Oropharynx - SCC of the Palatine Tonsil
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Hello everyone,
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Dr. Sidney Levy here.
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Today I would like to continue our discussion of diagnosis
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and staging of oropharyngeal squamous cell malignancy.
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I would like to focus on the palatine tonsils.
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These are the most common site of oropharyngeal
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squamous cell malignancy, constituting
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between 70% to 80% of identified tumors.
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I have some pre-contrast T1-weighted
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imaging without fat suppression on the left.
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T2-weighted imaging with fat suppression in the
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middle and post-contrast T1-weighted imaging with fat
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suppression on the right in the axial and sagittal planes.
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So, palatine tonsil tumors may be clinically occult
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or very difficult to identify, if at all, on imaging.
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And sometimes the only way that they are
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discovered is secondarily after a nodal metastasis
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is identified within the ipsilateral neck.
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In this case though, I will use a larger tumor
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to help demonstrate the imaging features.
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The first thing I'd like to do is to draw the tumor for you.
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So, on T1-weighted imaging,
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the tumor is often slightly hypointense or isointense
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25 00:01:27,090 --> 00:01:29,090 to normal tonsillar tissue.
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You can always look at the opposite
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side for normal tonsillar tissue.
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So, here's the normal left tonsil.
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Here is the abnormal right tonsil with the tumor.
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In this case, it's isointense.
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On T2-weighted imaging, it is
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mildly to moderately hyperintense.
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On post-contrast imaging, it is usually hyper-
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enhancing, but in this particular case, not so much.
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So this is a bit atypical,
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but here is the outline of the tumor.
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The morphology of the tumors may be ulcerative,
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infiltrative, or exophytic if large.
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Because this is a large tumor, it has taken on a
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combination of exophytic and ulcerative properties.
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The big clues are to look for asymmetric enlargement of
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the palatine tonsil and a blurring of the deep margin.
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So, in this case, if you look at the normal tonsil,
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you can see that there is a fat plane between the
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normal tonsil and adjacent soft tissue, just here.
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So we've got some fat in here,
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which helps to provide a delineation.
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On the right-hand side, this is all lost.
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So, we can say that there is an invasive
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deep margin of this tonsillar tumor.
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The last thing to remember is that the location of
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these tumors is usually within the tonsillar fossa,
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as opposed to the anterior or posterior tonsillar pillars.
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In our next vignette, we will discuss the patterns
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of spread and nodal drainage of these tumors.
Sidney Levy, PhD, MBBS
Radiologist and Nuclear Medicine Specialist
I-MED
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