Synovial sarcoma of the cervical area

Synovial sarcoma is a malignant tumor which usually arises from the extremities. Involvement of the cervical area has been quite rare and to date only 12 cases have been reported. Two additional cases are reported in this paper and their management discussed. Case 1 is a 32‐year‐old white female with a submucosal mass of the right retromolar area displacing the tonsillar fossa and soft palate anteriorly. Surgical exploration revealed a well encapsulated mass separate from the parotid gland. Surgical excision was carried out on August 30, 1972. Pathological report was a synovial sarcoma. There has been no recurrence to date. Case 2 is a 34‐year‐old male with a 4 to 5 centimeter submandibular mass. Sialography and carotid arteriography were non‐contributory. Biopsy showed synovial sarcoma. On May 12, 1973, surgical excision of the mass was carried out with the ipsilateral attached greater corneal of the hyoid bone and right hypoglossal nerve which ran into the tumor. Postoperative X‐ray therapy was given. There is no recurrence to date. Discussion: Synovial sarcoma represents a type of mesenchymal tumor whose differention can mimic non‐neoplastic synovial membrane. Histologically the tumor contains two neoplastic cell types. These are described as the fibrosarcomatous element and the synovial element. The tumor usually has no true capsule and grows by expansion with adherance to surrounding structures. The rate of growth is slow but the long term prognosis is poor. Metastasis usually occurs via blood stream most commonly to the lungs. Regional lymph node metastasis occurs in areas outside of the head and neck but has not been recorded in synovial sarcoma of the head and neck to date. Surgical excision is agreed to be the mode of treatment. The value of X‐ray therapy is uncertain but Pack and Ariel were able to show their best results with a combination of surgical resection followed by postoperative X‐ray therapy. It has been suggested that synovial sarcoma of the head and neck may behave in a more benign manner than synovial sarcoma elsewhere. Long term follow‐up is not available in enough of the cervical sarcoma cases to determine if this is true. Until a more benign behavior is proven the tumor should be treated as an aggressive malignancy. Wide surgical excision is the treatment of choice. Postoperative X‐ray therapy should be considered.