Diagnostic Challenges in Poorly Differentiated Primary Synovial Sarcoma of the Breast

Diagnostic Challenges in Poorly Differentiated Primary Synovial Sarcoma of the Breast | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Diagnostic Challenges in Poorly Differentiated Primary Synovial Sarcoma of the Breast Burak Kankaya This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7417798/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Synovial sarcoma (SS) is a rare and aggressive soft tissue malignancy, typically occurring in the extremities, but extremely rare as a primary tumor of the breast. We present a case of a 53-year-old Nigerian female with a recurrent breast lesion previously misdiagnosed as metaplastic carcinoma. Imaging revealed a large, multifocal mass with aggressive features. Histopathologic and immunohistochemical evaluation following modified radical mastectomy supported a diagnosis of poorly differentiated synovial sarcoma. Due to the aggressive nature and rarity of this tumor in the breast, this case highlights the diagnostic challenges and importance of molecular and immunohistochemical studies. The patient was advised to pursue chemotherapy and radiotherapy but opted to continue treatment in her home country. Synovial Sarcoma Breast Neoplasm Poorly Differentiated Case Report Immunohistochemistry Figures Figure 1 Figure 2 Figure 3 Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 08 Dec, 2025 Reviews received at journal 20 Nov, 2025 Reviews received at journal 19 Nov, 2025 Reviewers agreed at journal 12 Nov, 2025 Reviewers agreed at journal 12 Nov, 2025 Reviews received at journal 03 Nov, 2025 Reviewers agreed at journal 03 Nov, 2025 Reviewers agreed at journal 31 Oct, 2025 Reviewers invited by journal 28 Oct, 2025 Editor invited by journal 16 Oct, 2025 Editor assigned by journal 15 Oct, 2025 Submission checks completed at journal 10 Oct, 2025 First submitted to journal 10 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7417798","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":539165428,"identity":"37d99201-2806-4851-a4d2-093dc1f5f45d","order_by":0,"name":"Burak Kankaya","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEUlEQVRIiWNgGAWjYBACAyBmbDjAwCAB4n0ActpADB5itTDOQNIiQZQWZh4Qh5AWc4nchx9nnLHLk2w/Y/jZpuawbJ90A+ODt20MdeYN2LVYzkg3ltxwI7lYmifHWDrn2GHjNpkDzIZz2xgkZA7gcNiNNAbJBx+YE+cx5BhI57AdTmyTSGCT5gVqweUyoBbmnw8+1CfO439j/NviH1gL+28CWtiADjucOFsix0yasQ1iCzM+LZY9z9gsZ5w5njhzxrMyy96+dOM2icRmyTnnJCRn4Aox9jTmmz3HqhNnnE/efOPHN2vZ+TOSD354U2bDjzOUEYADFEfNDNCoIUIDAwP7AyBRR4zKUTAKRsEoGGEAACDGXJwIwsM8AAAAAElFTkSuQmCC","orcid":"","institution":"Istanbul Aydin University","correspondingAuthor":true,"prefix":"","firstName":"Burak","middleName":"","lastName":"Kankaya","suffix":""}],"badges":[],"createdAt":"2025-08-20 13:08:37","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7417798/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7417798/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":95353857,"identity":"5db4fd63-d3d1-4bf8-b435-96da1d8278fd","added_by":"auto","created_at":"2025-11-07 06:00:16","extension":"png","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":228309,"visible":true,"origin":"","legend":"","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-7417798/v1/fb29ab9d5243897f0c5a40ce.png"},{"id":95353860,"identity":"adbbbe3d-f8bf-4baf-92e0-db21193b804f","added_by":"auto","created_at":"2025-11-07 06:00:16","extension":"png","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":1790099,"visible":true,"origin":"","legend":"","description":"","filename":"Fig3..png","url":"https://assets-eu.researchsquare.com/files/rs-7417798/v1/a5e6249044ec487bfcf29d17.png"},{"id":95353864,"identity":"915508f1-4ceb-4b5e-b7f0-14ec33d2ec92","added_by":"auto","created_at":"2025-11-07 06:00:17","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":400807,"visible":true,"origin":"","legend":"","description":"","filename":"revisedmanuscript3.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7417798/v1/38d571f702135274633b7719.pdf"},{"id":95353862,"identity":"89cf07ca-723e-4ccd-9ccf-1816b073de07","added_by":"auto","created_at":"2025-11-07 06:00:16","extension":"png","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":62003,"visible":true,"origin":"","legend":"","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-7417798/v1/d928b4b9225d4ae82947d204.png"},{"id":95525326,"identity":"9c2787ac-125b-44d9-b409-8d9ff274cda3","added_by":"auto","created_at":"2025-11-10 10:04:50","extension":"json","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":2652,"visible":true,"origin":"","legend":"","description":"","filename":"6a4a3b21fc4d42d6909c589ca56388de.json","url":"https://assets-eu.researchsquare.com/files/rs-7417798/v1/87482425e7a47dc8058d0de7.json"},{"id":95525151,"identity":"e7f6b3b5-c1e0-4044-929c-c9145dca9598","added_by":"auto","created_at":"2025-11-10 10:04:21","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":62003,"visible":true,"origin":"","legend":"\u003cp\u003eMRI imaging of the right breast shows multiple malignant mass lesions. The largest lesion measures approximately 6.5 cm, occupying the upper outer quadrant and extending to the mid-outer quadrant in a craniocaudal length of about 12 cm. The lesions exhibit heterogeneous contrast enhancement, cystic-necrotic components, and skin invasion signs, suggestive of a malignant phyllodes tumor.\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-7417798/v1/45bceb6854e8107f282a1a70.png"},{"id":95353859,"identity":"100ebe21-7d2f-450c-82c1-005624277a36","added_by":"auto","created_at":"2025-11-07 06:00:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":228309,"visible":true,"origin":"","legend":"\u003cp\u003ePET-CT scan demonstrates intensely FDG-avid masses in the right breast. The largest lesion measures 4.6 × 4.8 cm with peripheral SUVmax of 25.9. Increased FDG uptake is also seen in the skin and subcutaneous tissue (SUVmax: 1.7), indicating possible superficial invasion.\u003c/p\u003e","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-7417798/v1/b1fd5a3083a7b1bcb3ae04ca.png"},{"id":95524699,"identity":"7858531d-0eda-447a-bdcc-fa64fd276e6e","added_by":"auto","created_at":"2025-11-10 10:03:14","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1790099,"visible":true,"origin":"","legend":"\u003cp\u003eHistologic appearance of the tumor showing poorly differentiated synovial sarcoma (PDSS) under 10× magnification.The section demonstrates a densely cellular tumor composed of small round to oval cells with hyperchromatic nuclei and scant cytoplasm. Mitotic figures (green box) and areas of vascularization (orange box) are present. The cells form solid sheets with loss of normal architecture, supporting a diagnosis of poorly differentiated morphology. These findings are characteristic of PDSS, a high-grade variant with aggressive clinical behavior.\u003c/p\u003e","description":"","filename":"Fig3..png","url":"https://assets-eu.researchsquare.com/files/rs-7417798/v1/b3c25aad99564e0900b17977.png"},{"id":95653921,"identity":"08b5f728-fc90-4594-9be7-d309fa7e2a0c","added_by":"auto","created_at":"2025-11-11 16:06:02","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":438281,"visible":true,"origin":"","legend":"","description":"","filename":"revisedmanuscript3.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7417798/v1_covered_bfaf3180-5fce-40c4-bc25-8bcfd11ce248.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Diagnostic Challenges in Poorly Differentiated Primary Synovial Sarcoma of the Breast","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dion","sideBox":"Learn more about [Discover Oncology](https://www.springer.com/12672)","snPcode":"","submissionUrl":"","title":"Discover Oncology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Synovial Sarcoma, Breast Neoplasm, Poorly Differentiated, Case Report, Immunohistochemistry","lastPublishedDoi":"10.21203/rs.3.rs-7417798/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7417798/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Synovial sarcoma (SS) is a rare and aggressive soft tissue malignancy, typically occurring in the extremities, but extremely rare as a primary tumor of the breast. We present a case of a 53-year-old Nigerian female with a recurrent breast lesion previously misdiagnosed as metaplastic carcinoma. Imaging revealed a large, multifocal mass with aggressive features. Histopathologic and immunohistochemical evaluation following modified radical mastectomy supported a diagnosis of poorly differentiated synovial sarcoma. Due to the aggressive nature and rarity of this tumor in the breast, this case highlights the diagnostic challenges and importance of molecular and immunohistochemical studies. The patient was advised to pursue chemotherapy and radiotherapy but opted to continue treatment in her home country.","manuscriptTitle":"Diagnostic Challenges in Poorly Differentiated Primary Synovial Sarcoma of the Breast","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-07 06:00:12","doi":"10.21203/rs.3.rs-7417798/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-08T11:32:48+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-20T10:53:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-19T14:52:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"18853857970583513957260171281829285593","date":"2025-11-12T13:18:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"275135093796587732651838212387423861798","date":"2025-11-12T10:07:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-03T11:45:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"210172485526454495490355377942254588357","date":"2025-11-03T11:36:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"30138003212938842263452125131374538655","date":"2025-10-31T06:05:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-28T12:10:28+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-16T08:59:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-15T11:32:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-10T14:48:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Oncology","date":"2025-10-10T14:25:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-oncology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dion","sideBox":"Learn more about [Discover Oncology](https://www.springer.com/12672)","snPcode":"","submissionUrl":"","title":"Discover Oncology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d3d3eed2-56f6-437c-b95c-015156090cf9","owner":[],"postedDate":"November 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-06T08:40:01+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-07 06:00:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7417798","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7417798","identity":"rs-7417798","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}