title: Primary synovial sarcoma of the thyroid gland: case report and review of the literature.
abstract: Synovial sarcoma (SVS) of the thyroid gland is exceedingly rare. We report the case of a 55-year-old man with a rapidly growing 7-cm neck mass. Because of suspicion of anaplastic thyroid carcinoma, a total thyroidectomy was planned, without preoperative cytology. During surgery, the tumor ruptured, leading to fragmented and incomplete resection. The morphological and immunohistochemical aspects suggested thyroid SVS, which was confirmed by fluorescent in situ hybridization (SYT gene rearrangement). The patient experienced immediate local relapse in close contact with large vessels and the thyroid cartilage and was referred to our institution. Doxorubicin-ifosfamide chemotherapy led to a minor response that authorized secondary conservative surgery. Because of microscopically incomplete resection, adjuvant radiotherapy was chosen and is ongoing 10 months after initial surgery. The prognosis of thyroid SVS is associated with a high risk for local and metastatic relapses. Pretreatment diagnosis is fundamental and may benefit from molecular analysis. Margin-free monobloc surgical excision is the best chance for cure, but adjuvant chemotherapy and radiotherapy deserve to be discussed.
authors.affiliation: Department of Medical Oncology, Hôpital d'Instruction des Armées Sainte-Anne, Toulon, France ; Department of Medical Oncology, Marseille, France.
authors.forename: Laurys
authors.initials: L
authors.lastname: Boudin
authors.affiliation: Department of Otorhinolaryngology - Head and Neck Surgery, la Timone Universitary Hospital, Marseille, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Fakhry
authors.affiliation: Department of Pathology, Marseille, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Chetaille
authors.affiliation: Department of Medical Oncology, Marseille, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Perrot
authors.affiliation: Department of Medical Oncology, Hôpital d'Instruction des Armées Sainte-Anne, Toulon, France.
authors.forename: Anh Tuan
authors.initials: AT
authors.lastname: Nguyen
authors.affiliation: Department of Radiology, Marseille, France.
authors.forename: Nassima
authors.initials: N
authors.lastname: Daidj
authors.affiliation: Department of Surgical Oncology, Marseille, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Guiramand
authors.affiliation: Department of Radiology, Marseille, France.
authors.forename: Anthony
authors.initials: A
authors.lastname: Sarran
authors.affiliation: Department of Radiotherapy, Institut Paoli-Calmettes, Marseille, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Moureau-Zabotto
authors.affiliation: Department of Medical Oncology, Marseille, France ; Department of Aix-Marseille University, Marseille, France.
authors.forename: François
authors.initials: F
authors.lastname: Bertucci
keywords: Chemotherapy; Primary synovial sarcoma; Prognosis; Thyroid gland