Presentation
Painful right tongue mass. Referred by dentist.
Patient Data
Contrast-enhanced axial CT shows an enhancing mass in the lateral border of right oral tongue extending onto the floor of the mouth. Ulceration noted. There are no abnormal lymph nodes. Base of tongue is not involved. Normal mandible cortex.
Contrast-enhanced coronal images demonstrate the enhancing mass in the right oral tongue extending onto the floor of the mouth.
The right lateral border oral tongue lesion appears to be isointense on T1W, hyperintense on T2W.
Though significantly degraded by motion artefact, post-contrast T1 fat sat images show the tumor to be enhancing.
Inferiorly, it extends into the right floor of the mouth/sublingual space. The right hyoglossus muscle is involved. It does not cross midline to involve the lingual septum. It abuts the right genioglossus-geniohyoid complexes.
Normal marrow signal is seen within the mandible. The base of tongue is not involved.
As on the prior CT, no abnormal lymph nodes are identified.
DIAGNOSIS
INVASIVE SQUAMOUS CELL CARCINOMA, MODERATELY DIFFERENTIATED; Biopsy, Right Lateral Tongue.
FDG PET shows the right tongue squamous cell carcinoma to be intensely FDG avid.
There are no FDG avid cervical lymph nodes or evidence of distal metastases.
There is intense FDG activity throughout the colon related to metformin.
Focal FDG activity in the left antecubital fossa is related to injection.
The patient underwent a sub-total glossectomy, bilateral neck dissections, tracheostomy and reconstruction
One right-level IB lymph node was positive for metastatic spread.
He was subsequently treated postoperatively with radiation and chemotherapy.
Case Discussion
FDG PET-CT is valuable for the initial staging of head and neck squamous cell carcinoma, being sensitive for the detection of nodal spread as well as distal metastases.
In the setting of neoadjuvant chemoradiation therapy, it helps guide radiation planning and provides an accurate means for response assessment.
After treatment, it is a useful tool for surveillance and the investigation of suspected recurrence.
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