Presentation
Oropharyngeal dysphagia.
Patient Data
There is a 4 x 5 x 5.2 cm intermediate signal (on T1/T2) heterogenous enhancing mass lesion infiltrating the tongue base, carotid, para pharyngeal, and pharyngeal mucosal spaces on the left side causing to narrowing of the oropharynx with the following relations:
anteriorly, the mass protruded into the oral cavity
posteriorly, the mass impressing the prevertebral space
laterally, the mass bulges to the masseteric and parotid spaces involving the medial and lateral pterygoid and temporalis muscles
superiorly, the mass abuts the soft palate
inferiorly, the mass bulges to the submandibular space
There is a 25 x 50 mm abnormal signal necrotic mass lesion and another smaller lesion measuring about 10 x 15 mm along with the left parotid space could be due to metastatic lymphadenopathy.
Fluid signal is present in the left mastoid air cells.
Case Discussion
Imaging findings are suggestive of a bulky heterogeneous enhancing mass involving the tongue base, carotid, para-pharyngeal, and pharyngeal mucosal spaces associated with left-sided parotid space metastatic lymphadenopathy.
In view of the well defined sharp margin without local infiltration, it is likely to be minor salivary gland tumor or HPV related tumor. Unlikely to be squamous cell carcinoma as SCC to be this size, we would expect infiltrative/invasive margin.
The patient underwent a neck mass biopsy and histopathological examinations revealed a pleomorphic adenoma with stromal hyalinization.
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