Synovial sarcoma of the posterior neck : a case report and review of literature

Abstract

We recently experienced a case of synovial sarcoma in the posterior neck, which involved adjacent bony structures. Synovial sarcoma is rare, malignant soft tissue tumor that occur predominantly in the lower extremities. Wide surgical excision with involved tissue is the treatment of first choice, because most synovial sarcomas reveal aggressive features. We removed the tumor with involved bony structures and patient was given postoperative radiation therapy. Despite these treatment options, the patient died 1 year after surgery. We report this case with a review of the literature.

Keywords: Bony involvement; Posterior neck; Synovial sarcoma.

Fig. 1

A : Non-enhanced neck computed tomography (CT) scan shows a mass lesion with mixed density in the left paraspinal area. B : Neck CT scan in bone setting showed destruction of the spinous process and lamina of cervical vertebra.

Fig. 2

A : Cervical T2-weighted sagittal magnetic resonance (MR) image reveals mixed signal (mainly high signal intensity) in the lesion with an internal cystic component. B : Cervical T1-weighted sagittal enhanced MR image showing the heterogenous enhanced, well demarcated mass lesion in the posterior neck.

Fig. 3

In gross finding, the removed mass is well capsulated, soft, gray colored, and low vascular lesions. The upper part of the tumor consists of old hematoma.

Fig. 4

A : Microscopically, the tumor consists of spindle cell and epithelial cell components. B : On immunohistochemistry, the tumor isfocally stained by CK-7.

Fig. 5

A : Six months after surgery, a follow up MR image shows no recurrent lesion on the previous operation site. B : Follow up positron emission tomography (PET) scan reveals multiple lung metastasis.