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Background: Synovial sarcoma is a translocation-associated mesenchymal neoplasm that represents around 10% of all soft tissue sarcomas. Diagnosing biphasic synovial sarcoma is generally straight forward, owing to distinctive histologic features. Transducer-like enhancer of split 1 (TLE1) is overexpressed in synovial sarcomas. Study aimed to evaluate sensitivity and specificity of TLE1 immunohistochemical expression in synovial sarcoma and its histological mimics. Methods: Conventional sections from 30 cases of synovial sarcoma, 24 cases of monophasic synovial sarcoma mimics and 6 cases of poorly differentiated sarcoma mimics were subjected to TLE1 IHC staining. TLE1 immunostaining was graded from 0, 1+, 2+, 3+, with 2+ or 3+ grades interpreted as positive staining. Results: Of the 60 tumours, majority are monophasic spindle cell type (56.6%), followed by biphasic (16.6%), monophasic epithelial (6.6%), poorly differentiated (13.3%) and calcifying type (6.6%). Upon expression of TLE1 in tumors, 20 cases showed Grade 3, 8 cases shown Grade 2, 2 cases shown Grade 1 TLE1 Expression in Synovial sarcoma. 2 cases shown Grade 3 and 2 cases shown Grade 2 TLE1 expression in Schwannoma. Whereas 1case shown grade 2 in Rhabdomyosarcoma. 1case shown grade 2 in Hemangiopericytoma. TLE1 sensitivity for diagnosis of synovial sarcomas was 93.3%, and specificity of 73.3% with positive predictive value of 77.77% and negative predictive value of 91.6%. Conclusion: Specificity can be increased with optimal IHC panel which includes BCL2, Pan Cytokeratin, EMA, CD99 and CD34. Molecular confirmation is the diagnostic gold standard for synovial sarcoma, TLE1, in view of its high sensitivity may be a useful marker within the optimal IHC panel for substantiating a diagnosis of synovial sarcoma. Awareness of TLE1 expression in other tumours and its correct interpretation are necessary.

Tissue Microarray Based Immunohistochemical study of TLE1 in Synovial Sarcoma and its Histologic Mimics