Synovial sarcoma of the head and neck masquerading as a vagal schwannoma

Abstract

Background: 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. Case description: 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. Conclusions: 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.

Keywords

• Synovial sarcoma
• Head and neck cancer
• Vagal schwannoma