Oropharyngeal squamous cell carcinoma

Case contributed by Dr Smita Deb

Presentation

Clinically visualised posterior oropharyngeal mass.

Patient Data

Age: 65
Gender: Male
Modality: CT
  • Large mass involving posterior wall of oropharynx (3.3 x2.0 cm axial, across midline), extending into lower nasopharynx just above level of palate.
  • Inferiorly it extends to level of valleculae. Contiguous soft tissue thickening extends across right tonsillar fossa into right 
  • Posteriorly it extends into prevertebral space, likely involving longus colli. No vertebral cortical breach seen.
  • Symmetrical thickening of aryepiglottic folds is suspicious for tumour involvement and requires direct 
  • Bilateral level 2a lymphadenopathy.
Modality: MRI
  • Large mass in posterior wall of oropharynx extending across midline. (7.2 x 2.0 x 3.2 cm). Low T1, intermediate T2 signal with homogeneous enhancement.
  • Superiorly it extends to level of hard palate, displacing the soft palate anteriorly which does not appear 
  • Inferior extension to the level of vallecula.
  • Lateral extension to involve right palatine fossa and the lateral aspect of right vallecula.
  • There is involvement of the posterior wall of the hypopharynx. The aryepiglottic folds appear thickened, particularly on the right.
  • Posteriorly tumour extends into prevertebral space and involve the longus colli, abutting the 
  • There is no vertebral body enhancement.
  • Lingual tonsillar enlargement.
  • Lymphadenopathy:
    • Bilateral levels 1b and 2a.
    • Prominent lymph nodes along bilateral levels 3 and 4 and in the retropharyngeal region-measuring up to 10mm on the left.

Case Discussion

Case submitted by Dr Smita Deb and A/Prof Pramit Phal.

Oropharyngeal SCC. Staging- likely T3N2c:

  • T3 -  tumor > 4 cm in greatest dimension (but likely no involvement of: larynx, tongue muscles, pterygoids, hard palate, mandible, lateral nasopharynx, skull base or carotid artery).
  • N2c - metastasis in bilateral lymph nodes (not > 6 cm in greatest dimension).
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Case Information

rID: 31177
Case created: 22nd Sep 2014
Last edited: 27th Sep 2015
System: Head & Neck
Inclusion in quiz mode: Included

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