Biphasic synovial sarcoma of the cervical esophagus confirmed by the presence of SYT-SSX1 fusion transcripts

Abstract

Synovial sarcoma of the digestive tract, including that of the esophagus, is extremely rare. To our knowledge, only 9 cases of primary synovial sarcoma of the esophagus have been reported worldwide. Here, we describe the case of a 70-year-old man who presented with dysphagia and hoarseness, which he had been experiencing for 4 months. A pigmented polypoid mass was detected at the cervical esophagus and spindle cell sarcoma was suspected on the basis of biopsy findings. Two operations were performed to completely excise both the tumor and regional lymph nodes. The tumor was diagnosed as a biphasic synovial sarcoma on the basis of the detection of SYT-SSX1 fusion transcripts by reverse transcription-polymerase chain reaction and fluorescence in situ hybridization. Twenty-two months following surgery, the patient developed local recurrence and received radiotherapy with 60 Gy in 30 fractions. Post-treatment follow-up uncovered the presence of left cervical lymph node metastases that were then removed. Approximately 1 month after resection, multiple metastases developed in the lungs. At his request, the patient did not receive any chemotherapy and died at 42 months after the first operation.