Microcystic adnexal carcinoma (MAC) is a rare, locally infiltrative adnexal malignancy that may be underdiagnosed on limited biopsy. A 51-year-old man presented with a left forehead mass. Initial punch biopsy showed an atypical adnexal proliferative tumor. After excision revealed MAC with positive margins, wide excision with reconstructive planning were performed. Peripheral margins were evaluated by frozen biopsy in 8 sectors, and the deep margin was additionally assessed. Final margins were negative, and no recurrence was observed during 3 years of follow-up. This case highlights the limitations of limited biopsy and the importance of margin-controlled re-excision and integrated reconstructive planning in forehead MAC.
Synchronous multiple primary cancers occurring in the head and neck region are a relatively rare clinical scenario; distinguishing whether anatomically adjacent lesions represent a single continuous lesion or independent primary lesions has a direct impact on the determination of treatment strategies. The authors report a case of synchronous multiple primary cancer involving the base of the tongue and the supraglottic region. In a 59-year-old man, flexible laryngoscopy revealed non-contiguous papillary masses in the left base of the tongue and the left supraglottic region. Findings from neck computed tomography (CT), magnetic resonance imaging (MRI), PET-CT, and suspension laryngoscopy showed no anatomical continuity between the two lesions, and there were no signs of cervical or distant metastasis. Pathologically, the supraglottic lesion was diagnosed as squamous cell carcinoma, while the base of the tongue lesion showed findings consistent with high-grade dysplasia or higher. Considering the imaging findings suggestive of malignancy and the results of immunohistochemical staining, it was judged reasonable to interpret the latter as a malignant lesion. Accordingly, the two lesions were interpreted as synchronous multiple primary cancer rather than a single continuous lesion. Through a multidisciplinary approach, the anatomical location of the lesions, the anticipated extent of resection, and the importance of functional preservation were comprehensively considered, and concurrent chemoradiotherapy was administered. This case demonstrates that distinguishing between a continuous lesion and synchronous multiple primary cancer in adjacent head and neck lesions can alter the actual treatment strategy, and suggests the importance of a multidisciplinary approach that considers not only oncological outcomes but also anatomical location and functional preservation when making treatment decisions.
Nevoid basal cell carcinoma syndrome (NBCCS), or Gorlin syndrome, is a hereditary disorder characterized by multiple basal cell carcinomas (BCCs) and systemic abnormalities. We report a 63-year-old male with a history of multifocal BCCs beginning approximately 20 years ago, who underwent staged wide excisions and reconstructions. Computed tomography revealed lamellar calcification of the falx cerebri and tentorium cerebelli, fulfilling a major diagnostic criterion. Despite the absence of palmar pits and skeletal anomalies, a clinical diagnosis of NBCCS was established based on two fulfilled major criteria: multiple BCCs and falx calcification. Molecular genetic testing for PTCH1 or SUFU variants was not performed; this absence of genotypic confirmation is acknowledged as a limitation. This case illustrates that NBCCS may remain undiagnosed until late adulthood when phenotypic expression is incomplete, and that incidental intracranial calcification on routine imaging can serve as the critical diagnostic bridge. Systematic application of the Kimonis criteria and long-term multidisciplinary surveillance are essential in such patients.
For over two decades, the standard of care for resectable locally advanced head and neck squamous cell carcinoma (LA-HNSCC) has remained radical surgery followed by risk-adapted adjuvant therapy. Despite this, high-risk patients experience significant relapse; in particular, current adjuvant concurrent chemoradiotherapy regimens fail to adequately control distant metastasis. Preclinical studies suggest that neoadjuvant immune checkpoint inhibitor (ICI) induces superior antitumor immunity compared to adjuvant therapy by leveraging the primary tumor as an antigen source for systemic T-cell priming. Phase II data further indicate that neoadjuvant ICI, either as monotherapy or in combination, can enhance pathological response rates without compromising surgical safety. Building on these findings, recent two pivotal Phase III KEYNOTE-689 and NIVOPOSTOP confirmed the definitive roles of perioperative immunotherapy. KEYNOTE-689 demonstrated that neoadjuvant-adjuvant pembrolizumab significantly improves event-free survival, primarily by reducing distant recurrence. Conversely, the NIVOPOSTOP trial, which utilized only adjuvant/concomitant nivolumab, showed significant improvement in disease-free survival driven by locoregional control but failed to significantly impact distant relapse. Perioperative ICI represents a transformative shift in LA-HNSCC management. The contrasting results of KEYNOTE-689 and NIVOPOSTOP highlight that the neoadjuvant window is critical for systemic disease control via immune priming. Future strategies will shift away from “one-size-fits-all” models toward risk-stratified, response-adapted approaches. Landmark trials in melanoma, which proved that extensive lymph node dissection can be safely omitted in patients with favorable pathologic responses, provide a blueprint for using pathological response as a surrogate marker to guide treatment de-escalation, aiming to maximize survival while preserving organ function and quality of life in LA-HNSCC.
Background/Objectives: Neoadjuvant chemotherapy (NACT) has re-emerged as a promising strategy in the management of head and neck squamous cell carcinoma (HNSCC), offering potential benefits in tumor downstaging, early eradication of micrometastases, and facilitation of function-preserving surgical approaches. With the increasing adoption of minimally invasive techniques such as transoral robotic surgery (TORS), the integration of NACT into surgical treatment pathways has gained renewed interest. However, the incorporation of NACT introduces important surgical considerations, including optimal timing of resection, intraoperative technical challenges, pathologic assessment of treatment response, and implications for postoperative therapy.Materials & Methods: A narrative review was conducted focusing on recent clinical trials, systematic reviews, and meta-analyses addressing NACT in HNSCC, with emphasis on surgical timing, technical considerations, complications, and oncologic outcomes.Results: NACT can induce tumor downstaging and improve R0 resection rates, with recent studies reporting high objective response rates and favorable pathological responses. However, its impact on overall survival remains inconsistent across studies. Surgical considerations include optimal timing after chemotherapy, tissue fibrosis and edema, altered anatomical planes, and perioperative complications. Meta-analyses suggest that while NACT does not significantly increase major surgical complications, variability exists depending on regimen and patient selection. In HPV-positive oropharyngeal cancer, NACT followed by TORS has demonstrated reduced pathological staging with comparable survival outcomes, supporting its role as a de-escalation strategy. Emerging strategies combining NACT with immunotherapy, including the phase 3 KEYNOTE-689 trial demonstrating improved event-free survival with perioperative pembrolizumab, are further reshaping surgical planning.Conclusion: NACT plays a growing but still selective role in HNSCC. Careful patient selection, multidisciplinary coordination, and awareness of altered surgical fields are essential to maximize benefits while minimizing risks.
Oropharyngeal metastasis from non-small cell lung carcinoma (NSCLC) is rare, particularly to the posterior pharyngeal wall (PPW), and can mimic head and neck neoplasms. A 78-year-old man with globus had a 2×3 cm PPW mass and a synchronous left upper-lobe lesion; biopsies from both revealed poorly differentiated pleomorphic carcinoma. Stereotactic body radiotherapy (SBRT; 60 Gy/4 fractions) to the lung achieved regression, and the PPW tumor was resected via transoral robotic surgery (TORS) with negative margins. Pathology confirmed metastatic pleomorphic carcinoma with thyroid transcription factor-1 (TTF-1) positivity and a high proliferative index. Ten months later, right level IIa nodal metastasis was excised by modified radical neck dissection; the node showed squamoid change with loss of TTF-1, and no human papillomavirus or tonsillar primary was identified. Without systemic therapy, the patient remains disease-free 5 years after TORS and 8 years after SBRT, supporting curative-intent local therapy in oligometastatic NSCLC.
Myxofibrosarcoma (MFS) is a malignant fibroblastic neoplasm that predominantly arises in the extremities, whereas its occurrence in the head and neck region is extremely rare. We report a 31-year-old male who presented with a scalp mass and had a 3-year history of a slowly growing, painless, non-ulcerated lesion. Computed tomography and magnetic resonance imaging showed no malignant features. The patient underwent tumor excision and local flap reconstruction. Histopathological examination confirmed low-grade MFS. After permanent biopsy, additional wide excision and adjuvant radiotherapy were recommended but declined. He has been followed for 3 years without evidence of recurrence or metastasis. This case highlights the diagnostic challenges and clinical management of scalp MFS, emphasizing the importance of considering MFS in the differential diagnosis of scalp tumors despite its rarity.
Skin cancers commonly affect the lower eyelid, necessitating reconstruction after tumor excision to restore both functional integrity and cosmetic appearance. Although various reconstructive techniques are available, substantial marginal lower eyelid defects often present considerable challenges. We report the case of an 83-year-old woman with sebaceous carcinoma involving two-thirds of the right lower eyelid. Following tumor resection, reconstruction was performed using a bipedicled orbicularis oculi myocutaneous flap (Tripier flap) combined with a palatal mucosal graft. This approach achieved excellent tissue match, robust vascularity, and preserved dynamic function, resulting in favorable postoperative outcomes without complications such as ectropion or lagophthalmos. This two-stage procedure offers a reliable solution for reconstructing substantial marginal defects of the lower eyelid.
Given the complex nature of head and neck cancers, multidisciplinary team (MDT) management has become increasingly important in contemporary oncologic care. However, MDT implementation often faces practical limitations due to time constraints, limited resources, and coordination challenges among specialists. To address these issues, there is a growing need for innovative decision-support tools. Recent advances in artificial intelligence (AI), particularly large language models (LLMs), have introduced new opportunities to enhance clinical decision-making. This review explores the current applications of AI technologies in oncologic treatment decision processes, with a focus on their potential integration into MDT-based decision-making for head and neck cancer. Furthermore, we introduce recent studies applying multi-agent LLM frameworks to MDT systems and discuss key challenges that must be addressed for successful clinical adoption. Ultimately, this review envisions an AI-augmented MDT model that enhances decision-making efficiency and objectivity, while enabling clinicians to focus more deeply on their core role—delivering optimal patient-centered cancer care.
Anaplastic thyroid carcinoma (ATC) is one of the most aggressive and lethal solid tumors, and its therapeutic outcomes remain extremely limited. The main objectives of treatment are to minimize the risk of airway obstruction, control disease burden, and relieve symptoms through a multidisciplinary approach. Surgery is recommended only for localized disease when complete resection is feasible, and morbidity is acceptable.A 62-year-old man presented with a right supraclavicular mass and hoarseness. Imaging revealed a right thyroid tumor with lymph node metastases to the supraclavicular, superior mediastinal, subcarinal, and hilar areas. He underwent total thyroidectomy, bilateral central neck dissection, right modified radical neck dissection, and VATS mediastinal lymph node dissection. Final pathology confirmed a squamous cell carcinoma pattern of anaplastic thyroid carcinoma. Adjuvant radiotherapy and palliative targeted therapy were administered, and he remained stable for 8 months. This case highlights the potential role of surgery in selected ATC patients.
Background/Objectives: Hypoparathyroidism is a post-thyroidectomy complication with multifactorial causes. This study aimed to investigate whether identifying all four parathyroid glands (PTGs) is associated with a reduced incidence of postoperative hypocalcemia.Materials & Methods: Seventy-seven thyroidectomies, with or without neck dissection, performed by one surgeon at a single institution (March 2021 - February 2024) were retrospectively analyzed. Patients were categorized into all-four-PTGs-identified group (A) and not-all-PTGs-identified group (N) to investigate factors associated with postoperative hypocalcemia. Subgroup analyses compared hypocalcemic and normocalcemic patients within each group A and N. Patient-related factors, including surgical extent, tumor size, lymph node metastasis, extranodal (ENE) or extrathyroidal extension (ETE), were evaluated as potential risk factors.Results: Statistics revealed no significant difference in incidence of postoperative hypocalcemia between groups A and N. Lateral neck dissection was more frequent in group N (p = .004), with higher rates of lymph node metastasis (p = .010), ENE (p < .001) and ETE (p = .019). On multivariable analysis, group A versus N was not independently associated with postoperative hypocalcemia (p = .940), whereas female sex showed higher risk (p = .035). No significant differences in the patient-related factors were observed within subgroups of groups A and N.Conclusion: Systematic identification of all four PTGs during thyroid surgery does not appear to have a beneficial effect on reducing postoperative hypocalcemia. Rather, this approach may increase the risk of injury to parathyroid tissue and its blood supply. Thus, preserving these glands by thyroidal capsular dissection is considered more important.
An auricular pseudocyst is an uncommon, benign cystic lesion that frequently occurs in the auricles of middle-aged male patients, characterized histologically by an intracartilaginous, non-epithelial-lined cystic space. This report presents two cases of auricular pseudocysts successfully treated using deroofing procedures, with excellent long-term outcomes observed at 6-month and 5-year follow-up, respectively. Although various treatment modalities may be employed for these lesions, surgical deroofing is considered a conventional and reliable option that provides low recurrence rates and superior aesthetic outcomes.
Alveolar soft part sarcoma (ASPS) is a rare and potentially aggressive soft tissue malignancy that primarily affects teenagers and young adults. It is generally associated with a high incidence of metastasis early in the disease course, with brain metastases occurring more frequently than in other high-grade sarcomas. ASPS most commonly arises in the extremities, particularly the lower limbs, while approximately one-fourth of cases occur in the head and neck region, with typical sites including the tongue and orbit, although involvement of the larynx is very rare. In this case report, we present a rare case of ASPS located in the larynx, accompanied by a review of the literature. This case emphasizes that ASPS should be considered in the differential diagnosis when evaluating solid and/or vascular laryngeal masses in the young population, and underscores the necessity of early surgical intervention.
Kimura’s disease is a rare, chronic inflammatory disorder that typically presents as painless head and neck masses in young Asian males, often accompanied by peripheral eosinophilia and elevated IgE levels. We report a case of recurrent Kimura’s disease involving the right parotid gland in a 35-year-old man, previously treated surgically. Due to tumor size (6 cm) and high risk of surgical complications, the patient underwent radiotherapy (30 Gy/15 fractions). Post-treatment imaging showed significant tumor reduction with no adverse effects or recurrence during 12 months of follow-up. While surgery remains the mainstay of treatment, recent studies suggest that radiotherapy or immunosuppressive therapy may be effective, especially in cases at high risk of recurrence. A recent meta-analysis identified tumor size ≥3 cm, prolonged disease duration (5 years), high eosinophil percentage (20%), and elevated IgE (10,000 IU/ml) as significant recurrence predictors. This case supports that radiotherapy may sere as a valuable treatment option when surgery in contraindicated or in high-risk recurrent cases.
Anaplastic thyroid carcinoma (ATC) is a rare and highly aggressive malignancy typically associated with dismal outcomes. Most patients present with advanced disease, often precluding curative resection. We report a case of intrathyroidal ATC incidentally identified in a 72-year-old male who underwent diagnostic lobectomy for a low-suspicion, predominantly cystic huge thyroid nodule. Final pathology revealed a completely resected, intrathyroidal ATC without extrathyroidal extension. Postoperative imaging showed no evidence of residual or metastatic disease. Based on multidisciplinary discussion, the patient underwent completion thyroidectomy and central neck dissection without adjuvant therapy. No residual malignancy was identified, and the patient remains recurrence-free at six months. This case highlights that early-stage intrathyroidal ATC may present without overt malignant features and can be curatively treated with complete surgical excision. Careful evaluation and multidisciplinary decision-making are essential in managing rapidly enlarging thyroid nodules with atypical features.
Pyogenic granulomas (PGs), also known as lobular capillary hemangiomas, are common reactive lesions that are non-neoplastic in nature. While they typically present as isolated lesions, they can rarely develop from preexisting port-wine stains (PWSs). PWS-associated PGs may occur spontaneously but are often linked to pregnancy or prior treatments such as laser therapy, intense pulsed light therapy, or radiotherapy. Here, we report a rare case of a PG arising from a PWS on the parietal scalp of a 27-year-old man with no history of trauma or prior treatment for his PWS. Given the potential for secondary lesion development in PWS, regular monitoring is essential, particularly in patients with associated risk factors.
Myoepithelioma is a relatively common benign tumor that exhibits various cellular morphologies. It primarily occurs in soft tissues, most commonly in the head and neck region, particularly in the salivary glands. Cases of intraosseous myoepithelioma have rarely been reported, with documented occurrences in sites such as the cranium, maxilla, iliac bone, vertebrae, tibia, and fibula. We present a rare case of intraosseous myoepithelioma involving zygomatic bone. 51-year-old male patient visited our clinic presenting zygomatic intraosseous tumor without any symptom. The patient underwent complete surgical excision involving subtotal portion of zygoma including frontal process, body and temporal process. The tumor had epithelial and spindle cell morphology and immunohistochemistry showed positive results for EMA, CK, SMA, S100, and negative results for CD34. After surgery, complete symmetry achieved, with no recurrence observed during a 1-year follow-up.
Although lipoma is a well-known non-malignant tumor, oral cavity lipoma is a rather uncommon disease. Intraoral lipoma originating from the buccal fat pad is an exceptionally rare disorder. Buccal fat pad lipomas typically impair the face's appearance and functionality. The treatment is surgical excision using an intraoral technique, and close identifying of the surrounding anatomical systems, including the parotid duct, vessels, and buccinator branch of the facial nerve. A fifty-year-old patient reported consistently growing swelling of the left cheek. Clinical examination revealed a unilateral mass in the soft tissue. An MRI scan showed a typical picture of a lipoma attached to the buccal fat pad. Surgery was performed to remove the tumor, and the histology report confirmed the clinical diagnosis of lipoma.
Epidermal cyst is a benign lesion which is commonly encountered in practice, and malignant transformation of it is rare. There are few case reports in the literature about malignant transformation of an epidermal cyst into a squamous cell carcinoma. We present a case of squamous cell carcinoma arising from a 3-year epidermal cyst in the right temporal area of a 68-year-old man. The epidermal cyst was initially identified as a spot and treated with laser therapy. However, it recurred, leading to three surgical interventions at a different surgical clinic. Despite these procedures, the cyst persisted, leading to presenting to our department of plastic and reconstructive surgery. He presented with a 2.5cm sized subcutaneous mass with skin ulcerative lesion. After excision, histopathological examination confirmed squamous cell carcinoma from a ruptured epidermal cyst, with clear resection margins. This case underscores the importance of routine histological examinations in excision of epidermal cysts.
Human papillomavirus-positive (HPV+) oropharyngeal cancer has a significantly better prognosis compared to HPV-negative cases, leading to a growing interest in de-escalation strategies that reduce treatment intensity without compromising oncologic outcomes. The potential for de-escalation in the treatment of HPV+ oropharyngeal cancer extends not only to radiation therapy but also to surgical interventions. This involves reducing the extent of surgery through minimally invasive techniques and minimizing the necessity or dosage of radiation therapy by employing neoadjuvant chemotherapy prior to surgery. De-escalated surgical approaches, which include minimized surgical fields, minimally invasive procedures, and the use of neoadjuvant chemotherapy, may effectively preserve oncologic control while improving patients' quality of life. However, careful patient selection and long-term outcome data are critical for optimizing these strategies.
