Despite advances in the management of head and neck squamous cell carcinoma (HNSCC), mortality within 6 months of diagnosis remains a substantial clinical challenge. The objectives of this study are: (i) to develop a machine learning (ML) model using data from the Surveillance, Epidemiology, and End Results (SEER) program to assess the influence of patient characteristics, tumor features, and treatment modalities on early mortality in HNSCC; (ii) to explore and compare the prognostic potentials of patient-, tumor, and treatment-related factors across distinct mortality time points-6-month mortality (early mortality), 24-month mortality, and 5-year mortality; and (iii) to externally and independently validate the early mortality model using multicenter data from the Thuringian Cancer Registry (Jena, Germany) and a prospective observational cohort from the Helsinki University Hospital (Helsinki, Finland). We identified 4802 patients with HNSCC from the SEER for model development. Permutation-based feature importance was used to identify risk factors associated with early mortality. External validation was conducted using 1952 cases from the Thuringian Cancer Registry and 58 cases from the Helsinki University Hospital. The ML model achieved a weighted area under curve (AUC) of 0.75 for predicting early mortality in the SEER cohort. External validation yielded weighted AUC values of 0.70 (Germany) and 0.60 (Finland). Aggregate feature importance for early mortality indicated that higher age at diagnosis, presence of earlier primary malignant tumors besides HNSCC, unmarried patients with T1-T3 HNSCC, T3 stage, and having hypopharyngeal or laryngeal cancer, in decreasing order of significance, were important. For 24-month mortality, the associated risk factors in decreasing order of significance were T3 stage, being elderly in terms of age at diagnosis, presence of earlier primary malignant tumors besides HNSCC, having hypopharyngeal or oral cavity cancer, and N3 stage. The associated risk factors for 5-year mortality were found to be the same with those of early mortality with the additional inclusion of T2 stage. Identification of patients at elevated risk of early death supports timely intervention and individualized therapeutic decision-making. The developed ML model identified several risk factors associated with early death and may aid in clinical decision-making with the potential to improve survival outcomes.

Tracheal diverticulum is frequently detected incidentally on cross-sectional imaging but may pose a significant intraoperative challenge when anticipated within or adjacent to the thyroid surgical field, particularly in close proximity to the recurrent laryngeal nerve (RLN) and during central compartment (level VI) dissection. Conventionally, surgeons use preoperative computed tomography (CT) to approximate diverticular anatomy and then rely on intraoperative experience and anatomic landmarks for dissection. Recognition is challenging because intraoperative localization relies on CT correlation and anatomic landmarks within the posterior capsular plane; limited exposure may obscure the diverticulum, and a non-aerated sac may collapse and become indistinguishable from surrounding soft tissue, increasing the risk of rupture and subsequent loss of tension with further obscured planes and potential operative-field contamination. However, a standardized intraoperative workflow to functionally localize the diverticulum (and confirm tracheal communication) before definitive posterior dissection, and to verify tracheal integrity after diverticulectomy and repair, is lacking. Here, we describe a stepwise surgical technique for planned thyroidectomy in which a cervical tracheal diverticulum has been identified preoperatively. The workflow integrates preoperative contrast-enhanced CT-based risk stratification with a ventilation-assisted functional visualization maneuver [standardized endotracheal tube (ETT) repositioning within recorded cuff-depth boundaries 'D_cuff, the ETT incisor depth at which the proximal cuff margin is visualized just distal to the vocal cords; D_cuff2, the deeper ETT incisor depth after advancement beyond the diverticular level to keep the cuff distal to the diverticular ostium'] to localize the diverticular sac at the CT-predicted region and confirm tracheal communication before definitive posterior dissection. After localization, posterior dissection proceeds with deliberate RLN identification and protection, followed by controlled diverticulectomy and submerged air-leak testing under gentle manual ventilation to verify tracheal wall integrity.

In our previous study, a home-built handheld OCT system was used to collect OCT images in vocal cord leukoplakia. First, 383 valid OCT images were collected from 12 patients with leukoplakia (including low-risk, high-risk, and malignant types). The best overall accuracy and recall were 92.59% and 93.25% for low-risk, high-risk, and malignant classification, by random forest (RF) model using 5-fold validation. However, low-risk dysplasia with a sensitivity of 87.72% could not meet clinical requirements. Here, we proposed an end-to-end joint learning model using optical coherence tomography (E2E-OCT) images for vocal cord leukoplakia diagnosis. The overall accuracy and recall improved by 5.58% and 4.87%, and especially the sensitivity for low-risk dysplasia improved from 87.72% to 97.48%. Notably, under leave-one-patient-out (LOPO) cross-validation, the model also maintained 96.64% sensitivity for low-risk dysplasia. The ablation experiments and explanation experiments demonstrated the robustness of our model.

Rhabdomyoma is a skeletal muscle lesion. It is considered a rare and non-aggressive tumor originating from striated muscle. It may occur in the heart or in extracardiac region. In adults, it most typically occurs in the larynx and pharynx. The occurrence in the paracarotid space is extremely rare, and no similar cases was found in the recent literature. We present an unprecedented case of a paracarotid rhabdomyoma in a 50-year-old female who underwent total thyroidectomy for a goiter. Clinical examination revealed an asymptomatic cervical mass on the left side of the neck. Ultrasound showed a hypoechoic, solid lesion, which was characterized as a parathyroid adenoma. The diagnosis was confirmed postoperatively by histopathology. The aim of this article is to report a rare extracardiac location of this tumor. Complete surgical excision is paramount due to the high potential for recurrence in cases of incomplete excision.

Laryngeal squamous cell carcinoma (LSCC) frequently arises from premalignant dysplastic lesions, yet reliable predictors of malignant transformation remain limited. This study investigates the immune microenvironment of laryngeal dysplasia and its association with progression to invasive carcinoma. We conducted a retrospective cohort study of 110 patients with histologically confirmed laryngeal dysplasia excised between 2009 and 2022, reclassified according to the 2022 WHO two‑tier system. Clinical data, including tobacco and alcohol exposure, were collected, and outcomes included recurrence, progression to invasive carcinoma, and cancer‑free survival. Immunohistochemistry and digital image analysis were used to quantify intraepithelial and stromal immune markers (CD3+, CD4+, CD8+, CD68+, CD163+, PD-L1). High-grade dysplasia represented 68% of cases, and 33% progressed to invasive carcinoma. Intraepithelial T-cell and macrophage densities did not differ significantly between progressing and non-progressing lesions, whereas stromal immune characteristics showed prognostic value. In multivariate analysis, alcohol exposure, dysplasia grade, stromal CD8 + density, and PD-L1 expression were independently associated with progression. Former drinkers showed a higher risk than lifelong abstainers, while high-grade dysplasia carried a fourfold increased risk relative to low-grade lesions. Higher stromal CD8 + infiltration and lower stromal PD-L1 expression correlated with progression, though with modest effect sizes. Digital immune profiling validated distinct stromal immune signatures associated with progression in laryngeal dysplasia. These findings suggest that malignant transformation depends not only on histological grade and alcohol exposure but also on subtle immune alterations, supporting integration of stromal immune markers with WHO grading to refine risk stratification and guide surveillance strategies.

Background/Objectives: Management of cervical esophageal cancer after induction therapy remains unsettled. Definitive chemoradiotherapy is the guideline default, but a subset of patients with residual but resectable disease may still benefit from surgery. No validated multidisciplinary selection framework exists for this subsite. Methods: We conducted a systematic review registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420261369102) and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement, using searches of PubMed/MEDLINE, Web of Science, Scopus, and the Cochrane Library from inception through 14 April 2026. We identified 1779 records, removed 873 duplicates, and screened 906 records; 87 full-text reports were assessed, of which 67 were excluded at the full-text stage (66 on population grounds-disease not cervical esophageal; and 1 because cervical-direct outcomes were not separable within a mixed cervical/thoracic cohort), leaving 20 cervical-direct studies included in the primary synthesis. Thoracic and meta-analytic sources are cited for indirect comparison and biological rationale but are not counted in the included set. Included studies were evaluated using the Newcastle-Ottawa Scale (NOS) and Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I); certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. Formal meta-analysis was not performed because study design, treatment approach, and outcome reporting were too heterogeneous. Results: Cervical-specific evidence is predominantly retrospective but consistent in direction. Available cervical-specific observational data suggest benefit mainly in patients with biopsy-confirmed incomplete response, resectable residual disease, preserved performance status, and access to experienced centers. Larynx-preserving resection is feasible in 90% of T1-2 tumors and 54% of T3-4 responders. In thoracic esophageal squamous cell carcinoma, neoadjuvant chemoimmunotherapy yields pathologic complete response rates of approximately 29-48%; in cervical disease, the SCENIC trial has reported interim clinical response of approximately 50% in 28 patients, but pathology-confirmed response is not yet available. We present a proposed multidisciplinary selection framework integrating response depth, post-induction stage, laryngeal preservation feasibility, sarcopenia, circulating tumor DNA dynamics, and programmed death-ligand 1 (PD-L1) expression. The framework has not been prospectively validated and is presented as a hypothesis-generating, conceptual tool for multidisciplinary discussion rather than a clinically validated instrument. Adjuvant nivolumab is recommended for residual pathologic disease after margin-negative (R0) resection when surgery follows preoperative chemoradiotherapy; after PD-1-based induction, adjuvant checkpoint inhibition remains investigational. Conclusions: The available cervical-direct evidence is predominantly retrospective and selection-prone, and several inputs supporting the framework are extrapolated from thoracic ESCC cohorts; conclusions about the survival benefit of surgery should therefore be read as associations rather than causal claims. Surgery has a role after induction therapy in carefully selected incomplete responders. The proposed framework is designed for multidisciplinary use and requires prospective validation before routine clinical application.

Background: Critical upper airway obstruction caused by advanced laryngeal malignancy poses an extreme risk of airway loss during induction of anesthesia and instrumental airway management. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) has emerged as a strategy to enable safe performance of high-risk airway interventions. However, reports on heparin-free protocols in this setting remain scarce. Methods: A 46-year-old male with progressive dyspnea caused by a large laryngeal tumor reducing the residual glottic lumen to ~1 mm was admitted urgently. Safe endotracheal intubation was deemed impossible. Elective heparin-free VV-ECMO was established under local anesthesia via percutaneous femoro-femoral cannulation before induction of general anesthesia. Results: Under ECMO support, a technically demanding tracheostomy and tumor biopsy were performed without hypoxemic episodes. VV-ECMO was maintained postoperatively for 48 h without systemic anticoagulation and was weaned without hemorrhagic or thrombotic complications. Histopathology confirmed squamous cell carcinoma grade 2; the patient was discharged home after initiation of systemic immunotherapy. Conclusions: Elective heparin-free VV-ECMO can provide effective and safe respiratory support for patients with critical airway obstruction undergoing high-risk airway procedures. Pre-emptive cannulation under local anesthesia, femoro-femoral access in anatomically compromised necks, and short heparin-free circuit runs mitigate both airway and hemorrhagic risk. Prospective studies are needed to establish standardized patient selection criteria and anticoagulation protocols.

Laryngeal cancer is a relatively uncommon malignancy with predisposing genetic factors that remain unclear. Single-nucleotide polymorphisms (SNPs) in genes involved in innate immune signaling may contribute to the development and progression of laryngeal carcinoma. This study aimed to evaluate the association of TLR4 (rs7037225, rs11536889, rs7037117) and MYD88 (rs7744, rs6853) polymorphisms with the risk of laryngeal squamous cell carcinoma (LSCC), as well as its clinical and pathological characteristics and survival. A retrospective case-control study involving 172 LSCC patients and 220 healthy controls was conducted. Genotyping was performed using real-time PCR from venous blood samples. MYD88 rs7744 was significantly associated with tumor size and lymph node involvement. Survival analysis showed a significant association between rs7744 and recurrence-free survival (RFS), with the AG and GG genotypes linked to poorer outcomes. Conversely, carriers of the TLR4 rs7037225 CT genotype showed significantly improved RFS, with p ranging from 0.024 to 0.037 across models. Considering the significant roles of TLR4 and MYD88 in Toll-like receptor signaling, these findings may reflect the involvement of innate immune pathways in LSCC progression. In summary, MYD88 rs7744 was associated with clinicopathological features and RFS, while TLR4 rs7037225 appeared to have a potential protective effect on survival.

ObjectivesLocally advanced laryngeal cancer (LALC) treatment options include surgery followed by postoperative radiotherapy (PORT) or chemoradiotherapy (POCRT) versus non-surgical definitive radiotherapy (RT) or chemoradiotherapy (CRT). Their comparative efficacy remains debated. This study aimed to evaluate survival outcomes and prognostic factors in LALC patients receiving postoperative (PORT/POCRT) versus definitive (RT/CRT) treatment.MethodsWe retrospectively enrolled 210 LALC patients treated at our hospital (2010-2021). Overall survival (OS) and progression-free survival (PFS) were analyzed. Prognostic factors were identified using multivariate Cox regression.ResultsMedian follow-up was 46 months. Median, 3- and 5-year OS was 70 months, 73.2%, and 57.7%, respectively, while the corresponding PFS was 45 months, 55.8%, and 41.3%. Multivariate analysis identified Karnofsky Performance Status (KPS) score, pathological differentiation, and pretreatment prognostic nutritional index (PNI) as independent risk factors for OS and PFS; second primary cancer and lesion site were independent risk factors for PFS. PORT/POCRT was associated with significantly higher local control and PFS than definitive CRT (P < 0.05). Both PORT/POCRT and definitive CRT were associated with significantly better OS and PFS than definitive RT alone (P < 0.05).ConclusionHigher KPS, moderate-to-high differentiation, and higher PNI predict better OS and PFS. Absence of a second primary cancer and presence of a glottic primary tumor predict better PFS. PORT/POCRT was most effective, followed by definitive CRT; definitive RT alone was least effective.

Extramedullary plasmacytomas (EMPs) are uncommon neoplasms that rarely involve the feline larynx. This report details a solitary laryngeal EMP in a 12-year-old female domestic shorthair cat presenting with progressive dysphonia, dyspnea, and severe upper airway obstruction. Clinical and imaging examination revealed a mass originating from the epiglottis, causing severe chronic laryngeal stenosis. Due to the complexity and poor prognosis of the condition, euthanasia was elected. Histopathology demonstrated a non-encapsulated, submucosal proliferation of well-differentiated plasma cells within the epiglottis. The neoplastic cells exhibited mild to moderate cellular pleomorphism, characterized by anisocytosis, anisokaryosis, karyomegaly, occasional binucleation, and the presence of Mott cells. Immunohistochemistry (IHC) showed diffuse nuclear and cytoplasmic immunolabelling for MUM-1, confirming the plasma cell lineage. Based on the morphological and immunohistochemical findings, a diagnosis of solitary benign laryngeal EMP was established. This case emphasizes that while laryngeal EMPs are often histologically benign, their critical anatomical location can confer the potential for life-threatening obstructive respiratory disease. EMPs should thus be considered a key differential diagnosis for obstructive upper airway lesions in cats.

Sequential triple primary malignancies are very uncommon. Distinguishing new primary tumors from metastases in cancer survivors is a diagnostic challenge. This case illustrates how comprehensive immunohistochemistry (IHC), particularly p53 expression patterns as a surrogate for TP53 gene status, can determine clonal independence. A 71-year-old male ex-smoker presented with three malignancies over 4 years. First, laryngeal squamous cell carcinoma (pT1bN0M0) showed complete loss of p53 staining (null pattern, truncating mutation). Four years later, lung adenocarcinoma (pT1bN1M0; TTF-1+/Napsin A+) showed strong, diffuse p53 nuclear positivity (missense mutation pattern). One month later, intrahepatic cholangiocarcinoma (pT1N0M0; CK7+/CK19+/TTF-1-) showed wild-type p53 (scattered weak positivity). Divergent p53 IHC patterns (two mutant phenotypes and one wild-type) indicated three independent primaries. The patient recovered well after each curative-intent surgery. Meticulous IHC profiling and careful interpretation of p53 staining patterns are crucial for distinguishing multiple primary cancers from metastatic disease.