Fonseca Adriano Santana, Azevedo Amanda Canário Andrade, Magalhães Fabíola Moreira, Andrade Nilvano Alves de
Santa Casa de Misericórdia da Bahia, Salvador, BA, Brazil.
Int Arch Otorhinolaryngol. 2014 Jan;18(1):87-9. doi: 10.1055/s-0033-1361081. Epub 2013 Nov 25.
Introduction Synovial sarcoma is a malignant tumor of mesenchymal pluripotent cells. Objectives We present a case of synovial sarcoma in the posterolateral wall of the oropharynx. Resumed report The patient, a 23-year-old woman, was admitted with a history of dysphagia and difficulty in breathing for 8 months, resulting in progressive deterioration and onset of snoring, muffled voice, and local pain. An oropharyngeal tumor in the left posterolateral wall touched the base of the ipsilateral tongue. The patient underwent endoscopic pharyngectomy to remove the lesion. Pathologic examination revealed synovial sarcoma with positive margins, and Mohs technique was proposed for margin control. The margins were disease-free, without the need for total laryngectomy. The pharynx was reconstructed with a microvascular forearm flap. The patient developed postoperative stability. Conclusion Despite its name, synovial sarcoma is rarely sourced directly from synovial membranes. It is most commonly found in the vicinity of large joints. The location at the head and neck, a location poor in synovial tissue, is unusual. Synovial sarcoma in the head and neck has an aggressive nature and poor prognosis. Resection with negative margins remains the foundation of therapy, which is not so easily achieved in the head and neck. It is important for the otorhinolaryngologist and head and neck surgeon to be familiar with this aggressive tumor, which carries high mortality and morbidity. The appropriate diagnosis and treatment can improve prognosis and patient survival.
引言 滑膜肉瘤是一种间充质多能细胞的恶性肿瘤。目的 我们报告一例发生于口咽后外侧壁的滑膜肉瘤病例。病例报告 患者为一名23岁女性,因吞咽困难和呼吸困难8个月入院,病情逐渐加重,出现打鼾、声音低沉和局部疼痛。口咽左侧后外侧壁有一肿瘤,累及同侧舌根。患者接受了内镜下咽切除术以切除病变。病理检查显示为滑膜肉瘤,切缘阳性,建议采用莫氏手术控制切缘。切缘无肿瘤残留,无需行全喉切除术。采用前臂游离皮瓣进行咽重建。患者术后病情稳定。结论 尽管名为滑膜肉瘤,但它很少直接起源于滑膜。最常见于大关节附近。发生在滑膜组织较少的头颈部则较为罕见。头颈部滑膜肉瘤具有侵袭性,预后较差。切缘阴性的切除仍然是治疗的基础,但在头颈部并不容易实现。对于耳鼻咽喉科医生和头颈外科医生来说,熟悉这种具有高死亡率和发病率的侵袭性肿瘤很重要。正确的诊断和治疗可以改善预后和患者生存率。