Synovial sarcoma of the Eustachian tube

Synovial sarcoma is a rare, aggressive high-grade neoplasm with poor prognosis. Synovial sarcoma is usually encountered in the lower extremities of young adults; only a few cases have been reported in the head and neck region.

We describe a case of a 44-year-old man seen with a 3-month history of progressive nasal obstruction. Nasoendoscopy revealed a pink polypoid mass filling in the entire right posterior nasal cavity. CT and MRI studies showed that a hyperintense mass on the right nasopharynx extending to the nasal cavity anteriorly and the oropharynx inferiorly. During the operation, the mass was noted as originating from the lower portion of anterior cushion of the right Eustachian tube. We endoscopically removed the tumor and part of the anterior cushion of the right Eustachian tube. Because of the large tumor size (7.0 x 3.5 cm), we took the tumor out transorally.

The histopathology and genetic analysis confirmed the diagnosis of monophasic synovial sarcoma prominent myxoid pattern. The patient then underwent adjuvant irradiation to 64.8 Gy, and he was free of recurrence and distant metastasis in the 5-year follow-up.

To our knowledge, this is the first case report of synovial sarcoma of the Eustachian tube. Synovial sarcoma should be included in the differential diagnosis when managing the Eustachian tube region mass. Recommended treatment is surgery and postoperative adjuvant radiotherapy.