A Case of Synovial Sarcoma of the Maxillary Sinus

Abstract

Synovial sarcoma is a malignant soft-tissue tumor that arises predominantly in the limbs in young adults, and rarely originates in the paranasal sinuses. Herein, we report a case of synovial sarcoma of the maxillary sinus seen at our department. A 31-year-old man was referred to our department with a neoplastic lesion in the left nasal cavity. Since histological examination could not confirm the diagnosis, endoscopic-assisted maxillary tumor resection was performed, in addition to gingival incision. Postoperative histopathological examination confirmed the diagnosis of synovial sarcoma. Since the resected margin in the infraorbital wall was microscopically positive for tumor cells, we administered radiation therapy and chemotherapy to preserve the eyeball and facial morphology. One year and 3 months after the initial surgery, the patient was diagnosed as having a tumor recurrence, and we performed total left maxillary resection, left upper neck dissection, and reconstruction with an anterolateral thigh flap. Subsequently, due to repeated tumor recurrences, the patient needed CyberKnife palliative irradiation and chemotherapy, but the regional invasion worsened, and the patient died 2 years and 7 months after the initial surgery. Primary synovial sarcoma of the paranasal sinuses is a very rare disease, and radical surgical resection with multidisciplinary involvement, including of doctors of the departments of oncology, orthopedic surgery, and radiology, is necessary. Further case reports are needed to establish evidence for treatment.