title: Clear cell sarcoma of the kidney distinguished from synovial sarcoma using genetic analysis: a case report.
abstract: BACKGROUND
  The most common pediatric renal neoplasm is Wilms tumor, but clear cell sarcoma of the kidney or synovial sarcoma of the kidney are also sometimes encountered. Accurate pathological diagnosis is important, because adjuvant therapies including chemotherapy and radiotherapy differ according to the pathological type.
  
  
  METHODS
  A 9-year-old boy presented with a headache, and ultrasonography, computed tomography, and magnetic resonance imaging revealed a heterogeneous enhancement of soft tissue originating from the upper pole of the left kidney, measuring approximately 11.0 × 10.0 × 8.0 cm. A left radical nephrectomy was performed using an intraperitoneal approach through an anterior subcostal incision. Pathological examination suggested clear cell sarcoma of the kidney or synovial sarcoma of the kidney based on morphological and immunohistological features. Using genetic analysis, a final diagnosis of spindle cell pattern clear cell sarcoma of the kidney was made based on the absence of the SYT-SSX fusion gene. After adjuvant chemo-radiotherapy was administered, no recurrence or metastasis has been identified as of 60 months postoperatively.
  
  
  CONCLUSIONS
  In this case, it was difficult to discriminate clear cell sarcoma of the kidney from synovial sarcoma of the kidney based on histopathological examination alone, and genetic analysis was required. Accurate pathological diagnosis of pediatric renal tumor is important for determining optimal treatment and preventing recurrence and metastasis.
authors.affiliation: Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Aichi, Japan. hirose_masahito@yahoo.co.jp.
authors.forename: Masahito
authors.initials: M
authors.lastname: Hirose
authors.affiliation: Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Aichi, Japan. kmizuno@med.nagoya-cu.ac.jp.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Mizuno
authors.affiliation: Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Aichi, Japan. camyuro@yahoo.co.jp.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kamisawa
authors.affiliation: Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Aichi, Japan. hnishio@med.nagoya-cu.ac.jp.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Nishio
authors.affiliation: Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Aichi, Japan. moriji@anat2.med.kyoto-u.ac.jp.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Moritoki
authors.affiliation: Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Aichi, Japan. urokk@med.nagoya-cu.ac.jp.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Kohri
authors.affiliation: Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Aichi, Japan. yutaro@med.nagoya-cu.ac.jp.
authors.forename: Yutaro
authors.initials: Y
authors.lastname: Hayashi
mesh_terms: D002648:Child; D003937:Diagnosis, Differential; D005820:Genetic Testing; D006801:Humans; D007150:Immunohistochemistry; D007668:Kidney / Q000378:metabolism / Q000473:pathology / Q000601:surgery; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000601:surgery; D008297:Male; D009392:Nephrectomy; D015514:Oncogene Proteins, Fusion / Q000172:deficiency* / Q000235:genetics; D016133:Polymerase Chain Reaction; D018227:Sarcoma, Clear Cell / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000601:surgery; D013584:Sarcoma, Synovial / Q000175:diagnosis* / Q000235:genetics / Q000473:pathology / Q000601:surgery
chemical_list: D015514:Oncogene Proteins, Fusion; C116512:SYT-SSX fusion protein