Synovial sarcoma of the pharynx causing airway obstruction

Synovial Sarcoma of Cheek: A Rare Case Report with Review of Literature

Synovial sarcomas are a rare entity in the head and neck region. We present a rare case of a 50 year old female presenting with a painless mass over right cheek since one year which gradually increased in size since past two months. Imaging was done which revealed a mass lesion in soft tissue of right cheek deep to the masseter muscle with no obvious involvement of the adjacent part of maxilla and mandible. Local wide excision of tumor was done. Histopathological examination revealed a malignant mesenchymal tumour. Further the specimen was subjected to immunohistochemical marker studies and diagnosis of high grade spindle cell sarcoma possibly synovial sarcoma was given. Patient then received Image guided radiation therapy and along with platinum based chemotherapy. Patient tolerated the treatment well. Patient was followed up for one year after completion of treatment and no recurrence was observed.

Primary pharyngeal synovial sarcoma in a pediatric patient: A case report

RATIONALE

Synovial sarcoma is a rare malignant tumor that typically originates from the soft tissue of the extremities. The occurrence of primary pharyngeal synovial sarcoma is even rarer, and few studies have reported its radiological features. Here, we report a case of pediatric primary pharyngeal synovial sarcoma and describe the conventional and advanced magnetic resonance imaging (MRI) findings with pathologic correlation.

PATIENT CONCERNS

An 11-year-old girl presented to the otolaryngologic clinic with dysphagia.

DIAGNOSIS

Laryngoscopy revealed a large mass in the oropharynx. MRI revealed a well-defined soft tissue mass with a maximal diameter of approximately 5 cm originating from the submucosal space of the oropharynx. The mass was primarily solid and showed homogeneous contrast-enhancement. The mass was hypointense on T1-weighted images and hyperintense on T2-weighted images. The mass showed a homogeneously low apparent diffusion coefficient value on diffusion-weighted imaging, which indicated high tumor cellularity. Dynamic contrast-enhanced MRI revealed a hypovascular tumor with low values of the volume transfer constant between the extracellular extravascular space and blood plasma and blood plasma volume per unit tissue volume. Amide proton transfer-weighted MRI revealed a relatively high amide proton transfer signal in the tumor, indicating a high protein/peptide component. The patient underwent partial surgical resection of the tumor, and the diagnosis of biphasic synovial sarcoma was confirmed on postoperative pathological examination.

INTERVENTION

The patient was started on chemotherapy with vincristine, ifosfamide, doxorubicin, and etoposide.

OUTCOMES

The tumor did not respond to the 3 cycles of the chemotherapy. Thus, the patient underwent second surgery and subsequent radiation therapy. The patient is now under ifosfamide/carboplatin/etoposide chemotherapy.

LESSON

Synovial sarcoma should be considered in the differential diagnosis of pediatric oropharyngeal submucosal tumors. Multimodal MRI may aid diagnosis, although the final diagnosis should be based on the postoperative pathological examination findings.

A Rare Case of Synovial Sarcoma Involving the Brachial Plexus, Treated with Wide Local Excision and Reconstructed with Sural Nerve Grafts

This is a case report of monophasic synovial sarcoma involving right brachial plexus. Clinical and radiological examination is not very useful in diagnosis. Histopathology showed spindle cells with occasional mitotic figures. Immunohistochemistry showed positivity for EMA, S-100, Mic-2, Bcl-2, Calponin, TLE-1 and CD-56. Chromosomal translocation t (X;18) (p11.2;q11.2) and chimeric fusion proteins SYT/SSX1 or SYT/SSX2 are formed. Wide local excision of the tumour with involved brachial plexus and later reconstruction of the brachial plexus using sural nerve grafts was done. Patient showed full recovery. Wide excision and radiotherapy is the accepted mode of treatment.

Synovial sarcoma in head and neck: a case report

Introduction Synovial sarcoma is a malignant tumor of mesenchymal pluripotent cells.

Objectives We present a case of synovial sarcoma in the posterolateral wall of the oropharynx.

Resumed report The patient, a 23-year-old woman, was admitted with a history of dysphagia and difficulty in breathing for 8 months, resulting in progressive deterioration and onset of snoring, muffled voice, and local pain. An oropharyngeal tumor in the left posterolateral wall touched the base of the ipsilateral tongue. The patient underwent endoscopic pharyngectomy to remove the lesion. Pathologic examination revealed synovial sarcoma with positive margins, and Mohs technique was proposed for margin control. The margins were disease-free, without the need for total laryngectomy. The pharynx was reconstructed with a microvascular forearm flap. The patient developed postoperative stability.

Conclusion Despite its name, synovial sarcoma is rarely sourced directly from synovial membranes. It is most commonly found in the vicinity of large joints. The location at the head and neck, a location poor in synovial tissue, is unusual. Synovial sarcoma in the head and neck has an aggressive nature and poor prognosis. Resection with negative margins remains the foundation of therapy, which is not so easily achieved in the head and neck. It is important for the otorhinolaryngologist and head and neck surgeon to be familiar with this aggressive tumor, which carries high mortality and morbidity. The appropriate diagnosis and treatment can improve prognosis and patient survival.

Laryngeal synovial sarcoma: a rare clinical entity

Introduction. Synovial sarcomas (SS) are aggressive malignant soft tissue tumours that are thought to arise from pluripotent mesenchymal cells. Clinical Report. A 20-year-old male presented with an acute onset of respiratory stridor. Computer tomography scanning confirmed a mass arising from the left supraglottic larynx and an emergency tracheostomy was performed. A diagnosis of biphasic synovial sarcoma was formed. A total laryngectomy and left hemithyroidectomy was performed in conjunction with a left modified radical neck dissection. The patient received adjuvant chemotherapy followed by a course of radiotherapy and remains alive and disease free at 18 months after treatment. Discussion. Prognosis for patients with SS is related to primary tumour extent, grade, and size. The presence of the diagnostic translocation, t(X;18), is being targeted and hopefully will lead to the development of new therapeutics (Guadagnolo et al., 2007). Conclusion. Laryngeal SS remains a rare and poorly understood entity. A multidisciplinary approach to treatment is essential and long-term followup is imperative.