

组织图示：短梭形细胞，不规则或略成束状排列，易见核分裂。

从细胞图考虑：1、尤文氏肉瘤？2、PNET?3、未分化癌？4、小细胞癌？因肺中多发，考虑转移可能新大。

病史结合细胞块图，考虑1、尤文氏肉瘤？2、梭形细胞肉瘤？3、未分化癌？4、PNET？

呵呵，太多要考虑了，期待更多讨论。。。

低鳞

 我考虑：

1、肺小细胞癌。

2、转移性尤文氏肉瘤。

3、恶性黑色素瘤。