“Hard palate adenoid cystic carcinoma: surgical resection, radiotherapeutic strategy, and long-term surveillance”

Abstract

Adenoid cystic carcinoma (ACC) of the palate is a rare malignant tumor arising from minor salivary glands, characterized by slow but infiltrative growth, frequent perineural invasion, and a high risk of late recurrence and metastasis. We report the case of a 42-year-old male who presented with a progressively enlarging hard-soft palate mass over 5 years, associated with dyspnea, dysphagia, and mild hemipalatal paresthesia. Magnetic resonance imaging revealed a large, well-circumscribed, heterogeneously enhancing mass with extension toward the oropharyngeal lumen and suspected perineural spread. Histopathological examination confirmed ACC, solid subtype, with a Ki-67 index of XX% and perineural invasion (Szanto grade III). The patient underwent complete transoral resection followed by reconstruction using a local palatal flap and adjuvant intensity-modulated radiotherapy (66 Gy/6 weeks). At 12 months, follow-up MRI demonstrated no recurrence or metastasis. This case underscores the crucial role of multimodal imaging in defining tumor extent, guiding surgical margins, and detecting perineural spread, which directly influence treatment planning and long-term surveillance. Early diagnosis and a multidisciplinary approach are essential to optimize outcomes in palatal ACC.