Anterior buccal mucosal mass

Synovial Sarcoma of the Submaxillary Salivary Gland: A Rare Location and Challenging Diagnosis

Synovial sarcoma is a high-grade sarcoma. The periarticular region, deep soft tissues, and the extremities are where it is most frequently found. The head and neck regions are rarely affected and salivary gland localization is rather rare, especially the submaxillary gland. The process of diagnosis and therapeutic management remains challenging, particularly in cases with uncommon tumor locations where the establishment of a universal therapeutic consensus is complicated. Early diagnosis and a multidisciplinary approach can lead to success without locoregional recurrence or distant metastases.

Biphasic synovial sarcoma in mandibular region

The term synovioma was coined by Smith in 1927, and later in 1936 Knox suggested the name synovial sarcoma. It occurs primarily in the paraarticular regions, usually in close association with tendon sheaths, bursae, and joint capsules. On rare occasions it may be seen in areas without any apparent relationship to synovial structures as in parapharyngeal region or the abdominal cavity. The first description of synovial sarcoma in the head and neck region was by Pack and Ariel in 1950. The majority of these tumors seem to take origin from paravertebral connective tissue spaces and manifest as solitary retropharyngeal or parapharyngeal masses near the carotid bifurcation. Synovial sarcoma has been reported in soft palate, tongue, maxillofacial region, angle of mandible, sternoclavicular region, scapular region, and the esophagus. We report a case of 28-year-old male patient with synovial sarcoma in mandibular region with biphasic pattern.

Synovial Sarcoma of the Tongue Confirmed by Molecular Detection of the SYT-SSX2 Fusion Gene Transcript

Involvement of the tongue by a synovial sarcoma (SS) is an extremely rare event; there have only been 13 cases previously reported. The authors present herein a case of monophasic SS arising in the tongue in a 32-year-old woman. The neoplasm expressed cytokeratins AE1-3, OSCAR, and EMA as well as Bcl-2 and TLE1. Molecular analysis indicated that the patient tested positive for the SYT/SS2 fusion transcript.

Primary cervical tracheal monophasic synovial sarcoma confirmed by SYT–SSX gene rearrangement

Objective:

To review the existing diagnostic modalities and treatment for primary tracheal synovial sarcoma, and to report a case of primary cervical synovial sarcoma arising in the trachea.

Design:

Retrospective.

Setting:

Head and neck surgery unit at a tertiary university centre.

Patient:

One case of primary cervical tracheal monophasic synovial sarcoma diagnosed by SYT–SSX gene rearrangement.

Intervention:

This patient underwent surgical resection of the synovial sarcoma, together with tracheal resection and primary anastomosis assisted by laryngeal-releasing manoeuvres, without complication.

Main outcome measures:

Clinical, radiographical, pathological and surgical information were collected.

Result:

One year post-operatively, there was no evidence of recurrence.

Conclusion:

Synovial sarcoma arising in the trachea is very rare. Diagnosis is confirmed by demonstrating the SYT–SSX gene rearrangement. The first-line treatment is surgery.