Parajulee Gaurav, Jha Uzwal Kumar, Dahal Aarya, Jha Ria, Thakur Prabhat Chandra
Janaki Medical College and Teaching Hospital, Janakpur, Nepal.
Department of ENT- Head and Neck, Nepal Cancer Hospital and Research Center, Lalitpur, Nepal.
Ann Med Surg (Lond). 2025 Jul 17;87(9):6092-6095. doi: 10.1097/MS9.0000000000003598. eCollection 2025 Sep.
Mucoepidermoid carcinoma (MEC) of the vallecula is exceptionally rare and presents significant diagnostic and therapeutic challenges. This case highlights the complexities in diagnosing and managing MEC in an atypical location, where initial benign findings led to recurrent symptoms and required further investigation and intervention.
A 64-year-old diabetic male presented with progressive hoarseness, dysphagia, and intermittent shortness of breath. Despite initial biopsy results indicating a benign fibrous lesion, recurrent symptoms prompted further investigation with MRI, which revealed a lobulated mass in the vallecula extending to adjacent structures. Surgical intervention via wide local excision using the lip-split mandibulotomy approach was performed. Histopathological examination confirmed a diagnosis of low-grade mucoepidermoid carcinoma, with no evidence of lympho-vascular or perineural invasion.
MEC is typically associated with a specific genetic translocation (t(11;19)), and its management involves surgery as the primary treatment modality. The prognosis is generally favorable for low-grade tumors, with recurrence being rare but possible. In this case, a thorough multidisciplinary approach involving histopathology, immunohistochemistry, and advanced imaging techniques was essential for accurate diagnosis and planning effective treatment.
MEC of the vallecula, though rare, should be considered in patients with persistent progressive symptoms, even when initial biopsies suggest a benign lesion. A comprehensive diagnostic approach and early surgical intervention are crucial for favorable outcomes. Long-term follow-up is recommended to monitor for recurrence, as MEC can reappear years after initial treatment.
会厌谷黏液表皮样癌（MEC）极为罕见，在诊断和治疗方面存在重大挑战。本病例突出了在非典型部位诊断和管理MEC的复杂性，最初的良性检查结果导致症状复发，需要进一步检查和干预。
一名64岁的糖尿病男性患者出现进行性声音嘶哑、吞咽困难和间歇性呼吸急促。尽管最初的活检结果显示为良性纤维性病变，但症状复发促使进一步进行MRI检查，结果显示会厌谷有一个分叶状肿块，延伸至相邻结构。采用唇裂下颌骨切开术进行广泛局部切除的手术干预。组织病理学检查确诊为低级别黏液表皮样癌，无淋巴管或神经周围侵犯迹象。
MEC通常与特定的基因易位（t(11;19)）相关，其治疗以手术作为主要治疗方式。低级别肿瘤的预后通常较好，复发虽罕见但有可能。在本病例中，涉及组织病理学、免疫组织化学和先进成像技术的全面多学科方法对于准确诊断和规划有效治疗至关重要。
会厌谷MEC虽然罕见，但对于有持续进行性症状的患者应予以考虑，即使最初的活检提示为良性病变。全面的诊断方法和早期手术干预对于取得良好预后至关重要。建议进行长期随访以监测复发情况，因为MEC可能在初始治疗数年之后再次出现。
