Nasal spindle cell sarcoma

BACKGROUND: Synovial sarcoma is a mesenchymal high grade tumor. It is found in soft tissue mostly lower extremities. It is rarely found in the head and neck area with paraspinal neck accounting for the most common location. In rare occasions, it can be found in nasal cavity. CASE PRESENTATION: A 46-year-old female patient presented with recurrent epistaxis for 7 months. A 0-degree rigid scope examination revealed a left nasal cavity mass. A non-contrasted CT scan of the paranasal sinus showed heterogeneous and hypodense lesion in the left nasal cavity. Functional endoscopic sinus surgery was performed and multiple nasal-mass biopsies were taken which showed high grade spindle cell sarcoma favoring synovial type. Further workup and management were done from MRI, cranial tumor resection with skull base reconstruction to adjuvant radiotherapy. Patient has regular follow up with involved specialties and thus far is doing well. CONCLUSION: Spindle cell synovial sarcoma is a rare lesion found in soft tissue. It is unusual to be found in nasal cavity. Thus crucial attention to the clinical, radiographical and histopathological manifestation should be taken for more accurate diagnosis and further appropriate management.