Journal List > J Korean Assoc Oral Maxillofac Surg > v.37(6) > 1032519

J Korean Assoc Oral Maxillofac Surg. 2011 Dec;37(6):545-549. Korean.
Published online December 27, 2011.  https://doi.org/10.5125/jkaoms.2011.37.6.545
Copyright © 2011 by The Korean Association of Oral and Maxillofacial Surgeons
Synovial sarcoma in the buccal space: a case report
Ji-Hoon Han,1 Kyu-Ho Yoon,1 Jeong-Kwon Cheong,1 Jung-Ho Bae,1 Hsueh-Yu Li,1 Young-Il Oh,1 Jae-Myung Shin,2 Jee-Seon Baik,2 and Kwan-Soo Park1
1Department of Oral and Maxillofacial Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
2Department of Oral and Maxillofacial Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.

Corresponding author: Kwan-Soo Park. Department of Oral and Maxillofacial Surgery, Sanggye Paik Hospital, Inje University College of Medicine, 761-1 Sanggye 7 dong, Nowon-gu, Seoul 139-707, Korea. TEL: +82-2-950-1161, FAX: +82-2-950-1167, Email: oms_kspark@paik.ac.kr
Received August 11, 2011; Revised October 11, 2011; Accepted November 23, 2011.

Abstract

Synovial sarcoma (SS) is a malignant soft tissue tumor comprising 5-10% of all soft tissue sarcomas. This tumor normally occurs in the paraarticular regions of the extremities but is rare in head and neck sites. SS is sometimes difficult to diagnose because it can mimic benign lesions both clinically and radiologically. This paper presents a rare case of a SS of the buccal space of a 25-year old man. The histology examination and immunohistochemistry of the mass led to a diagnosis of synovial sarcoma. The patient was treated primarily with a surgical resection, followed by radiotherapy and chemotherapy. The follow up examination 17-months after surgery showed no signs of tumor relapse or metastasis.

Keywords: Synovial sarcoma; Head and neck neoplasms

Figures


Fig. 1
Pre-operative extraoral photo.
Click for larger image


Fig. 2
Pre-operative intraoral photo. Palpable elevated mass on right buccal mucosa and retromolar area.
Click for larger image


Fig. 3
Pre-operative computed tomography. Round shaped relatively well-defined mild to moderately enhancing inhomogeneous mass (3.2 cm×2.8 cm, arrow) with internal high density foci in right buccal space without adjacent bony erosions.
Click for larger image


Fig. 4
Pre-operative salivary gland sonography. Ovoid shaped well-defined heterogeneous mass (2.8 cm×2.5 cm×3.9 cm) with increased blood flow in right buccal space.
Click for larger image


Fig. 5
Gross finding. Well defined pinkish gray soft tissue (5 cm×4 cm×3 cm).
Click for larger image


Fig. 6
Photomicrographs of synovial sarcoma in the buccal space. A. It reveals proliferation of spindle cells and the epithelial components forming gland-like structures (H&E staining, ×200). B. The spindle cells are stained for bcl-2 immunoreactivity (×200). C. The spindle cells are stained for CD99 immunoreactivity (×200). D. The epithelial components are stained for cytokeratin immunoreactivity (×200).
Click for larger image


Fig. 7
Post-operative intraoral photo (15-months after). Scar formation on right retromolar area.
Click for larger image


Fig. 8
Post-operative computed tomography (15-months after). Mild fat infiltration and fascial thickening in right retromolar and buccal space.
Click for larger image

References
1. Cadman NL, Soule EH, Kelly PJ. Synovial sarcoma: an analysis of 134 tumors. Cancer 1965;18:613–627.
2. Shmookler BM, Enzinger FM, Brannon RB. Orofacial synovial sarcoma: a clinicopathologic study of 11 new cases and review of the literature. Cancer 1982;50:269–276.
3. Tilakaratne WM. Synovial sarcoma of the mandible. J Oral Pathol Med 2006;35:61–63.
4. Jernstrom P. Synovial sarcoma of the pharynx: Report of a case. Am J Clin Pathol 1954;24:957–961.
5. Amble FR, Olsen KD, Nascimento AG, Foote RL. Head and neck synovial cell sarcoma. Otolaryngol Head Neck Surg 1992;107:631–637.
6. Capote A, Acero J, García-Recuero I, Rey J, Guerra B, de Paz V. Infratemporal-preauricular-cervical approach for resection of a cavernous intramasseteric hemangioma: a case report. J Oral Maxillofac Surg 2008;66:2393–2397.
7. Weiss SW, Goldblum JR. In: Enzinger and Weiss's Soft Tissue Tumors. 4th ed. St. Louis: Mosby; 2001. pp. 1483-1509.
8. Bukachevsky RP, Pincus RL, Shechtman FG, Sarti E, Chodosh P. Synovial sarcoma of the head and neck. Head Neck 1992;14:44–48.
9. Rangheard AS, Vanel D, Viala J, Schwaab G, Casiraghi O, Sigal R. Synovial sarcomas of the head and neck: CT and MR imaging findings of eight patients. AJNR Am J Neuroradiol 2001;22:851–857.
10. Bridge JA, Bridge RS, Borek DA, Shaffer B, Norris CW. Translocation t(X;18) in orofacial synovial sarcoma. Cancer 1988;62:935–937.
11. Koyama S, Morimitsu Y, Morokuma F, Hashimoto H. Primary synovial sarcoma of the kidney: Report of a case confirmed by molecular detection of the SYT-SSX2 fusion transcripts. Pathol Int 2001;51:385–391.
12. Coindre JM, Pelmus M, Hostein I, Lussan C, Bui BN, Guillou L. Should molecular testing be required for diagnosing synovial sarcoma? A prospective study of 204 cases. Cancer 2003;98:2700–2707.
13. Miloro M, Quinn PD, Stewart JC. Monophasic spindle cell synovial sarcoma of the head and neck: report of two cases an review of the literature. J Oral Maxillofac Surg 1994;52:309–313.
14. Bilgic B, Mete O, Oztürk SA, Demiryont M, Keles N, Basaran M. Synovial sarcoma: a rare tumor of larynx. Pathol Oncol Res 2003;9:242–245.
15. Eilber FC, Brennan MF, Eilber FR, Eckardt JJ, Grobmyer SR, Riedel E, et al. Chemotherapy is associated with improved survival in adult patients with primary extremity synovial sarcoma. Ann Surg 2007;246:105–113.
16. Moore DM, Berke GS. Synovial sarcoma of the head and neck. Arch Otolaryngol Head Neck Surg 1987;113:311–313.
17. Dei Tos AP, Dal Cin P, Sciot R, Furlanetto A, Da Mosto MC, Giannini C, et al. Synovial sarcoma of the larynx and hypopharynx. Ann Otol Rhinol Laryngol 1998;107:1080–1085.
18. Meer S, Coleman H, Altini M. Oral synovial sarcoma: a report of 2 cases and a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:306–315.
19. Carrillo R, Rodriguez-Peralto JL, Batsakis JG. Synovial sarcomas of the head and neck. Ann Otol Rhinol Laryngol 1992;101:367–370.
20. Torsiglieri AJ Jr, Hendrix RA, Quinn PS. Synovial sarcoma of the jaw. Ear Nose Throat J 1991;70:396–398.