Mucoepidermoid carcinoma of the vallecula mimicking a benign lesion: a case report

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.