A Novel Surgical Approach to Synovial Sarcoma of the Esophagus: New Possibilities for the Management of a Rare Tumor

Synovial sarcoma (SS) is an uncommon soft tissue malignancy that typically occurs in surrounding joints. Rarely, this malignancy may occur in the gastrointestinal (GI) tract, including the esophagus. Given the rarity of this malignancy, treatment recommendations are limited. In all reviewed cases, surgical resection was performed via some variation of esophagectomy. Here, we present a novel approach to the treatment of esophageal SS. A 30-year-old patient was found to have a large upper esophageal mass after developing symptoms of dysphagia, cough, and regurgitation. Otolaryngology was consulted for the removal of the mass. A CO₂ laser was used to remove the pedicled mass from the esophageal wall. Given the size of the mass, it could not be removed through the upper esophageal sphincter despite significant effort. The decision was made to allow the mass to pass to the stomach to be digested. The patient had an uncomplicated postoperative course with seemingly complete spontaneous digestion of the tumor and no evidence of residual tumor, metastasis, or recurrence. Frozen section pathology confirmed SS of the esophagus. SS of the esophagus is a rare malignancy that presents unique treatment challenges. This case represents a novel strategy for resecting esophageal SS utilizing transoral esophagoscopy. The preservation of the upper esophageal sphincter may also be accomplished using this approach by allowing for the autodigestion of tumors in some cases. This case also suggests that esophagectomy may not be necessary for all cases of esophageal SS.