Primary synovial sarcoma is an unusual tumor of the head and neck. Fewer than 75 cases have been reported in the literature. We have treated 7 additional cases; 3 in the hypopharynx, 2 in the parapharyngeal space, 1 in the oral pharynx and 1 in the posterior triangle of the neck. An enlarging cervical mass, voice change, and dysphagia were among the presenting complaints. CT revealed solitary nonhomogenous tumors from 3 to 7 cm in diameter. Microscopically, all cases showed a biphasic cellular pattern verified by immunohistochemical staining. Multimodality treatment consisted of surgery and postoperative radiation therapy with 3 patients receiving chemotherapy. Although the original pathology report was incorrect in 3 cases, clinical suspicion for synovial sarcoma ensured proper diagnosis.

During 1978-1988, we treated 197 patients with thyroid carcinoma. Twenty-seven patients (14.0%) presented with a regional cervical mass and a clinically normal thyroid gland on initial evaluation. Excisional biopsy proved the diagnosis of metastatic thyroid carcinoma in every patient. Subsequent thyroid scans were 42% sensitive. Only 3 patients underwent fine-needle aspirations; none showed evidence of malignant cells. Review of surgical specimens showed total involvement of the gland in 13 of 17 cases, with extracapsular spread of tumor in 3 patients. Multicentric disease was present in all but 2 neck specimens. Patient follow-up from 1 month to 10 years revealed an 11.5% recurrence rate. The results in this group of patients is compared to the larger group of thyroid carcinoma patients, where three recurrences were found in 170 patients presenting with a clinically palpable mass in the thyroid gland. Analysis of our population comparing the subgroup with the larger series of thyroid carcinoma patients suggests that thyroid carcinoma presenting as a regional neck mass is a more aggressive disease.

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Mucoepidermoid carcinoma is a relatively common neoplasm of the major and minor salivary glands that can secondarily involve skin. In the vicinity of the ear lobe, mimicry of a benign cyst, both clinically and histopathologically is a diagnostic pitfall to avoid. The clinical manifestations, diagnostic histopathology, and clinical course of mucoepidermoid carcinoma of the parotid gland presenting as a clinically benign periauricular cystic nodule in four patients ranging in age from 11 to 63 years, are analyzed in the present report. Illustrating the challenge of accurate diagnosis, three of the four cases were initially misinterpreted on biopsy as benign cystic lesions. Multiple biopsies displayed foamy histiocytes around mucinous extravasations into dermis that mimicked ruptured epithelial cysts in two cases before malignancy was ascertained. This series demonstrates the need to include parotid tumor in the differential diagnosis of odd periauricular cyst-like expansions and adenosquamous proliferations. Mucoepidermoid carcinoma in particular can explain indolent, infra-auricular 'mucinous cysts'. Familiarity with this syndrome should arouse suspicion of parotid carcinoma when a 'cyst' or nodule is located near the earlobe. Delay in diagnosis results in larger surgical procedures than are otherwise necessary.