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The histopathological diagnosis of salivary tumors is considered complex, due to their histological, phenotypic, and genotypic diversity. There are numerous tumors with morphological and/or immunohistochemical aspects that are superimposable but require very different treatment. In this context, salivary lesions containing clear cells are numerous and form part of the diagnostic challenges. We present the case of a 63-year-old woman with a tumor of the accessory salivary glands of the palate, with a predominant clear cell contingent. The aim of this paper is to report a case of a clear cell salivary tumor and to detail the difficulties of differential diagnosis, highlighting new data in the literature and the role of molecular biology., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Strokov et al.)

Cystadenocarcinoma is a malignant tumor that has undergone various classifications due to its wide variety of pathological forms since the World Health Organization (WHO) classification in 2005. We present a case involving a 72-year-old man who reported pain and swelling in the left floor of his mouth during eating. Examination demonstrated a thumb-sized, mobile mass with elastic softness. Resection of the sublingual gland tumor and left submandibular neck dissection were performed under general anesthesia. The lesion was encased in a thin fibrous capsule and consisted of tall columnar epithelium with papillary proliferation of homogeneous eosinophilic columnar cells with minimal pleomorphism. It demonstrated continuous proliferation from the sublingual gland, extracapsular invasion, infiltrative growth, and mild nuclear atypia, leading to a diagnosis of cystadenocarcinoma. Owing to multiple lymph node metastases, left radical neck dissection was performed 21 months post surgery. The patient remains disease-free 85 months after surgery., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Yasui et al.)

Introduction Salivary gland lesions include a diverse range of histological types and biological behaviors, making accurate diagnosis and effective treatment challenging for specialists. Fine needle aspiration cytology (FNAC) plays a significant role in making preoperative diagnoses and further plans of surgery. In differentiating malignant from benign salivary gland tumors, the diagnostic accuracy of fine needle aspiration cytology (FNAC) is high. However, the final diagnosis is histopathological. The aim of this study is to correlate cytological and histopathological interpretations in salivary gland lesions. Materials and method Thirty patients were included in this study, all of them were diagnosed with salivary gland swellings and operated on in the ear, nose, and throat (ENT) department of Mata Gujri Memorial (MGM) Medical College, Kishanganj, in the northeastern region of India, between December 2020 and November 2022. Ultrasonography (USG) and computed tomography (CT) scans were performed in each case, and FNAC was done to make a preoperative diagnosis. After surgery, specimens were collected for histopathological examination. A correlation was then made between the findings of the preoperative cytological examination and the results of the postoperative histopathological examination. The comparison was performed using a 2×2 table, and the analysis of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) was carried out using Microsoft Excel (Microsoft Corp., Redmond, WA) and SPSS software (IBM SPSS Statistics, Armonk, NY). Results An equal number of male and female samples were included in the study, in which parotid involvement was predominant (60%). On FNAC, 53% of parotid gland tumors were found to be benign, whereas only 23.3% of submandibular gland tumors were benign. Pleomorphic adenoma was the most common finding. In the present study, the sensitivity, specificity, positive predictive value, and negative predictive value of USG-guided FNAC, compared to the gold standard histopathology, were 96%, 33.3%, 92.3%, and 50%, respectively. The diagnostic accuracy was found to be 89.3%. Conclusion The findings of this study suggest that FNAC is a reliable technique for the preoperative diagnosis of salivary gland tumors, as it is minimally invasive and offers valuable diagnostic information. An accurate cytological diagnosis can help avoid unnecessary surgery., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Ethical Committee of Mata Gujri Memorial (MGM) Medical College and Lions Seva Kendra (LSK) Hospital, Kishanganj, issued approval MGM/IEC-72/2023. The required permission for the proposed research methodology was obtained from the Ethical Committee of Mata Gujri Memorial (MGM) Medical College and Lions Seva Kendra (LSK) Hospital, and it subsequently satisfied all institutional rules and regulations during the period of research in this hospital. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kumar et al.)

Adenoid cystic carcinoma (ACC) is an aggressive form of salivary gland cancer that mostly affects the accessory, parotid, and submandibular salivary glands. This tumor is characterized by slower development, perineural invasion, and possible local recurrence in clinical and pathological findings. A male patient, aged 71, who was from a remote area, appeared with a lesion affecting the right submandibular gland and had been experiencing discomfort in the same region for four months. Following a biopsy and the histological confirmation of ACC in the right submandibular gland, the tumor was widely excised locally., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Dadgal et al.)

The most commonly occurring malignant salivary gland tumor is mucoepidermoid carcinoma (MEC). It consists of intermediate cells, squamous cells, and mucous-secreting cells. It is usually not capsulated and is identified by mucocarmine staining. Mucoepidermoid carcinoma exists in the thyroid gland and lungs as well. This report presents a case of a very rare sclerosing variant of MEC of the parotid gland in a 48-year-old patient. The patient presented with a small swelling below the left earlobe. Ultrasound-guided fine-needle aspiration cytology (FNAC) was carried out. A diagnosis of pleomorphic adenoma was given. The patient underwent a partial parotidectomy under general anesthesia. The final diagnosis was made through histopathological examination after the surgical removal of the tumor. The patient is now under close follow-up to look out for a recurrence. This case highlights the importance of recognizing and managing rare variants of MEC to optimize patient outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The scientific review board of Saveetha Dental College issued approval (SRB/SDC/OMFS-2206/23/156). Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Singh et al.)

Benign salivary gland tumors are a rare and diverse group of neoplasms with significant variations in their site of origin, histological features, and biological behavior. This report describes the case of a 93-year-old woman with a markedly enlarged left cervical mass. Physical inspection uncovered a tumor of approximately 32 x 30 cm, featuring necrotic and ulcerated areas. The neoplasm, diagnosed as a pleomorphic adenoma (PA) through prior biopsies, had been growing gradually over fifteen years, with delayed surgical intervention due to concerns about her age and the tumor's size. Preoperative contrast-enhanced CT imaging showed a large left-sided cervical mass in close proximity to the airway, but without displacement or infiltration into major structures. An elective surgical approach was undertaken, involving complete resection of the giant PA, confirmed by histopathological evaluation. During the first month of postoperative follow-up, the patient experienced partial facial nerve paralysis but showed no evidence of tumor recurrence. Despite the tumor's considerable size, proximity to the airway, and the patient's advanced age, curative surgical intervention proved feasible. This case underscores that, with meticulous preoperative planning and careful surgical execution, age should not be a contraindication for surgery., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Palomino-Payan et al.)

Pleomorphic adenoma (PA) most commonly manifests in the parotid gland, though it occasionally emerges in atypical locations. We present a case involving an 87-year-old female who exhibited chronic left-sided nasal symptoms, leading to the diagnosis of PA in the nasal cavity. This diagnosis was confirmed through rhinoscopy and subsequent pathological examination following the surgical excision of an 8x8 mm mass. The procedure, which included tumor-based cautery, alleviated her symptoms effectively. A follow-up strategy was established to monitor for any signs of recurrence. The patient has shown no signs of recurrence at subsequent three-month follow-up visits, highlighting the success of the intervention. This case underscores the importance of early recognition and intervention in atypical presentations of PA, which is crucial to prevent potential complications and ensure favorable outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Basharat et al.)

Adenoid cystic carcinoma (ACC) is an uncommon and aggressive head and neck cancer mainly affecting minor salivary glands. It affects more women than men in their 60s and 70s. The tumor is typically locally aggressive and has a high rate of distant metastatic disease. This report unveils a potential avenue for targeted therapy for the management of metastatic disease: a patient with ACC who harbored a specific fibroblast growth factor receptor 2 (FGFR-2) mutation and responded significantly to a novel FGFR-2 inhibitor. This finding could pave the way for personalized treatment options for ACC patients with similar genetic alterations. Nevertheless, the use of futibatinib requires further investigation to optimize treatment protocols, including exploring combination therapies, identifying predictive biomarkers for treatment response, and developing strategies to overcome potential resistance., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Rodriguez et al.)

Introduction: Acinic cell carcinoma (AciCC) is a rare clinical entity and a salivary gland malignancy. It is associated with wide histological variations in the cytomorphological patterns., Methods: Sixty cases diagnosed as AciCC from 2002 to 2023 were assessed for diverse cytomorphological patterns., Results: The mean age of patients at the time of diagnosis was 44.35±16.8 years ranging from 15 to 81 years. Females comprised 58.3% for a F: M ratio of 1.4:1. Fifty three cases (88.3%) occurred in the parotid gland, two cases in the nasal region (3.3%), and one case each in the soft plate and upper lip (1.7%). The location of the remaining three cases was not specified. The most common presenting complaint was a well-defined facial swelling associated with pain. The average tumor size was 3.8±1.9 cm. The most predominant architectural pattern was solid (83.3%) followed by microcystic (60%), then follicular (41.7%), papillary cystic (14.3%), and tubulocystic (28.6%), and AciCC with de-differentiation/high-grade transformation was reported in three cases (5%). In 83.3% of the cases (50 out of 60), we noticed a mixture of two or more growth patterns. Other degenerative changes included prominent lymphoid stroma, hemorrhage, and cystic change., Conclusion: Awareness and recognition of diverse cytomorphological patterns of AciCC, especially in institutions of a developing country where there is limited availability of highly specific and sensitive immunohistochemical stains or molecular diagnostics, are crucial and essential., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Aga Khan University Ethics Review Committe issued approval 2023-7495-27326. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Suleman et al.)

Diagnosing a soft tissue tumor in the head and neck region can be challenging due to its complex anatomy and diverse histological spectrum. This case report highlights the case of a woman who presented with a painless neck lump in the posterior triangle of the neck. Various pathological and imaging studies were suggestive of pleomorphic adenoma, which arises from the left prevertebral space. The patient underwent complete surgical excision via the transcervical approach. Pleomorphic adenoma in the posterior triangle of the neck is extremely rare and causes a diagnostic dilemma in managing soft tissue tumors of the neck., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Musa et al.)

Facial nerve palsy (FNP) is a well-recognized complication following parotidectomy, with varying reported incidence rates in the literature. Understanding the incidence and factors contributing to FNP is crucial for optimizing patient care and surgical outcomes. A retrospective analysis was conducted on 78 patients who underwent parotidectomy at a tertiary care institution (Hospital de Especialidades Carlos Andrade Marin, Quito) over a 36-month period. Demographic data, preoperative pathology reports, surgical details, and postoperative outcomes, including FNP incidence and severity, were analyzed. The mean age of the cohort was 53 years, with a male-to-female ratio of 0.8:1. Fine needle aspiration revealed benign pathology in 70.5% of cases, with superficial parotidectomy being the most common surgical approach (84.6%). Postoperatively, FNP was observed in 51.2% of cases, with transient paralysis in 62.5% and persistent paralysis in 37.5%. The majority of FNP cases were classified as grade II and III according to the House-Brackmann grading system. A tumor size larger than 4 cm was associated with a higher incidence of FNP (57.5%). This study provides valuable insights into the incidence and severity of FNP following parotidectomy. Despite efforts to standardize surgical techniques, persistent paralysis remains a significant concern., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Otanez et al.)

Basal cell adenoma (BCA) is a rare, benign tumor originating from the epithelial cells of the salivary glands. It was earlier categorized as a subtype of monomorphic adenoma with distinctive histopathological features. BCA usually manifests as asymptomatic, slow-growing masses that exhibit a site and age predilection, commonly affecting the major salivary glands of elderly female patients. Histologically, solid, trabecular, tubular, and membranous patterns are recognized. It is imperative to establish a precise distinction between BCA, pleomorphic adenoma, and malignant salivary gland tumors before initiating treatment to ensure effective management. The standard treatment approach is surgical resection of the tumor. Recurrence and malignant transformation rarely occur, except for the membranous subtype. This article aims to report an unusual case of BCA arising from a minor salivary gland in the upper lip. The post-operative course was unremarkable, with complete healing of the surgical site. No recurrence was observed during a one-year follow-up. BCA arising from a minor salivary gland in the upper lip is an extremely uncommon entity. A comprehensive review of BCA in the upper lip, reported from 1991 to December 2023, revealed only 14 cases., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Ahmad et al.)

Carcinoma ex pleomorphic adenoma (Ca-ex-PA) is a rare tumor that arises from the malignant transformation of a primary or recurrent pleomorphic adenoma. Despite being benign, pleomorphic adenomas can rarely undergo malignant transformation. Risk factors include a long-standing primary tumor, a prior history of radiation exposure, increased tumor size, and recurrent disease. Ca-ex-PA usually affects patients between the sixth and eighth decades of life, approximately 10 to 20 years after the development of a pleomorphic adenoma. Patients usually present with the rapid expansion of an already existing mass. We describe a case report of a patient who presented with Ca-ex-PA of the submandibular gland. The patient underwent surgical excision of the affected gland, which was consistent with a widely invasive myoepithelial Ca-ex-PA. The patient underwent postoperative radiation to the neck and the tumor bed. No local or distant recurrence was noted during the one-year follow-up. Due to the rarity of the disease entity and the infrequent location of the tumor, this case presents a particular diagnostic and therapeutic challenge., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Syrnioti et al.)

Pleomorphic adenoma (PA) of the parotid gland is considered one of the commonest benign salivary gland neoplasms in both adults and pediatrics. However, metastatic pleomorphic adenoma (MPA) is extremely rare. In the past three decades, multiple cases were reported in the literature of MPA, where the metastatic phase has been preceded by a local recurrence for the majority of the cases. Metastases to the lungs, liver, bone, head and neck were reported. This paper will discuss a rare case presentation of MPA that metastasised solely to the face and scalp subcutaneous tissue with no other sites of metastases in a male adult., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, AlNahwe et al.)

In the treatment of various patients, the presence of lymphovascular invasion is a prognostic determinant, often taken into account by surgeons and oncologists. The exact frequency and prognostic impacts of this microscopic event in adenoid cystic carcinoma (ACC) patients are, however, not clear. This systematic review and meta-analysis aimed to investigate the lymph node involvement and the clinical stage of cancer as predictors of ACC prognosis. A systematic search was conducted covering a number of databases, including PubMed, Science Direct, Google Scholar, Web of Science, and EBSCO. A total of three studies were included in this analysis, with 591 participants, 247 of whom were males. Lymph node involvement and clinical stage were demonstrated as significant bad prognosis factors among ACC patients (HR = 1.48, 95% CI, 1.00, 1.96; P<0.0001). We found that lymph node involvement and clinical stage of the cancer are both significant predictors of bad prognosis of ACC., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Alsarraj et al.)

Salivary gland tumors can also occur rarely in the retromolar area, though common near the junction of hard and soft palate, labial mucosa, and buccal mucosa. Most salivary gland tumors in the retromolar pad area are malignant and should be excised. The cystadenoma is a rare, benign, salivary gland tumor. Importantly, incomplete resection of this tumor can lead to recurrence or cervical lymph node metastasis. We reported herein a case of cystadenoma arising in the right retromolar pad area in a 63-year-old male patient who underwent reconstruction using a buccal fat pad flap (BFPF) after the surgical removal of the tumor with a 10-mm margin left a defect with bone exposure. No evidence of recurrence or complication was found at the postoperative, three-year follow-up., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Watabe et al.)

Background and objective  Fast neutron radiotherapy (NRT) is a high linear energy transfer (LET) particle therapy that offers a local control (LC) advantage over low-LET X-rays in the treatment of advanced and unresectable salivary gland malignancies. However, in tumors approximating the base of skull (BOS), target volumes may be underdosed to minimize toxicity to the central nervous system (CNS). In this setting, a proton beam boost to the underdosed part of the tumor may improve LC. We report our early experience with a hybrid neutron-proton approach in patients with BOS involvement. Materials and methods We retrospectively reviewed 29 patients with locally advanced and unresectable salivary gland tumors involving the BOS between 2014-2018. The median age of the patients was 56 years, with the majority of them having adenoid cystic carcinomas (ACC) (79%) with advanced T4a/b disease (86%), pathologic perineural invasion (PNI) (55.2%), and orbital invasion (34.5%). Five patients (17.2%) were cases of re-irradiation. Surgical resection was attempted in 15 patients (51.7%), of which none achieved negative margins. The median neutron dose was 18.4 neutron Gray (nGy) with a sequential proton boost (PB) with a median dose of 25 Gy [relative biological effectiveness (RBE)] (range: 16-45 Gy). Toxicity was graded per the Common Terminology Criteria for Adverse Events (CTCAE) version 4.03. Descriptive statistics and the Kaplan-Meier method were used. Results At a median follow-up of 18.9 months [interquartile range (IQR): 6.1-32.5], the entire cohort's overall survival (OS) was 93.1%, progression-free survival (PFS) was 79.3%, and LC was 89.7%. Among patients who were not re-irradiated (n=24), the most commonly recorded acute grade 3 toxicities were mucositis (50%) and dermatitis (37.5%). There was no documented acute grade 4/5 events. Late grade 3/4 events included trismus (n=1), hearing loss (n=2), visual loss (n=6), and bone necrosis (n=1). There were no reported late grade 5 events in de novo patients. Conclusion In this challenging cohort with a poor prognosis, early outcomes for a hybrid neutron-proton approach were found to be promising. Further studies involving longer follow-ups with a larger cohort of patients are required to validate our findings., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Aljabab et al.)

Myoepithelial carcinomas are rare malignant salivary gland tumours encountered most commonly in the parotid gland and are amenable to surgical resection. However, when they occur at complex anatomical locations, complete resection becomes difficult due to their locally aggressive nature. Here we describe a case of a large myoepithelial carcinoma arising in the floor of the mouth and involving major structures at the skull base. A 30-year-old female presented with a slow-growing mass in the oral cavity. Computed tomography (CT) scan showed a heterogeneous appearing lesion in the mouth floor measuring 6.7 x 5.8 x 7.3 cm. Superiorly, the lesion was extending up to the skull base, laterally extending up to the parotid gland and inferiorly up to the submandibular gland. This lesion was also encasing the internal carotid artery. Incisional biopsy under local anaesthesia was performed, and the specimen was sent for histopathological analysis. Microscopic examination showed a neoplastic lesion composed of sheets of cells with oval nuclei and clear cytoplasm with a myxoid background. Immunohistochemical expression of pan-cytokeratin (CKAE1/AE3), p63, anti-smooth muscle actin (ASMA) and glial fibrillary acidic protein (GFAP) supported the diagnosis of myoepithelial neoplasm. The patient then underwent excision of the mass followed by histological analysis, which further showed microscopic evidence of infiltration into the surrounding tissue along with areas of atypia and significant mitoses. These morphological findings supported the diagnosis of myoepithelial carcinoma. The excised tumour was reaching up to the excision margin. Myoepithelial carcinomas are rare malignant tumours with diverse histomorphological patterns frequently present as a diagnostic challenge. The mainstay of treatment is complete surgical excision with disease-free margins, which can be challenging due to local aggressiveness and large size of these tumours. When these tumours occur in complex anatomical locations, complete excision becomes difficult, resulting in a dismal prognosis., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Ali et al.)