Synovial sarcoma of the head and neck is a rare, aggressive malignancy that requires careful pathological and molecular testing for accurate diagnosis, especially when symptoms do not align with initial imaging.
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Alerts clinicians to consider synovial sarcoma in aggressive neck masses mimicking schwannoma; leaves open optimal diagnostic and therapeutic strategies.
Synovial sarcomas (SS) are aggressive soft tissue malignancies that classically affect the lower extremities of young patients. They are particularly rare in the head/neck region, comprising <0.01% of all head and neck cancers, and portend a poor prognosis. A 30-year-old male presented with a 4–6 month history of a rapidly enlarging neck mass associated with dysphagia, dyspnea, dysphonia, and left vocal fold paralysis. Imaging was concerning for schwannoma vs paraganglioma, and initial pathology analysis was consistent with a neuroendocrine neoplasm. Repeat pathology/molecular analyses at a tertiary medical center suggested a diagnosis of sarcoma. The patient underwent surgical resection followed by chemo-radiation. Final pathology confirmed the diagnosis of synovial sarcoma. Although rare, synovial sarcoma of the head and neck is highly aggressive and should be quickly diagnosed using imaging, pathology, and molecular testing. Repeat pathology review at a tertiary center is indicated if symptoms do not fully align with imaging findings.
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Ye et al. (2021) studied this question.
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