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case_images: Preoperative enhanced CT images of the patient. The sagittal, horizontal and coronal planes of the CT images reveal a well-defined nodular soft tissue shadow on the right side of the tongue root (arrow). The lesion had regular edges, although the tongue border was unclear. The maximum cross-section measured ~3.7x2.3 cm, with no enlarged lymph nodes in the maxillofacial and cervical regions. Additionally, there was no apparent thickening or protrusion on either side of the inner wall of the vocal folds. The laryngeal soft tissue structure remained symmetrical, with no apparent high-density masses. The epiglottis was not visibly enlarged, the pyriform sinuses on both sides and the paralaryngeal space were clear, and there was no damage to the surrounding bone. CT, computed tomography.
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case_images: Enhanced head and neck computed tomography (CT) revealed a homogeneously enhancing mass to the right of the tongue root, causing narrowing of the right epiglottic vallecular (Fig. 1).
case_images: Preoperative laryngeal magnetic resonance imaging of the patient. The image revealed a soft tissue mass shadow on the right side of the posterior part of the tongue root with slightly high signal intensity on the T2WI fat-compression image (arrow), along with a linear isointense shadow within the lesion. The lesion measured ~3.5x2.3 cm, with compression of the epiglottic vallecula. The enhancement scan showed significant homogeneous lesion enhancement and no obviously enlarged lymph nodes were observed bilaterally in the neck.
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case_images: Magnetic resonance imaging (MRI) of the head and neck showed an abnormal signal to the right of the posterior root of the tongue, suggesting an abnormal localization (Fig. 2).
case_images: Hematoxylin and eosin staining results of the tongue root mass. (A) The area indicated by the arrow shows the cell nuclei were small with inconspicuous nucleoli and distinct cell boundaries (magnification, x40). (B) Hyaline cells formed strips or trabeculae, extruding hyalinized and sclerotic fibrous mesenchyme (arrow) (magnification, x100). (C) The stroma surrounding the cell nests shows a fibrillary red staining, and the mesenchyme around the tumor was fibrocystic in nature. Tumor cells infiltrated into the fibrous interstitium as indicated by the arrow (magnification, x200). (D) Cancer cells were distributed in nests within the fibrous interstitium with a more homogeneous nuclear morphology, and the phenomenon of nuclear fission was infrequent as indicated by the arrow (magnification, x400).
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case_images: The cytoplasm of the tumor cells was transparent, the stroma around the nests of the cells was reddish-stained, and the mesenchymal stroma around the tumor showed fibrous changes (Fig. 3).
case_images: Immunohistochemical staining results of the tongue root mass. (A) CK5/6 (+), magnification x100, (B) CK7 (+), magnification x100, (C) calponin (-), magnification x40, (D) p63 (+), magnification x40, (E) Ki-67 (5%+), magnification x40, (F) CD34 (-), magnification x40, (G) S-100 (-), magnification x40, (H) SOX10 (-), magnification x40 and (I) DOG-1 (-), magnification x40. CK, cytokeratin.
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case_images: Immunohistochemical staining revealed the following results: CK5/6 (+), CK7 (+), calponin (-), p63 (+), CD117 (-), p40 (+), Ki-67 (5% +), CD34 (-), S-100 (-) and SOX10 (-; Fig. 4). DOG1 result (Fig. 4). DOG1, or discovered on gastrointestinal stromal tumors 1, is an immunohistochemical marker primarily used to identify
case_images: Postoperative enhanced computed tomography of the tongue. The image revealed discontinuity in the alignment of the cortical and mandibular bones. The right side of the tongue was partially missing, and the structure of the operative area was disorganized (arrow). The right submandibular gland was not visible, and the operative area appeared as a dense nodular shadow. Pore patches of adipose tissue accumulation and soft tissue density shadows were observed from the operative area to the right sternocleidomastoid muscle. The enhancement scan of the operative area showed linear enhancement of density shadows. The right submandibular area of soft tissue was slightly swollen, and the surrounding fat interstitial space was slightly turbid. The right laryngopharyngeal and oropharyngeal cavities were slightly narrowed, indicative of postoperative change.
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case_images: The right submandibular gland was not visible (Fig. 5), consistent with the postoperative changes from the localized surgery.
case_images: Schematic diagram of the literature review for HCCC. HCCC, hyalinizing clear cell carcinoma.
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case_images: After thoroughly reviewing these reports and their relevant references, 15 reports with adequate clinical data, including complete pre- and postoperative information, were identified (Fig. 6).