Introduction: Synovial sarcoma represents a type of cancer derived from soft tissues; young males are more affected.
Material and methods: This is a case report of a male with a cervical mass confirmed as sarcoma. Later on the investigations lead to the discovery of a thyroid nodule challenging the differential diagnosis. We assessed thyroid ultrasound, computed tomography (CT) at the cervical, thorax, mediastinum and abdomen; TSH (Thyroid Stimulating Hormone), TPO antibodies (anti-thyreoperoxidase); pathological and immune-hysto-chemistry (IHC) reports.
Results: A 31-year patient accidentally discovered by self-palpation a right cervical mass which required investigations including CT. An oval, well shaped, encapsulated tumor of 4.7/3.5 cm (axial plane) was found with inhomogeneous structure (and some areas of necrosis) at the level of right lateral wall of oro-pharynx. Cranio-caudally, the mass was situated between cervical vertebras C2C6. The lesion was removed and a biphasic synovial sarcoma was confirmed: highly cellular structure with oval cells and reduced eosinophilic cytoplasm, small amorphic cysts, multiple vascular elements of hemangioperycitoma- like pattern, and an epithelial component with glandular elements. IHC revealed: positive VIM, TLE-1, EMA, MIC2 in tumor cells, negative SOX10, S100, positive ACT and CD34 reaction for vessels. After surgery, CT did not find any secondary lesions (neither local or at distance) except for a small thyroid nodule. The thyroid ultrasound identified a hypo-echoic, inhomogeneous nodule of 1.44/0.78 cm at inferior right lobe. Endocrine profile revealed: TSH=1.27 μUI/ml (N: 0.54.5 μUI/ml), TPO=10 UI/ml (N: 035 UI/ml), parathormon of 43.54 pg/ml (N: 1565 pg/ml). Neuroendocrine markers were: chromogranin A of 42 mg/ml (N: 20125 ng/ml), neuron specific enolase of 4.2 ng/ml (N: 012 ng/ml), circulating serotonin of 95.4 ng/ml (N: 40400 ng/ml), calcitonin of 1 ng/ml (111.8 ng/ml). Fine needle aspiration pointed benign features. Close follow-up is recommended knowing the general oncologic and particular thyroid context.
Conclusion: Biphasic synovial sarcoma of cervical origin is extremely rare and thyroid may be involved as a spreading site.