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Oropharynx - Base of Tongue SCC: T-Staging

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Hello, everyone.

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Dr. Sidney Levy here, continuing our discussion

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4 00:00:04,760 --> 00:00:08,320 of the diagnosis and staging of base of

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tongue oropharyngeal squamous cell malignancy.

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I would like to formally stage this

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example case for you in this vignette.

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I have post-contrast T1 weighted imaging

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in three planes with fat suppression.

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And we are looking at a bilateral base of

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tongue malignancy which has originated on the

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right-hand side but since spread to the left.

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The first thing I'd like to do is to draw the

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outline of the tumor for you to help orient you.

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So it is the region of abnormal enhancement

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which is clearly visible in all three planes.

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So what are the salient features to T stage this tumor?

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The first one

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is how much does it measure in its maximal dimension.

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So, this tumor, if we measure it from here to here,

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is about four centimeters in maximal dimension.

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If we're in any doubt, you should always give the

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benefit of the doubt to the lower measurement.

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But in this case, we can confidently

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say that this tumor is just over four

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centimeters in maximal dimension.

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So that automatically places

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it into at least T3 category.

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It also has crossed over to the contralateral side.

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The other important features are

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invasion of nearby structures.

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So these include, as previously discussed in

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another vignette, extrinsic tongue musculature.

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This tumor is involving the genioglossus.

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So they are the most commonly

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involved extrinsic tongue muscles.

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I will draw them for you.

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This is the right one.

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And then the left one, as you can see, has

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been partially obscured at this level by

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the tumor which has extended posteriorly.

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We can also get an impression of it

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in this region here on the sagittal.

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So, given that this tumor has invaded extrinsic

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tongue musculature, it is automatically upgraded

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to a T4A tumor, irrespective of its dimensions.

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It is not a T4B tumor because the masticator

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space, the nasopharynx, the skull base,

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and the carotid artery are not involved.

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In our next vignette, we will end stage this tumor.

Report

Description

Faculty

Sidney Levy, PhD, MBBS

Radiologist and Nuclear Medicine Specialist

I-MED

Tags

Oral Cavity/Oropharynx

Neuroradiology

Neuro

Neoplastic

MRI

Head and Neck

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