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Background Primary tumors of early-stage (T1-2N0M0) head and neck squamous cell carcinoma (HNSCC) can be treated by transoral minimally invasive surgery, but the cervical lymph node lacks corresponding minimally invasive treatment. Therefore, our study was to evaluate the safety and effectiveness of endoscopic-assisted selective neck dissection (EASND) via small lateral neck incision in treatment of early-stage HNSCC. Methods From May 2008 to April 2012, 29 patients with early-stage HNSCC were enrolled in this retrospective study. EASND via small lateral neck incision was followed by primary tumors treated by transoral endoscopy or CO 2 laser microsurgery in all patients. The clinical data and follow-up results were analyzed retrospectively. Results Twenty-nine patients (male 22, female 7) were successfully treated by EASND and no case conversed to open surgery. EASND included eight cases of level I–III and 21 cases of level II–IV. The operative time was 68.4 ± 10.3 min, and the operative bleeding was 40.8 ± 12.4 ml. The number of lymph nodes was 19.1 ± 4.1. There were 19 cases of T1, 10 cases of T2, 22 cases of N0, 7 cases of N1, no cases with positive margin or extracapsular spread in lymph node. Temporary sensory changes in the postauricular area occurred in two cases, both recovered within 3 months after the surgery, postoperative seromas occurred in one case. No patient showed postoperative bleeding, chylous fistula, incision infection, facial nerve injury, and accessory nerve injury. All patients were satisfied with the postoperative cosmetic results. The 3-year OS was 96.5 %, while DFS, LRFS, and DMFS were 100 %. Conclusion EASND via small lateral neck incision is a feasible and safe technique with achieved short-term oncologic outcomes in early-stage (T1-2N0M0) HNSCC patients. But the long-term results of EASND on oncologic safety and functional outcomes are required to confirm by larger, randomised studies.

Photodynamic therapy (PDT) of early stage oral cavity tumors have been thoroughly reported. However, statistical comparison of PDT to the surgical treatment is not available in published literature. We have identified and matched cohorts of patients with early stage oral cavity cancers undergoing surgery ( n  = 43) and PDT ( n  = 55) from a single institute experience. The groups are matched demographically and had the same pre-treatment screening and follow-up schedule. Both groups consisted only of tumors thinner than 5 mm to ensure comparability. The endpoints were local disease free survival, disease free survival, overall survival and response to initial treatment. Local disease free survival at 5 years were 67 and 74 % for PDT and surgery groups, respectively [univariate HR = 1.9 ( p  = 0.26), multivariable HR = 2.7 ( p  = 0.13)]. Disease free survival at 5 years are 47 and 53 % for PDT and surgery groups, respectively [univariate HR = 0.8 ( p  = 0.52), multivariable HR = 0.75 ( p  = 0.45)]. Overall survival was 83 and 75 % for PDT and surgery groups, respectively [(univariate HR = 0.5 ( p  = 0.19), multivariable HR = 0.5 ( p  = 0.17)]. In the PDT group, six patients (11 %) and in the surgery group 11 patients (26 %) had to receive additional treatments after the initial. All of the tested parameters did not have statistical significant difference. Although there is probably a selection bias due to the non-randomized design, this study shows that PDT of early stage oral cavity cancer is comparable in terms of disease control and survival to trans-oral resection and can be offered as an alternative to surgical treatment.

Background Extramedullary plasmacytoma (EMP) is a rare solitary malignancy that accounts for 3% of plasma cell neoplasms, and EMP with a primary occurrence in the palate is extremely uncommon. Owing to the long course of EMP and the limited available data on treatment outcomes, there are no definitive guidelines for its management, especially for high-risk patients who are more susceptible to early progression to multiple myeloma. Case presentation In this study, we review nine relevant studies and describe a 54-year-old woman who presented with an asymptomatic nonulcerative mass localized in the palate. After initial radical surgical resection of the lesion, the patient was definitively diagnosed with EMP with minimal plasmacytosis in the bone marrow, and adjuvant intensity-modulated radiation therapy with a minimum dose of 39.6 Gy was administrated in the surgical area. There was no evidence of local recurrence, nodal metastasis or progression to multiple myeloma (MM) during the seven-year follow-up period. Conclusion Given the atypical clinical features of palate EMP reported in the literature and the encouraging results of our patient, sequential therapy involving surgery and adjuvant radiotherapy for primary palatal lesions in high-risk EMP patients without nodal involvement could be an effective treatment modality.

Lipoma is a common, benign soft tissue neoplasm consisting of mature adipocytes. Other variants exist, notably angiomyxolipoma, also referred to as vascular myxolipoma, which is an exceedingly rare benign lipomatous tumor characterized by the intimate admixture of three components: mature adipose tissue, paucicellular myxoid stroma, and a prominent vascular network. We present the case of a 55-year-old female patient who presented with a palatal swelling. Histopathological examination after surgical excision revealed an angiomyxolipoma. No abnormalities were noted after one year. Angiomyxolipoma of the oral cavity is an exceptionally rare benign neoplasm, with only a handful of well-documented cases involving the buccal mucosa, floor of mouth, tongue, and lip. Despite its rarity, recognition is important because the lesion can closely mimic other lipomatous or myxoid tumors, including malignant entities such as myxoid liposarcoma.

Microsecretory adenocarcinoma (MSA) is a new type of salivary gland neoplasm identified in the 2022 World Health Organization Classification of Head and Neck Tumour (Skalova et al., Head Neck Pathol 16:40-53, 2022) and is characterized by a unique set of histomorphologic and immunohistochemical features and a recurrent MEF2C::SS18 fusion. MSA was initially misdiagnosed as another salivary gland tumour due to its similar morphology; until recently, only fewer than 50 cases were reported. We present a case of MSA of the hard palate with diverse architectural growth patterns, bland cytological features, abundant basophilic intraluminal secretions and fibromyxoid stroma. The tumour cells were positive for the SOX10, S100, and p63 protein and negative for the p40 protein according to immunohistochemistry. SS18 gene rearrangement was demonstrated via break-apart fluorescence in situ hybridization. We also provided a comprehensive literature review and integrated the clinicopathological features, immunophenotype, and molecular alterations of the disease. A comprehensive understanding of MSA enables us to accurately distinguish and categorize MSA from other salivary gland tumours with analogous morphologies.

Background The synchronous development of multiple, histologically distinct primary salivary gland tumors is exceedingly rare, especially with involvement of both major and minor glands. Although growing research has advanced epidemiological understanding, clinical management continues to be significantly impeded by underdiagnosis and misdiagnosis. Case presentation We present an 18-year-old female with two slow-growing, asymptomatic masses over a two-year period. The palatal mass showed gradual enlargement and mucosal protrusion. In contrast, the sublingual mass grew more rapidly, becoming fixed and immobile within the past year. Magnetic resonance imaging (MRI) revealed corresponding nodular soft-tissue masses with heterogeneous signals. The palatal lesion was irregular yet relatively well-defined; however, the sublingual mass displayed locally aggressive behavior with invasion of the mandibular lingual periosteum and floor-of-mouth muscles, resulting in ill-defined margins and submandibular duct dilation. Histopathologic correlation confirmed an intermediate-grade mucoepidermoid carcinoma of the sublingual gland and a pleomorphic adenoma of the palate. Conclusions The synchronous occurrence of benign and malignant salivary gland tumors is a rare clinical phenomenon that demands thorough evaluation to ensure diagnostic accuracy and a favorable prognosis. We report a unique case of synchronous mucoepidermoid carcinoma in the sublingual gland and pleomorphic adenoma in the palate, which, to our knowledge, is the first such documented instance. This report expands the documented spectrum of multiple primary salivary gland tumors and serves as a vital clinical reference, underscoring the need for heightened awareness when assessing concurrent lesions.

Adenoid cystic carcinoma (ACC) is a rare, slowly growing salivary gland neoplasm distinguished by its versatile phenotype and destructive clinical course. Its underlying aetiology is unclear. It is characterised by a gradual yet infiltrative progression, perineural invasion (PNI), a worse prognosis, late recurrence and distant metastases. ACC is recognised for its unique histological features and susceptibility to PNI.We present a case of a female in her 50s with a history of progressively enlarging swelling in the right palate diagnosed as a “hybrid variant of adenoid cystic carcinoma”. Histopathological analysis confirmed the diagnosis, emphasising the need for long-term follow-up given ACC’s propensity for late recurrence and distant spread, particularly to the lungs. For individuals with advanced non-resectable, recurring and/or metastatic illness, there is currently no viable treatment. But its prevalence impedes the advancement of additional studies and clinical investigations to study new approaches and novel treatments.

Background Oral squamous papilloma is a common benign tumor of the oral mucosa that typically presents as a solitary, exophytic mass less than 10 mm in diameter. The abnormal outgrowth is often slow-growing and asymptomatic. However, its finger-like projections or cauliflower-like appearance, as well as emerging complications such as pain, can raise concerns. While most solitary oral squamous papillomas are usually innocuous, large, symptomatic, or multiple lesions may warrant closer surveillance because they have been linked, albeit rarely, to malignant transformation. Case presentation We report two atypical cases of large, symptomatic oral squamous papilloma. In the first case, two lumps were found on the surface of the soft palate in a female patient: a large pediculated mass (15 × 10 × 8 mm) with finger-shaped projections and irritating pain, and a small asymptomatic sessile mass (3 × 2 × 2 mm) with a pink, cauliflower-like appearance. In the second case, a large papilloma (20 × 10 × 6 mm) developed on the buccal gingiva of an impacted, decayed maxillary third molar, accompanied by orofacial pain and limited mouth opening. These papillomas were surgically removed for histopathological examination. The final diagnoses of oral squamous papilloma in both cases were based on clinical presentation and histopathological examination. Notably, the oral mucosa of the first patient was positive for human papillomavirus type 58 (HPV58), which is a high-risk type of HPV and prevalent in countries of East Asia. In contrast, the oral mucosa of the second patient was negative for all 21 HPV subtypes that were tested. There were no recurrences in the two cases at the 6- and 18-month follow-up, respectively. Conclusions The first unusual case shows that HPV58 infection of the oral mucosa might be associated with oral squamous papillomas, particularly large, multiple papillomas. Meanwhile, the second case in this report demonstrates that chronic gingival inflammation caused by microbial infection around an impacted third molar may contribute to the development of large, symptomatic oral squamous papillomas. These two atypical cases also underscore the importance of histopathological examination and HPV screening of the oral mucosa for diagnosis, differential diagnosis, and elucidation of the etiology and pathophysiology of oral squamous papillomas. Large, symptomatic, and multiple oral squamous papillomas require early intervention and close postoperative follow-up to monitor recurrence and potential malignant transformation.

Background Clear-cell carcinoma, a rare malignancy of the minor salivary gland of the soft palate, is diagnostically challenging neoplasm due to its rarity and overlapping features with other neoplasms. We report a case of atypical presentation, diagnostic challenges, and long-term follow-up post-surgical resection of the tumor, which adds valuable insights to literature on this rare malignancy. Case presentation A 34-years-old Pakistani female came to the hospital with a 2 × 2 cm ulcerative lesion of soft palate. The lesion had no active bleeding and any associated discharge. However, during history taking, she reported pain and occasional bleeding from the lesion. Diagnosis and therapeutic interventions Excisional biopsy was performed, and the specimen was sent for histopathological examination and immunohistochemistry, which confirmed the diagnosis of clear-cell carcinoma. Later on, radiological evaluation confirmed the diagnosis of hyalinizing variant of clear-cell carcinoma. Long-term follow-up revealed no recurrence and postoperative complications. Conclusion This case report highlights the importance of thorough diagnostic evaluation and long-term follow-up in management of a rare oral malignancy. Histopathological examination and immunohistochemistry are crucial in differentiating clear-cell carcinoma from other malignancies with overlapping features. Surgical excision remains the primary treatment modality, with a favorable prognosis if diagnosed and managed adequately.

Background Surgery is the primary therapy for hard palate cancer, but this sometime worsens oral function and unavailable for patients with several comorbidities. Radiotherapy represents an alternative curative treatment option to preserve oral function, however, there are few reports on the use of radiotherapy for squamous cell carcinoma of the hard palate (SCCHP). High-dose-rate (HDR) brachytherapy has been known as an effective treatment for SCCHP, which seems to be less invasive when mold technique is used. In our hospital, the HDR customized mold brachytherapy (HDR- customized MBT) is available for patients with SCCHP. This study aimed to report the efficacy and toxicity of HDR- customized MBT for patients with early-stage SCCHP. Case presentation Four patients with early-stage SCCHP were treated with mainly HDR- customized MBT between June 2015 and May 2023. Three of four patients received the combined radiotherapy: one patient underwent short-term external beam radiotherapy (EBRT) before the HDR- customized MBT; two patients underwent single-fraction interstitial brachytherapy before HDR- customized MBT. The total biological effective dose was 77–110 Gy (α/β = 10). All patients completed HDR- customized MBT with or without the combined radiotherapy and experienced no local recurrence. The acute toxicity was only mucositis limited to the irradiated area: one case with EBRT developed grade 2 mucositis. Only this case had late grade 2 mucositis; no late adverse events were observed in the other cases. No oral dysfunction or cosmetic problems occurred in any of the patients. Conclusions This study might show that HDR-customized MBT is useful for early-stage SCCHP and might be an alternative curative treatment option for them to preserve oral function.