Synovial sarcoma is a malignant mesenchymal neoplasm, most commonly occurring near the joints of the extremities. Its occurrence in the neck is less common. Surgical excision is the first choice of treatment, postoperative radiotherapy and chemotherapy are often required to reduce the risk of recurrence. The size of the malignancy is one of the indicators for prognosis, primary lesions of 5 cm or greater in diameter usually give rise to poorer outcomes [3] . Here, we report a case of massive recurrent synovial sarcoma in the neck which was successfully resected following embolization of the supplying arteries to the tumor.
Case reportA 25-year-old female was admitted to our hospital complaining of a gigantic mass in the left cervical area. The mass was recurring. A resection was performed on the mass 6 years ago in the local hospital and a subsequent recurrence was resected 4 years later. It recurred again last year, developed rapidly and was painful. Percutaneous needle biopsy revealed a synovial sarcoma. On admission, physical examination showed a 30 × 28 cm welldefined mass occupying the entire left cervical region. There were petechiae on the surface of the skin overlying the mass with a cutaneous ulceration in the center. Compression of the trachea and oesophagus caused both dyspnea and dysphagia (Fig. 1).Needle biopsy (gauge 20) was repeated to confirm the histological diagnosis of synovial cell sarcoma. No metastatic lesions were found in the lungs on radiological examination. Digital subtraction angiography (DSA) was performed on the left common carotid and subclavian arteries revealing the left external carotid and subclavian arteries as supplying vessels to the tumor. All supplying branches of those arteries were successfully embolized in order to shrink the tumor preoperatively (Fig. 2, 3). Subsequently the tumor was resected along with the left thyroid. The tumor, which measured 15 × 16 × 11 cm, had well-defined smooth margins adjacent to the trachea, oesophagus and the left recurrent laryngeal nerve. The left external carotid vein was invaded by the tumor, which was careful dissected. The left common carotid artery was wrapped in the tumor mass, which was peeled and preserved because the option to replace the artery was not available. As the result, the mass weighing 2.5 kg was completely resected (Fig. 4). The patient was discharged accordingly after recovery from the surgery. The inpatient time was 15 days, during which no sequelae were noticed. Pathological examination revealed biphasic morphology consisting of glandular structures and spindle cells (Fig. 5, 6) with no calcifications.
DiscussionSynovial sarcoma accounts for 5%-10% of all soft tissue sarcomas [7, 9] . More than 80% of cases occur in the extremities. The head and neck region is a rare (3%-9%) but a known location [2, 9] . This patient's age is typical for Abstract We report a rare case of massive recurrent synovial sarcoma of the neck in a 25-year-old woman. Physical examination showed a 30 × 28 cm well-defined subcutaneous mass ...
