Synovial sarcoma of pharynx – A rare case report in Nepal

Synovial sarcoma (SS) is a very rare mesenchymal tumor, mostly arising in the extremities of young adults, with head and neck involvement being extremely uncommon. Pharyngeal SS is exceptionally rare, and to the best of our knowledge, this is the first reported case from Nepal. This case highlights the importance of considering SS in the differential diagnosis of atypical oropharyngeal masses. This is a case of a 34-year-old male who presented with a six-month history of sore throat, progressive dysphagia, muffled voice, and occasional dyspnea. Intraoral examination revealed a bluish globular mass in the left vallecular region, and MRI demonstrated a well-circumscribed mass extending into the hypopharynx, causing marked airway narrowing. Surgical excision was planned after elective tracheostomy for securing airway. It was followed by intraoral endoscopic-assisted complete excision of the mass. Histopathology and immunohistochemistry confirmed biphasic synovial sarcoma. The patient was referred for adjuvant radiotherapy and remains under regular follow-up with no immediate postoperative complications. Although rare, synovial sarcoma should be considered in the differential diagnosis of pharyngeal masses to avoid delayed recognition and misdiagnosis as benign conditions especially in a resource limited setting like ours. Early diagnosis, complete surgical excision, and long-term follow-up are essential for optimal outcomes in this aggressive tumor. • This case highlights a previously undocumented presentation of Synovial Sarcoma(SS) of pharynx in Nepal which was misdiagnosed at many centres before presenting to us. • Key findings include a bluish globular mass arising from the left side of oropharynx and MRI showed well circumscribed mass lesion in the pharyngeal mucosal space in left side of oropharynx with extension into hypopharynx with marked narrowing of oropharynx and hypopharynx, which challenged initial diagnostics. • An elective tracheostomy and excision of the mass was done. Histopathological examination and Immunohistochemistry suggested a diagnosis of Synovial Sarcoma. • This report provides a new insight to have Synovial Sarcoma as a differential for oral cavity or pharyngeal mass in a resource limited setting like in Nepal. High index of suspicion leads to unnecessary investigations, early diagnosis and timely treatment.