Synovial sarcoma of the parapharyngeal space: CT and MRI

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.

Synovial sarcoma of the parapharyngeal space

Synovial sarcoma is a rare soft tissue sarcoma in the head and neck region and parapharyngeal space. A 21-year-old girl presented with a 6-month history of progressive right arm pain, neck mass and upper aerodigestive tract obstruction. On physical examination there was a large painless mass arising from the right-sided parapharyngeal space causing airway obstruction and with no cervical lymphadenopathy. Initial magnetic resonance imaging (MRI) revealed a large tumor in the right-sided parapharyngeal space. She underwent near total resection of the tumor. Pathologic report disclosed the diagnosis of synovial sarcoma. She then received postoperative adjuvant external radiotherapy to the primary site and a dose of 60 Gy was delivered. Less than 8 months after the completion of the treatment she developed widespread lung metastases. Herein we describe the clinical, radiological and pathological finding of the case.

Biphasic Synovial Sarcoma of the Posterior Pharyngeal Wall: A Case Report

Synovial sarcoma is not common in the head and neck region. Because its histopathologic features are many and varied, it is often misdiagnosed. We report a case of biphasic synovial sarcoma of the posterior pharyngeal wall, and we discuss the clinical and pathologic features of this case.

Imaging of benign and malignant soft tissue tumors of the neck

Soft tissue tumors of the neck are a heterogeneous group of neoplasms arising from adipose, muscular, and fibrous tissue. With the exception of lymphomas, they account for only a small fraction of neck masses. Nevertheless, accurate diagnosis is important since the behavior of these neoplasms differs markedly from each other and from other head and neck masses. Noninvasive imaging, usually with CT and MR imaging, plays an important role in diagnostic evaluation and treatment planning for these tumors. In some cases, imaging features may be suggestive of a single entity. In most cases, imaging is needed to assess the location and extent of the tumor prior to biopsy or excision. This article discusses imaging techniques used for such assessment, the imaging features that help to separate these neoplasms from other head and neck tumors, and the behavior and imaging features of each of the more common benign and malignant soft tissue tumors that occur in the neck.