{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T02:19:06Z","timestamp":1767061146129,"version":"3.48.0"},"reference-count":60,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100008375","name":"University of Basel","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100008375","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Virchows Arch"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    There is a wide range of tissue changes that may arise after exposition to ionizing radiation. Most of these changes fall in the non-neoplastic category. Nevertheless, due to the damaging effect radiation has on the DNA, there is a risk of developing secondary tumours, usually high-grade sarcomas. Here, we present a case of an elderly man who developed recurrent fibroepithelial polyps of the pharyngeal mucosa. He had a history of ipsilateral\u00a0squamous cell carcinoma of the tonsil 17\u00a0years before treated by complete surgical resection followed by adjuvant radiotherapy. Histologically, these polyps consisted of relatively well-defined, partially eroded mucosal projections with a fibro-myxoid and inflamed stroma lacking evident signs of malignancy. The 4th recurrence was submitted to DNA panel sequencing, which identified three pathogenic variants in the\n                    <jats:italic>PTEN<\/jats:italic>\n                    ,\n                    <jats:italic>DNMT3A<\/jats:italic>\n                    , and\n                    <jats:italic>TERT<\/jats:italic>\n                    genes that were not present in the local normal tissue before radiotherapy. On further analysis, well-known and established radiation induced changes such as copy number (CN)\u00a0alterations or a radiation signature were not detected. The clinical presentation and the mutations detected argue against a purely reactive, but rather a likely benign neoplastic process that is thought to have developed post-actinically, without clear evidence of malignancy (absence of atypia, no invasive growth,\u00a0flat CN profile). This case report raises awareness of a possible association between radiotherapy and the subsequent development of a benign-appearing low-grade mucosal soft tissue neoplasm.\n                  <\/jats:p>","DOI":"10.1007\/s00428-025-04252-w","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T21:15:28Z","timestamp":1757625328000},"page":"1407-1415","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Recurrent clonal radiotherapy-associated fibroepithelial polyp of the pharynx: do low grade radiogenic stromal tumours exist? Case report"],"prefix":"10.1007","volume":"487","author":[{"given":"Andrej","family":"Sirek","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivana Bratic","family":"Hench","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00fcrgen","family":"Hench","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilaria","family":"Alborelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus W.","family":"Gross","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jens","family":"Jakscha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Schaller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gideon","family":"Nagel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Baumhoer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1100-3819","authenticated-orcid":false,"given":"Alexandar","family":"Tzankov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,9,11]]},"reference":[{"key":"4252_CR1","doi-asserted-by":"publisher","unstructured":"Braunstein, Steve, and Jean L. Nakamura (2013) \u201cRadiotherapy-induced malignancies: review of clinical features, pathobiology, and evolving approaches for mitigating risk.\u201d Front Oncol 3.\u00a0https:\/\/doi.org\/10.3389\/fonc.2013.00073","DOI":"10.3389\/fonc.2013.00073"},{"issue":"5","key":"4252_CR2","doi-asserted-by":"publisher","first-page":"e232","DOI":"10.1016\/j.clon.2020.12.009","volume":"33","author":"LB Callesen","year":"2021","unstructured":"Callesen LB et al (2021) Radiation-induced sarcoma: a retrospective population-based study over 34 years in a single institution. Clin Oncol 33(5):e232\u2013e238. https:\/\/doi.org\/10.1016\/j.clon.2020.12.009","journal-title":"Clin Oncol"},{"key":"4252_CR3","doi-asserted-by":"publisher","unstructured":"Cronkite, Eugene P, et al (1960) \u201cRadiation leukemogenesis.\u201d American J Med 28(5)673\u2013682. https:\/\/doi.org\/10.1016\/0002-9343(60)90126-1","DOI":"10.1016\/0002-9343(60)90126-1"},{"key":"4252_CR4","doi-asserted-by":"publisher","unstructured":"Patel, Anand Ashwin, et al (2021) \u201cTherapy-related myeloid neoplasms in 109 patients following radiation monotherapy.\u201d Blood Adv\u00a05(20)\u00a0https:\/\/doi.org\/10.1182\/bloodadvances.2021004964","DOI":"10.1182\/bloodadvances.2021004964"},{"key":"4252_CR5","doi-asserted-by":"publisher","unstructured":"Su, Wei-Hsiang, et al (2022) \u201cNasopharyngeal radiation-induced sarcoma: a case report.\u201d Ear Nose & Throat J\u00a0103(10)NP584\u2013NP586.https:\/\/doi.org\/10.1177\/01455613221079499","DOI":"10.1177\/01455613221079499"},{"issue":"7697","key":"4252_CR6","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1038\/nature26000","volume":"555","author":"D Capper","year":"2018","unstructured":"Capper D et al (2018) DNA methylation-based classification of central nervous system tumours. Nature 555(7697):469\u2013474. https:\/\/doi.org\/10.1038\/nature26000","journal-title":"Nature"},{"key":"4252_CR7","doi-asserted-by":"publisher","unstructured":"Hench, J\u00fcrgen, et al (2024) \u201cEpiDiP\/NanoDiP: a versatile unsupervised machine learning edge computing platform for epigenomic tumour diagnostics.\u201d Acta Neuropathologica Communications 12(1)\u00a0https:\/\/doi.org\/10.1186\/s40478-024-01759-2","DOI":"10.1186\/s40478-024-01759-2"},{"issue":"1(21)","key":"4252_CR8","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-020-20603-4","volume":"12","author":"C Koelsche","year":"2021","unstructured":"Koelsche C et al (2021) Sarcoma classification by DNA methylation profiling. Nat Commun 12(1(21)). https:\/\/doi.org\/10.1038\/s41467-020-20603-4","journal-title":"Nat Commun"},{"key":"4252_CR9","doi-asserted-by":"publisher","unstructured":"Zbys\u0142aw So\u0144dka, et al. \u201cCOSMIC: a curated database of somatic variants and clinical data for cancer.\u201d Nucleic Acids Res 52(D1)D1210\u2013D1217. https:\/\/doi.org\/10.1093\/nar\/gkad986","DOI":"10.1093\/nar\/gkad986"},{"issue":"6","key":"4252_CR10","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1016\/j.semcancer.2011.10.001","volume":"21","author":"JW Shay","year":"2011","unstructured":"Shay JW, Wright WE (2011) Role of telomeres and telomerase in cancer. Semin Cancer Biol 21(6):349\u2013353. https:\/\/doi.org\/10.1016\/j.semcancer.2011.10.001","journal-title":"Semin Cancer Biol"},{"key":"4252_CR11","doi-asserted-by":"crossref","unstructured":"Kundoor Vinay Kumar Reddy, et al (2016) \u201cMucocutaneous manifestations of Cowden\u2019s syndrome.\u201d India Dermatol Online J\u00a07(6)512\u00a0https:\/\/doi.org\/10.4103\/2229-5178.193911","DOI":"10.4103\/2229-5178.193911"},{"issue":"6","key":"4252_CR12","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.1997.12.6.570","volume":"12","author":"HR Lee","year":"1997","unstructured":"Lee HR et al (1997) Cowden\u2019s disease\u2013a report on the first case in Korea and literature review. J Korean Med Sci 12(6). https:\/\/doi.org\/10.3346\/jkms.1997.12.6.570","journal-title":"J Korean Med Sci"},{"key":"4252_CR13","doi-asserted-by":"crossref","unstructured":"Marini, Katerina, et al (2021) \u201cFibroepithelial polyp of palatine tonsil: a case report.\u201d Pan African Med J\u00a039(276) https:\/\/doi.org\/10.11604\/pamj.2021.39.276.31057","DOI":"10.11604\/pamj.2021.39.276.31057"},{"issue":"37(28)","key":"4252_CR14","doi-asserted-by":"publisher","first-page":"5848","DOI":"10.1038\/sj.onc.1206697","volume":"22","author":"L Huang","year":"2003","unstructured":"Huang L et al (2003) Radiation-induced genomic instability and its implications for radiation carcinogenesis. Oncogene 22(37(28)):5848\u20135854. https:\/\/doi.org\/10.1038\/sj.onc.1206697","journal-title":"Oncogene"},{"issue":"9(1)","key":"4252_CR15","doi-asserted-by":"publisher","first-page":"2601","DOI":"10.7150\/jca.91955","volume":"15","author":"G Zhu","year":"2024","unstructured":"Zhu G et al (2024) ARID1B deficiency leads to impaired DNA damage response and activated CGAS-STING pathway in non-small cell lung cancer. J Cancer 15(9(1)):2601\u20132612. https:\/\/doi.org\/10.7150\/jca.91955","journal-title":"J Cancer"},{"key":"4252_CR16","doi-asserted-by":"publisher","unstructured":"Wei Dai, Yixin Yao (2014) \u201cGenomic instability and cancer.\u201d J Carcinogenesis & Mutagenesis 05(02). https:\/\/doi.org\/10.4172\/2157-2518.1000165","DOI":"10.4172\/2157-2518.1000165"},{"issue":"1020(1)","key":"4252_CR17","doi-asserted-by":"publisher","first-page":"e1166","DOI":"10.1259\/bjr\/25026140","volume":"85","author":"DJ Shah","year":"2012","unstructured":"Shah DJ et al (2012) Radiation-induced cancer: a modern view. Br J Radiol 85(1020(1)):e1166\u2013e1173. https:\/\/doi.org\/10.1259\/bjr\/25026140","journal-title":"Br J Radiol"},{"issue":"2","key":"4252_CR18","doi-asserted-by":"publisher","first-page":"84","DOI":"10.3857\/roj.2020.00213","volume":"38","author":"I Brook","year":"2020","unstructured":"Brook I (2020) Late side effects of radiation treatment for head and neck cancer. Radiat Oncol J 38(2):84\u201392. https:\/\/doi.org\/10.3857\/roj.2020.00213","journal-title":"Radiat Oncol J"},{"issue":"2","key":"4252_CR19","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1054\/cdip.2003.0164","volume":"9","author":"W-K Ng","year":"2003","unstructured":"Ng W-K (2003) Radiation-associated changes in tissues and tumours. Curr Diagn Pathol 9(2):124\u2013136. https:\/\/doi.org\/10.1054\/cdip.2003.0164","journal-title":"Curr Diagn Pathol"},{"issue":"3","key":"4252_CR20","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1002\/hed.27279","volume":"45","author":"Y-H Liao","year":"2022","unstructured":"Liao Y-H et al (2022) Radiation-induced sarcoma of head and neck: clinical characteristics and molecular signatures. Head Neck 45(3):638\u2013646. https:\/\/doi.org\/10.1002\/hed.27279","journal-title":"Head Neck"},{"issue":"10","key":"4252_CR21","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1046\/j.1440-1827.2003.01540.x","volume":"53","author":"K Miura","year":"2003","unstructured":"Miura K et al (2003) Radiation-induced laryngeal angiosarcoma after cervical tuberculosis and squamous cell carcinoma: case report and review of the literature. Pathol Int 53(10):710\u2013715. https:\/\/doi.org\/10.1046\/j.1440-1827.2003.01540.x","journal-title":"Pathol Int"},{"key":"4252_CR22","doi-asserted-by":"publisher","unstructured":"Raghavan, Prashant, et al (2021) \u201cImaging of complications of chemoradiation.\u201d Neuroimaging Clin North America\u00a032(1)93\u2013109.https:\/\/doi.org\/10.1016\/j.nic.2021.08.012","DOI":"10.1016\/j.nic.2021.08.012"},{"key":"4252_CR23","doi-asserted-by":"crossref","unstructured":"Ron, E, et al (1991) \u201cRadiation-induced skin carcinomas of the head and neck.\u201d Rad Res\u00a0125(3)318\u201325 pubmed.ncbi.nlm.nih.gov\/2000456\/. pubmed.ncbi.nlm.nih.gov\/2000456\/","DOI":"10.2307\/3578117"},{"issue":"5","key":"4252_CR24","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1016\/s0194-5998(96)70073-6","volume":"115","author":"E Ron","year":"1996","unstructured":"Ron E, Saftlas AF (1996) Head and neck radiation carcinogenesis: epidemiologic evidence. Otolaryngol Head Neck Surg 115(5):403\u2013408. https:\/\/doi.org\/10.1016\/s0194-5998(96)70073-6","journal-title":"Otolaryngol Head Neck Surg"},{"key":"4252_CR25","doi-asserted-by":"publisher","unstructured":"van der Laan, B F, et al (1995) \u201cRadiation-induced tumours of the head and neck.\u201d J Laryngol Otol 109(4)346\u20139.https:\/\/doi.org\/10.1017\/s0022215100130117","DOI":"10.1017\/s0022215100130117"},{"issue":"2(22)","key":"4252_CR26","doi-asserted-by":"publisher","first-page":"670","DOI":"10.1007\/s12032-011-9828-9","volume":"29","author":"Z Wei","year":"2011","unstructured":"Wei Z et al (2011) Radiation-induced sarcoma of head and neck: 50 years of experience at a single institution in an endemic area of nasopharyngeal carcinoma in China. Med Oncol 29(2(22)):670\u2013676. https:\/\/doi.org\/10.1007\/s12032-011-9828-9","journal-title":"Med Oncol"},{"issue":"45(1)","key":"4252_CR27","doi-asserted-by":"publisher","first-page":"e5364","DOI":"10.1097\/md.0000000000005364","volume":"95","author":"W Zhao","year":"2016","unstructured":"Zhao W et al (2016) The clinical characteristics of secondary primary tumors in patients with nasopharyngeal carcinoma after intensity-modulated radiotherapy. Medicine (Baltimore) 95(45(1)):e5364\u2013e5364. https:\/\/doi.org\/10.1097\/md.0000000000005364","journal-title":"Medicine (Baltimore)"},{"key":"4252_CR28","doi-asserted-by":"publisher","unstructured":"Kangabam, Boris, et al (2023) \u201cGiant fibroepithelial polyp of the penis.\u201d Cureus, vol. 15, no. 12, 8 Dec. 2023. https:\/\/doi.org\/10.7759\/cureus.50204","DOI":"10.7759\/cureus.50204"},{"issue":"4","key":"4252_CR29","doi-asserted-by":"publisher","first-page":"401","DOI":"10.5468\/ogs.2017.60.4.401","volume":"60","author":"MH Lee","year":"2017","unstructured":"Lee MH et al (2017) Fibroepithelial polyp of the vulva accompanied by lymphangioma circumscriptum. Obstet Gynecol Sci 60(4):401\u2013401. https:\/\/doi.org\/10.5468\/ogs.2017.60.4.401","journal-title":"Obstet Gynecol Sci"},{"issue":"S2","key":"4252_CR30","doi-asserted-by":"publisher","first-page":"S37","DOI":"10.1038\/modpathol.2008.201","volume":"22","author":"RH Young","year":"2009","unstructured":"Young RH (2009) Tumor-like lesions of the urinary bladder. Mod Pathol 22(S2):S37\u2013S52. https:\/\/doi.org\/10.1038\/modpathol.2008.201","journal-title":"Mod Pathol"},{"issue":"5","key":"4252_CR31","doi-asserted-by":"publisher","first-page":"1353","DOI":"10.1002\/cncr.11164","volume":"97","author":"S Oota","year":"2003","unstructured":"Oota S et al (2003) Oral pseudotumor. Cancer 97(5):1353\u20131357. https:\/\/doi.org\/10.1002\/cncr.11164","journal-title":"Cancer"},{"issue":"6","key":"4252_CR32","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.3174\/ajnr.A1043","volume":"29","author":"AD King","year":"2008","unstructured":"King AD et al (2008) MR imaging of nonmalignant polyps and masses of the nasopharynx and sphenoid sinus after radiotherapy for nasopharyngeal carcinoma. AJNR Am J Neuroradiol 29(6):1209\u20131214. https:\/\/doi.org\/10.3174\/ajnr.A1043","journal-title":"AJNR Am J Neuroradiol"},{"key":"4252_CR33","doi-asserted-by":"publisher","unstructured":"Yan, Jiehua, et al (2004) \u201cIn situ benign growth after radical radiation therapy of head and neck cancers - report of eight patients.\u201d Radiotherapy and Oncology 16(2)109\u2013113. https:\/\/doi.org\/10.1016\/0167-8140(89)90027-3","DOI":"10.1016\/0167-8140(89)90027-3"},{"issue":"3","key":"4252_CR34","doi-asserted-by":"publisher","first-page":"330","DOI":"10.4103\/0973-029x.174614","volume":"19","author":"S Vidyanath","year":"2015","unstructured":"Vidyanath S et al (2015) Reactive hyperplasic lesions of the oral cavity: a survey of 295 cases at a tertiary health institution in Kerala. J Oral Maxillofac Pathol 19(3):330. https:\/\/doi.org\/10.4103\/0973-029x.174614","journal-title":"J Oral Maxillofac Pathol"},{"issue":"3","key":"4252_CR35","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1016\/0030-4220(86)90010-1","volume":"62","author":"JE Bouquot","year":"1986","unstructured":"Bouquot JE, Gundlach KKH (1986) Oral exophytic lesions in 23,616 White Americans over 35 years of age. Oral Surg Oral Med Oral Pathol 62(3):284\u2013291. https:\/\/doi.org\/10.1016\/0030-4220(86)90010-1","journal-title":"Oral Surg Oral Med Oral Pathol"},{"key":"4252_CR36","doi-asserted-by":"publisher","unstructured":"de Santana Santos, Thiago, et al (2014) \u201cFocal fibrous hyperplasia: a review of 193 cases.\u201d J Oral Maxillofac Pathol 18(4)86.https:\/\/doi.org\/10.4103\/0973-029x.141328","DOI":"10.4103\/0973-029x.141328"},{"issue":"1","key":"4252_CR37","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/j.cden.2004.07.001","volume":"49","author":"T Esmeili","year":"2005","unstructured":"Esmeili T et al (2005) Common benign oral soft tissue masses. Dent Clin North Am 49(1):223\u2013240. https:\/\/doi.org\/10.1016\/j.cden.2004.07.001","journal-title":"Dent Clin North Am"},{"key":"4252_CR38","unstructured":"Hamideh Kadeh, et al (2015) \u201cReactive hyperplastic lesions of the oral cavity.\u201d Iran J Otorhinolaryngol 27(79)137 https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC4409958\/"},{"issue":"1","key":"4252_CR39","doi-asserted-by":"publisher","first-page":"125","DOI":"10.5114\/ada.2019.82834","volume":"36","author":"M Jiang","year":"2019","unstructured":"Jiang M et al (2019) A case of irritation fibroma. Adv Dermatol Allergol 36(1):125\u2013126. https:\/\/doi.org\/10.5114\/ada.2019.82834","journal-title":"Adv Dermatol Allergol"},{"key":"4252_CR40","doi-asserted-by":"publisher","unstructured":"Kleber, Gleyson, et al (2023) \u201cHamartomatous polyp of the palatine tonsil: a case report and critical literature review.\u201d Head and Neck Pathology, vol. 17, no. 2, 1 Feb. 2023, pp. 502\u2013508. https:\/\/doi.org\/10.1007\/s12105-023-01529-x","DOI":"10.1007\/s12105-023-01529-x"},{"key":"4252_CR41","doi-asserted-by":"publisher","unstructured":"Lee, Jae-Hoon (2019) \u201cFibroepithelial polyp arising from the nasal vestibule.\u201d Ear, Nose & Throat J 100(5)590S - 591S. https:\/\/doi.org\/10.1177\/0145561319892456","DOI":"10.1177\/0145561319892456"},{"key":"4252_CR42","unstructured":"Naderi, Noushin Jalayer, et al (2025) \u201cReactive lesions of the oral cavity: a retrospective study on 2068 cases.\u201d Dent Res J\u00a09(3)251. pmc.ncbi.nlm.nih.gov\/articles\/PMC3469888\/"},{"issue":"6","key":"4252_CR43","doi-asserted-by":"publisher","first-page":"289","DOI":"10.5177\/ntvt.2022.06.21117","volume":"129","author":"MT Tilkema","year":"2022","unstructured":"Tilkema MT et al (2022) A large maxillary fibroepithelial polyp: a lump in the throat. Ned Tijdschr Tandheelkd 129(6):289\u2013292. https:\/\/doi.org\/10.5177\/ntvt.2022.06.21117","journal-title":"Ned Tijdschr Tandheelkd"},{"issue":"2(6)","key":"4252_CR44","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1111\/ggi.12458","volume":"16","author":"K Dhanuthai","year":"2015","unstructured":"Dhanuthai K et al (2015) Geriatric oral lesions: a multicentric study. Geriatr Gerontol Int 16(2(6)):237\u2013243. https:\/\/doi.org\/10.1111\/ggi.12458","journal-title":"Geriatr Gerontol Int"},{"key":"4252_CR45","doi-asserted-by":"publisher","unstructured":"Lalchandani, Chahita M, et al (2020) \u201cRecurrent irritation fibroma - \u201cwhat lies beneath\u201d: a multidisciplinary treatment approach.\u201d Int J Clin Pedia Dent\u00a013(3)306\u2013309. https:\/\/doi.org\/10.5005\/jp-journals-10005-1769","DOI":"10.5005\/jp-journals-10005-1769"},{"issue":"1(13)","key":"4252_CR46","doi-asserted-by":"publisher","first-page":"66","DOI":"10.2174\/1874210601105010066","volume":"5","author":"NO Binmadi","year":"2011","unstructured":"Binmadi NO (2011) Oral inflammatory myofibroblastic tumor: case report and review of literature. Open Dent J 5(1(13)):66\u201370. https:\/\/doi.org\/10.2174\/1874210601105010066","journal-title":"Open Dent J"},{"issue":"2","key":"4252_CR47","doi-asserted-by":"publisher","first-page":"66","DOI":"10.5125\/jkaoms.2018.44.2.66","volume":"44","author":"S-K Min","year":"2018","unstructured":"Min S-K et al (2018) Desmoplastic melanoma of the oral cavity: diagnostic pitfalls and clinical characteristics. J Korean Assoc Oral Maxillofac Surg 44(2):66\u201372. https:\/\/doi.org\/10.5125\/jkaoms.2018.44.2.66","journal-title":"J Korean Assoc Oral Maxillofac Surg"},{"key":"4252_CR48","doi-asserted-by":"publisher","DOI":"10.1016\/j.omsc.2020.100174","author":"B Palla","year":"2020","unstructured":"Palla B et al (2020) Spindle cell variant squamous cell carcinoma of the oral cavity: case presentation and review of literature. Oral Maxillofac Surg Cases. https:\/\/doi.org\/10.1016\/j.omsc.2020.100174","journal-title":"Oral Maxillofac Surg Cases"},{"key":"4252_CR49","unstructured":"National Research Council (US) Committee on the Biological Effects of Ionizing Radiation (BEIR V (2015) \u201cGenetic effects of radiation.\u201d Nih.gov, National Academies Press (US). www.ncbi.nlm.nih.gov\/books\/NBK218706\/"},{"key":"4252_CR50","doi-asserted-by":"publisher","unstructured":"Sousa-Neto, Sebasti\u00e3o Silv\u00e9rio, et al (2022) \u201cOrofacial manifestations assisting the diagnosis of cowden syndrome in a middle-aged patient: case report and literature overview.\u201d Head and Neck Path\u00a016(1)304\u2013313.https:\/\/doi.org\/10.1007\/s12105-021-01345-1","DOI":"10.1007\/s12105-021-01345-1"},{"key":"4252_CR51","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1007\/s00277-022-04761-7","volume":"101","author":"F Consonni","year":"2022","unstructured":"Consonni F et al (2022) ALPS, FAS, and beyond: from inborn errors of immunity to acquired immunodeficiencies. Ann Hematol 101:469\u2013484. https:\/\/doi.org\/10.1007\/s00277-022-04761-7","journal-title":"Ann Hematol"},{"issue":"4","key":"4252_CR52","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1016\/j.humpath.2005.01.017","volume":"36","author":"K-I Kawaguchi","year":"2005","unstructured":"Kawaguchi K-I et al (2005) Genetic and epigenetic alterations of the PTEN gene in soft tissue sarcomas. Hum Pathol 36(4):357\u2013363. https:\/\/doi.org\/10.1016\/j.humpath.2005.01.017","journal-title":"Hum Pathol"},{"issue":"3","key":"4252_CR53","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/j.soncn.2009.05.002","volume":"25","author":"I Mallick","year":"2009","unstructured":"Mallick I, Waldron JN (2009) Radiation therapy for head and neck cancers. Semin Oncol Nurs 25(3):193\u2013202. https:\/\/doi.org\/10.1016\/j.soncn.2009.05.002","journal-title":"Semin Oncol Nurs"},{"key":"4252_CR54","doi-asserted-by":"publisher","unstructured":"Maria, Osama Muhammad, et al (2017) \u201cRadiation-induced oral mucositis.\u201d Front Oncol\u00a07(89)\u00a0https:\/\/doi.org\/10.3389\/fonc.2017.00089","DOI":"10.3389\/fonc.2017.00089"},{"key":"4252_CR55","doi-asserted-by":"crossref","unstructured":"Milella, Michele, et al (2015) \u201cPTEN: multiple functions in human malignant tumors.\u201d Front Oncol\u00a05(24) https:\/\/doi.org\/10.3389\/fonc.2015.00024","DOI":"10.3389\/fonc.2015.00024"},{"key":"4252_CR56","doi-asserted-by":"publisher","unstructured":"Pilarski, Robert (2019) \u201cPTEN hamartoma tumor syndrome: a clinical overview.\u201d Cancers\u00a011(6)844. https:\/\/doi.org\/10.3390\/cancers11060844","DOI":"10.3390\/cancers11060844"},{"issue":"7246","key":"4252_CR57","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1038\/nature07940","volume":"459","author":"DA Smirnov","year":"2009","unstructured":"Smirnov DA et al (2009) Genetic analysis of radiation-induced changes in human gene expression. Nature 459(7246):587\u2013591. https:\/\/doi.org\/10.1038\/nature07940","journal-title":"Nature"},{"key":"4252_CR58","doi-asserted-by":"publisher","unstructured":"Stefano, Sioletic, and Scambia Giovanni. \u201cThe PTEN tumor suppressor gene in soft tissue sarcoma.\u201d Cancers\u00a011(8)1169.https:\/\/doi.org\/10.3390\/cancers11081169","DOI":"10.3390\/cancers11081169"},{"key":"4252_CR59","doi-asserted-by":"publisher","unstructured":"Yehia, Lamis, et al (2019) \u201cThe clinical spectrum of PTEN mutations.\u201d Annual Rev Med 71(1). https:\/\/doi.org\/10.1146\/annurev-med-052218-125823","DOI":"10.1146\/annurev-med-052218-125823"},{"key":"4252_CR60","doi-asserted-by":"publisher","unstructured":"Yin, Liang, et al (2012) \u201cMutational analysis of P53 and PTEN in soft tissue sarcoma.\u201d Mol Rep 5(2)457\u201361.https:\/\/doi.org\/10.3892\/mmr.2011.660","DOI":"10.3892\/mmr.2011.660"}],"container-title":["Virchows Archiv"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00428-025-04252-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00428-025-04252-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00428-025-04252-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T02:06:30Z","timestamp":1767060390000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00428-025-04252-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,11]]},"references-count":60,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["4252"],"URL":"https:\/\/doi.org\/10.1007\/s00428-025-04252-w","relation":{},"ISSN":["0945-6317","1432-2307"],"issn-type":[{"type":"print","value":"0945-6317"},{"type":"electronic","value":"1432-2307"}],"subject":[],"published":{"date-parts":[[2025,9,11]]},"assertion":[{"value":"29 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 August 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 August 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 September 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Informed consent for research purposes was obtained from the patient.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}