Presentation
Throat pain with tongue base mass on examination. Heavy smoking and drinking history.
Patient Data
The quality of this study is limited by a number of factors:
- extensive streak artefact from dental amalgam (no metal reduction algorithm sequence applied)
- imaged during breath-hold with occluded glottis, opposed uvula to the nasopharyngeal wall and general shortening of the oropharyngeal structures
Within these limits, there is a right posterior tongue mass (at border of oral cavity and oropharynx) measuring at least 2 cm. There is also a partly necrotic (<50%) right IIA node.
Chest imaging (not uploaded) with no pulmonary metastases.
MRI better defines the right posterolateral tongue tumor. This measures 23 x 17 mm in largest axial dimensions. It comes to within 5 mm of midline, and appears to involve right genioglossus.
Pathological right IIA as identified on CT.
No other significant findings.
Case Discussion
Biopsy showed p16 negative squamous cell carcinoma, and further resection with tongue reconstruction confirmed staging at pT3 N2a (with extracapsular spread) M0.
This case is also an example of the common limitations of neck imaging on CT, with streak artefact from dental amalgam and issues relating to breath-hold. Good imaging technique relies on clear instruction with quiet breathing motion (keeping pharyngeal and laryngeal structures in a relatively neutral position).
The MRI appearances technically were better, although there was still some artefact from the dental amalgam locally.
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