Laryngeal Synovial Sarcoma-A Rare Entity With an Uncommon Clinical Manifestation of Hemoptysis: A Case Report and Review of the Literature.

Abstract

Background: Synovial sarcoma is a mesenchymal malignancy that most commonly arises in the lower extremities. Fewer than 5% of cases originate in the head and neck, and laryngeal involvement is exceptionally rare.

Case presentation: A 22-year-old man presented with a 6-month history of progressive hoarseness and hemoptysis. Direct laryngoscopy was performed, and biopsies were obtained. Histopathological examination established the diagnosis of laryngeal synovial sarcoma. The patient received three cycles of neoadjuvant chemotherapy, followed by total laryngectomy with bilateral neck dissection. Adjuvant radiotherapy was initiated postoperatively, and the patient remained recurrence-free at 12 months of follow-up.

Discussion: Fewer than 5% of synovial sarcomas occur in the head and neck, and laryngeal involvement is rare. Three histopathological subtypes are recognized: monophasic, biphasic, and poorly differentiated. Immunohistochemistry and detection of the t(X; 18) translocation play a key role in diagnosis. Surgical resection remains the mainstay of treatment, although chemoradiotherapy may also be beneficial. Recurrence is a major concern, with local recurrence reported in up to 45% of patients and distant metastasis in approximately 33%.

Conclusion: Because laryngeal synovial sarcoma is rare, reporting such cases may improve future diagnosis, evaluation, and management of this uncommon entity.