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.
Sidney Levy, PhD, MBBS
Radiologist and Nuclear Medicine Specialist
I-MED
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