Two cases of synovial sarcoma in the Adolescent and Young Adult （AYA） generation

Abstract

Functional preservation is an important issue in surgeries of head and neck malignancies in the adolescent and young adult (AYA) generation. We report two cases of primary synovial sarcoma of the head and neck in the AYA generation. Case 1: An 18-year-old man underwent computed tomography (CT) , which showed a 135-mm mass growing from the hypopharynx or posterior cricoid region. Preoperative biopsy revealed a malignant tumor. We considered total laryngectomy but performed hypopharyngeal tumor resection, bilateral neck dissection, and free jejunal reconstruction. The patient was diagnosed with synovial sarcoma due to permanent pathology, and adjuvant chemotherapy was administered. However, neck recurrence and pulmonary metastasis occurred, and he died of the disease three and a half years after the surgery. Case 2: A 15-year-old girl underwent CT, which showed a 95-mm mass in the right parapharyngeal space. Preoperative examination revealed a paraneuroma with adhesion to the right internal carotid artery.We performed tumor resection, and the right internal carotid artery was preserved. The patient was diagnosed with synovial sarcoma due to permanent pathology, and adjuvant chemotherapy was administered. However, local recurrence was found at the base of the skull, and bone metastasis and meningeal dissemination were observed. She died of the disease five and a half years after the surgery. The first choice for treatment of synovial sarcoma is surgery, but recurrence occurred in the present two cases, suggesting the need for a wider safety margin. It is difficult to select a surgical procedure for malignancies in the AYA generation; more cases need to be accumulated in the future.