PMC5031474_01
Endoscopic view of the larynx and pharynx. A lateral normal mucosa covered mass displaces the larynx.
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Flexible endoscopy (Fig. 1) revealed a left submucosal lateral pharyngeal wall mass impinging on the larynx but with normal vocal cords mobility.
The mass parenchyma showed T1 weighted signal isointense to skeletal muscle and hyperintense signal on T2 weighted imaging with remarkable enhancement. T1 SPAIR sequence after gadolinium shown.
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Gadolinium enhanced T1 weighted image obtained after surgery shows contrast enhancement along the outer border of the thyroid cartilage in the left prelaryngeal strap muscles and along the left sternocleidomastoid muscle due to inflammatory postoperative changes. Follow-up MRI eight months later revealed gradual decrease of contrast enhancement.
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At 8 months follow up, no recurrence was detected (Fig. 3).
Malignant spindle-cell proliferation. Hematoxylin-eosin, original magnification, 20x.
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Histology revealed a biphasic Synovial sarcoma(SS), with malignant spindle-cell proliferation (Fig. 4) and focal epithelioid cells, showing vascular invasion.
Break-apart FISH. The red and green signals normally flank the SS18 gene; splitting of these signals indicates a rearrangement (arrow). Magnification 10x.
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RT-PCR showed a t(X;18)(p11;q11) translocation, and fluorescence in situ hybridization (FISH) showed a rearrangement of the SS18 gene (Fig. 5).