Presentation
Smoker with right sided neck mass.
Patient Data
Neck ultrasound demonstrates an enlarged right level 2 node, with loss of normal hilar architecture. Long axis measurement 36 mm.
No other nodal abnormality.
Core biopsy performed following this.
Asymmetric bulky right palatine tonsil, measuring 28 mm in long axis.
Closed glottis, but no other aerodigestive tract mass.
Abnormal right level 2A node (interval sampling noted). Predominantly cystic content with peripheral enhancement. Long axis 38 mm. No features of extracapsular extension.
No other ipsilateral or contralateral nodes.
Right mylohyoid boutonniere noted, with normal major salivary glands. Normal major head and neck vessels.
Chest / skeleton normal (not included in upload).
Primary right palatine tonsil tumor, approximately 30 mm in size.
Predominantly necrotic right 2A node (43 mm long axis). Further asymmetric right 1B node (adjacent to the herniated sublingual gland) appears to have lost normal hilar architecture and is slightly rounded - possibly also pathological.
No contralateral nodal disease.
Signal abnormalities in the facial tissues along the jawline and nasolabial folds bilaterally - best seen as high T2w signal - compatible with cosmetic filler.
Case Discussion
Right palatine tumor, maximally measuring 30 mm on imaging, with pathological right 2A and possible 1B nodal disease (longest axis measurement 43 mm). No distant disease.
Nodal core biopsy confirmed HPV-associated squamous cell carcinoma. Under AJCC 8 staging, this is T2 N1 M0 (tumor between 2-4 cm, one or more ipsilateral nodes <6 cm).
Additional findings of mylohyoid boutonniere with sublingual gland herniation (not to be mistaken for nodal disease) and cosmetic filler in the facial soft tissues - increasingly seen across all adult age groups.
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