Biphasic Synovial Sarcoma of the Palatine Tonsil: A Case Report and Literature Review

Synovial sarcoma (SS) is a rare soft tissue tumor, accounting for 5%-10% of all soft tissue sarcomas, with an unusual occurrence in the head and neck region. This report presents a 29-year-old male with a biphasic SS of the left palatine tonsil, manifesting as progressive dysphagia, odynophagia, hoarseness, and left cervical lymphadenopathy. Clinical examination and imaging revealed a 4 × 4 mass arising from the left tonsil and obstructing the oropharyngeal inlet. Left tonsillectomy was done and the histopathological evaluation revealed a biphasic SS and negative margins. The diagnosis was further supported by a positive transducin-like enhancer of split-1 (TLE-1), SS translocation on chromosome 18 (SS18), and epithelial membrane antigen (EMA). The patient underwent chemotherapy and external beam radiotherapy (60 Gy in 30 fractions), with significant clinical improvement. This case highlighted the importance of a multidisciplinary approach in diagnosing and managing a rare head and neck SS. Furthermore, this is the first reported case from Pakistan, emphasizing the need for awareness in atypical locations.