Presentation
Right side neck swelling. Paraplegia for 2 months.
Patient Data
A large heterogeneously enhancing soft tissue mass with cystic areas within and showing diffusion restriction, with an epicenter in the right perivertebral space and reaching up to the right supraclavicular region. Fluid-fluid levels are seen on T2W images.
The mass shows an epidural component from C6 to T1, with cord compression and edema at these levels. There is erosion of the right-side transverse process of the C6 and C7 vertebrae with expansion of the respective transverse foramina and collapse (>50%) of the C7 and T1 vertebrae.
Ill-defined enhancing lesions are also seen in the C6 and T2 vertebral bodies. The mass encases the right vertebral artery and compresses the right internal jugular vein. The mass causes a large cutaneous bulge on the right side of the neck.
Histopathology and immunohistochemistry (IHC) findings are consistent with synovial sarcoma.
Case Discussion
Synovial sarcomas afflict both men and women equally at any age, but young adults and adolescents are the most frequently affected. These soft tissue tumors usually affect the extremities, with the lower leg being the most frequent site, and frequently occur near the joints, particularly around the knees. Rarely, the head and neck can be involved.
As opposed to synovial tissue, pluripotent mesenchymal cells give rise to synovial sarcomas, which can develop close to or even far from articular surfaces, fascia, and tendon sheaths.
MRI is one of the most frequently used imaging tests for soft-tissue cancers and is regarded as the preferred modality for the early diagnosis and staging of these tumors. It exhibits T1-weighted intermediate signal intensity and may show varied signal intensity on T2-weighted sequences with heterogeneous post-contrast enhancement. Areas of cystic changes, bleeding, and fluid-fluid levels can be seen within the mass.
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