Transoral Robotic Surgery for High Grade Oropharyngeal Mucoepidermoid Carcinoma With Good Outcome and Preserved...

Mucoepidermoid carcinoma (MEC) is a common malignant salivary gland tumor but rarely seen in the tonsil.

We report a case of a 68-year-old woman who presented with a 1.0 cm left neck mass. Laryngoscopy revealed a 1.0 cm nodule in the left tonsil, extending into the base of tongue (BOT). Biopsies from the left tonsil and left BOT revealed similar histology with fragments of minor salivary gland tumor composed of predominantly clear cells, squamous cells, and focal mucous cells, morphologically favoring MEC. Fluorescence in situ hybridization (FISH) revealed that the tumor was positive for mastermind-like transcriptional coactivator 2 (MAML2) (11q21) gene rearrangement, confirming the diagnosis of MEC. The tumor was resected by transoral robotic assisted surgery (TORS) with negative margins. The final diagnosis was high grade MEC with a tumor size of 4.0 cm (pT2N1). The patient underwent post-surgical adjuvant radiotherapy. At four-year follow up, the patient is doing well and has no signs of recurrence or metastasis.

This case report illustrates, to the best of our knowledge, the first documented case of using TORS for MEC of the BOT involving both lingual and palatine tonsils with four years of disease-free survival, despite high histologic grade. Our case sheds light on the use of TORS for improved long-term outcome and preserved oropharyngeal functions for patients with oropharyngeal MEC.