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Synovial sarcoma is a malignant tumor which is mesenchymal in nature and most commonly involves the joints of the lower limbs. Sarcomas of the head and neck region are very rare, accounting for less than 1% of all neoplasms of the head and neck. Case report: A 60-year-old male presented to ear, nose, and throat (ENT) emergency with complaints of change in voice and difficulty in swallowing since 10 days. On indirect laryngoscopic examination, there was a reddish smooth mass seen involving the left lateral pharyngeal wall and obscuring left pyriform sinus. A contrast-enhanced computed tomography (CECT) scan of the neck was done, which revealed a well-defined heterogeneously enhancing soft tissue lesion in the left pyriform sinus. On direct endoscopic assessment, a friable reddish mass was seen in the left pyriform sinus, which was excised and sent for biopsy. Pathological examination showed a biphasic lesion comprising of epithelial component arranged in nests and stromal component arranged in spindled out cells. Immunohistochemistry was positive for vimentin and cytokeratin suggestive of biphasic synovial sarcoma. Before definitive management as a part of metastatic work-up, patient underwent magnetic resonance imaging (MRI) of neck and spine, which revealed a metastatic lesion in cervical spine. Subsequently, the patient was referred to radiation oncology for radiotherapy. Conclusion: Synovial sarcoma is a rare malignant tumor whose management is mainly surgical resection with postoperative radiotherapy for residual or recurrent disease. We have presented this case on account of its rarity of occurrence and its aggressive nature, as it presented with vertebral metastasis which further emphasizes the need for a complete metastatic work-up for cases before being planned for surgery.

Biphasic Synovial Sarcoma of the Hypopharynx with Vertebral Metastasis: A Rare and Aggressive Entity