2022 Volume 61 Issue 4 Pages 648-655
Synovial sarcoma (SS) is a relatively rare malignant tumor of the soft tissue. The most common site of occurrence is the extremities, whereas SS rarely occurs in the head and neck region. We report the case of a 69-year-old woman who presented with a chief complaint of left epistaxis. A vascular tumor was diagnosed based on gross appearance and imaging findings. Endoscopic sinus surgery was performed and the tumor was resected en bloc. SS was suspected based on histopathological findings and immunohistochemical staining. Fluorescence in situ hybridization (FISH) indicated the presence of the SYT fusion gene, which is specifically expressed in SS, and thus, SS was the final diagnosis. There are no specific CT and MRI findings for SS, and it is difficult to diagnose the tumor based on cytology or angiography. However, immunohistochemistry and genetic tests are useful for diagnosis of SS. Surgical resection is the first choice for treatment of SS and it is important to resect the tumor with a safety margin. However, in the head and neck region, surgical resection with a safety margin cannot always be performed, and multimodal therapy with chemotherapy and radiotherapy may be required. In our case, postoperative radiotherapy resulted in local control, and there has been no evidence of recurrence in follow up for 28 months after surgery.
