Oropharyngeal SCC of the Base of Tongue
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Hello everyone, it's Dr. Sidney Levy.
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3 00:00:03,920 --> 00:00:06,900 I'm here to discuss diagnosis and staging
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of oropharyngeal squamous cell carcinoma.
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Today I'd like to focus on the base of tongue.
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In a previous vignette, we've discussed the
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anatomy of the oropharynx and the base of tongue.
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Today I'd like to use a sample case to demonstrate the
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general imaging features of base of tongue squamous
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cell malignancy and then to stage a sample case.
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So firstly, I have three sequences here, two axial
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sequences, T1 pre-contrast, no fat suppression,
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T2 with fat suppression, and a sagittal
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sequence, T1 post-contrast with fat suppression.
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The tumor, I will draw the outline of
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it so that we're all on the same page.
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Starting off with the sagittal, we can
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see this tumor outline here on the axial.
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And similarly on the pre-contrast T1.
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So what can we say about these tumors?
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On T1-weighted imaging, they tend to be of
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similar signal intensity to normal tongue muscle.
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So let me demonstrate that.
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This is the normal T1 signal intensity of tongue.
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The tumor itself is similar, in this
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case maybe slightly hypointense.
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Thanks for watching!
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On T2-weighted imaging, they are hyperintense, and on
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post-contrast imaging, they enhance in a heterogeneous,
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mild to moderate fashion, depending on the tumor.
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The next thing to say is, how do they spread?
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So, these tumors may spread across the midline to
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the contralateral base of tongue, as this case has.
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They may also spread anteriorly into the
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sublingual space or floor of mouth, or tongue
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root, as indeed this tumor has as well.
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They can also spread laterally into
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the masticator space, over here.
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This tumor has not done that.
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They can also spread posteriorly into
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the remainder of the oropharynx, more
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specifically the glossotonsillar sulcus.
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And the palatine tonsils.
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They're a bit further up in this
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case, so this tumor hasn't done that.
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Lastly, they can spread inferiorly into the
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supraglottic larynx and the pre-epiglottic space.
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This tumor is closely abutting the lingual surface
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of the epiglottis, which I will draw for you.
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This here is the lingual surface of the
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epiglottis, that's the laryngeal surface.
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This!
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In this case, this tumor is closely abutting
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the lingual surface of the epiglottis and is not
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involving the laryngeal surface of the epiglottis.
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In our next vignette, we will discuss how these
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tumors drain into which lymph node groups.
Sidney Levy, PhD, MBBS
Radiologist and Nuclear Medicine Specialist
I-MED
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