Presentation
Dysphagia. Heavy cigarette smoking and alcohol consumption.
Patient Data
Age: 65
Gender: Male
From the case:
Oropharyngeal squamous cell carcinoma
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- Large exophytic mass centered on the right side of the posterior oropharyngeal wall (13 x 26 x 22 mm).
- Extends between tongue base and hyoid level. There is involvement of both the posterior wall, with crossing of the midline, and the lateral wall, to the superior aspect of the piriform sinus.
- Lymphadenopathy:
- Right level 2b with central necrosis
- Right level 2a lymphadenopathy
- The largest conglomerate mass invades the adjacent right internal jugular vein at C3 level, decreasing its lumen to trickle flow.
- Incidental note is made of occlusion of the left internal carotid artery from its origin. The right ICA has about a 50% proximal stenosis.
From the case:
Oropharyngeal squamous cell carcinoma
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- Posterior right exophytic oropharyngeal mass (27 x 13 x 23 mm) demonstrates homogenous enhancement.
- Abnormal enhancing tissue extends into the epiglottis, across the midline and into a T2 hyperintense region, which lies in the left epiglottis fold and valleculae.
- No pre-epiglottic space involvement. No bony invasion.
- The uvula is prominent ? tumor or venous congestion.
- Left internal carotid flow void is lost consistent with occlusion.
- Lymphadenopathy
- Right neck enhancing necrotic nodal mass present (56 x 28 x 64mm). Probable extracapsular spread. It contacts the left jugular vein and compresses/invades it but flow is seen distally and convincing evidence of thrombosis present.
- Right level Ib
- Other tiny bilaterally scattered lymph nodes not suspicious on size criteria.
Case Discussion
Case submitted by Dr Smita Deb and A/Prof Pramit Phal.
Oropharyngeal SCC. Staging:
- T4a - tumor invasion is seen in the larynx (epiglottis + folds).
- N3 - lymph node metastasis >6cm.
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