Oropharyngeal large B cell lymphoma
Swollen left side of neck for 2- 3 weeks. Hoarse voice. Dysphagia. O/E: left neck mass and oropharyngeal mass.
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Large enhancing well defined oropharyngeal mass with bulk dimensions of 7.3 x 5.5cm centered on the left side oropharynx with right sided extension. The mass is causing severe narrowing of the oropharynx to less than 1cm. The lesion extends superiorly to left nasopharynx causing asymmetry and inferiorly to the base of the tongue which is displaces. The mass abuts the prevertebral space without invasion of the longus capiti.
High T2 signal and enhancement in left masticator space surrounding the pterygoids muscles and mandibular ramus suggestive of disease extension.
Multiple bilateral enlarged cervical lymph nodes, the largest on the left measures 9.7cm centered on the left submandibular space and compresses both the submandibular and parotid glands. 2.2cm right level Ib node.
The carotid sheath vessels and left retro- mandibular vessels are intact.
No lower visualized intracranial extension seen. Both parotid and thyroid glands are normal.
Huge symptomatic oropharyngeal mass with airway compromise and advanced nodal involvement.
An fibroscopic biopsy was performed.
Oropharyngeal biopsy: Diffuse large B cell lymphoma (CD20,CD79a,BCl 6 positive, CD5,CD10,CD56 and cyclin D1 negative)
Another example of an extreme head and neck space pathology. It continues to amaze me how late many patients present with pathology.