Synovial Sarcoma of the Oropharynx

Oropharyngeal synovial sarcoma is a rare and aggressive soft tissue malignancy, warranting a comprehensive diagnostic approach involving clinical presentation, imaging, histological confirmation with molecular testing. Wide surgical excision with radiotherapy is the recommended treatment of choice, which is difficult to attain in this region due to close proximity to neurovascular structures. SS (Synovial Sarcoma) is a rare malignant tumour of young adults typically arising in the deep soft tissues of the extremities, most commonly, the lower thigh-knee region. The occurrence of this tumour in unusual sites, distant from synovium-lined spaces, particularly, the abdominal wall[1] and head and neck region[2] has been highlighted in the literature, as case reports. The hypo-pharynx is the most common site of HNSS (Head and Neck Synovial Sarcoma).[3] Oropharyngeal SS is extremely rare, and the subsite such as the tonsillo-lingual sulcus has not been reported in the literature yet.[4] The correct diagnosis, planning for surgery, and supportive therapies for synovial sarcoma at the oropharynx threatening the airway are always a challenge. Here we report a case of a female in her 4th decade, presenting with a mass obstructing the supra-glottic airway mimicking a vallecular cyst, which was finally diagnosed as a primary SS and treated with functional preservation. We report a 40-year-old female with an oropharyngeal mass, mimicking a vallecular cyst, compromising the supraglottic airway and comprehensively diagnosed as synovial sarcoma. Treated by transoral excision with neoadjuvant radiotherapy which helped in functional preservation. At the five-year follow-up, the patient was disease-free.