Squamous cell carcinoma - neck

Case contributed by Bahman Rasuli

Presentation

Voice changes and painless swelling of the left-sided neck and mandibular regions.

Patient Data

Age: 50 years
Gender: Male

There is a large lobulated solid enhancing subcutaneous soft tissue mass of the left submandibular and parapharyngeal regions with areas of necrosis. It appears in contact with the left submandibular gland, parotid gland, thyroid cartilage and is associated with infiltration of the skin layers.

Ill-defined soft tissue infiltration of the glottic and supraglottic regions including the left true and false vocal cords with the anterior commissure extension, laryngeal ventricle, and the aryepiglottic fold associated with the effacement of left-sided pyriform sinus, para glottic, and pre epiglottic fat planes.

Infiltration and effacement of the intratumoral segment of the left internal jugular vein and tumoral thrombosis at the upper extra tumoral segment with extension to the jugular foramina are seen.

Encasement of the left external carotid artery distal branches at the superior bulk of the tumor is seen.

Bilateral neck spaces adenopathy is seen. The largest one is at the right side of the neck, zone IV, and next to the SCM muscle posterior margin that shows internal necrotic changes.

Photo

Left-sided neck mass was biopsied and the pathological report was compatible with invasive squamous cell carcinoma.

Case Discussion

The recent case was referred to our imaging center with the complainant of voice changes and painless swelling of the neck on the left side. He mentioned that this swelling started 6 months ago in addition to voice changes and was left untreated. The recent neck CT scan with contrast was the first imaging modality for assessment of the mass and patient problems. Regarding the clinical and imaging findings as well as the pathological report of the left-sided neck palpable mass, a metastatic advanced laryngeal carcinoma is the preferred diagnosis. 

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