Oropharynx - SCC: Paths of Spread and Differential Dx
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Hello everyone.
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Dr. Sydney Levy here, continuing our discussion
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of the diagnosis of soft palate squamous cell
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carcinoma as part of our oropharyngeal series.
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We have our sample tumor in the left soft palate.
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I'd like to use it to demonstrate patterns of spread
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and then discuss nodal drainage of these tumors.
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I will draw the tumor outline to orient everyone.
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Often easiest to appreciate on the
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T2-weighted imaging in the center.
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And don't forget to make use of your orthogonal planes.
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In this case, the asymmetry is most easily demonstrated
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in the coronal plane, as well as the axial plane.
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How do these tumors spread?
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They may cross the midline to the contralateral side.
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This tumor hasn't, but it is quite common
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to have bilateral soft palate tumors.
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They commonly like to spread infralaterally
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into the ipsilateral palatine tonsil.
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And that's actually what has occurred here.
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So this tumor is encroaching on the
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palatine tonsil on the left-hand side.
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It's starting to head downwards.
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There is that infralateral spread.
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They may also spread anteriorly into the hard palate.
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Remember, the hard palate is best
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appreciated on sagittal imaging.
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This being the hard palate, this being the soft palate.
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The hard palate is spared by this tumor.
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Sometimes soft palate tumors can also spread
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posterosuperiorly into the nasopharynx.
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Remembering that the superior border of the soft palate
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here is actually considered part of the nasopharynx.
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But in this case, the tumor is not involving the
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superior border or any other part of the nasopharynx.
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It's also important to note that tumors may
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spread laterally into the parapharyngeal fat.
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So going back to the axial level of the
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tumor, it is important to look at the adjacent
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parapharyngeal fat to see if it is effaced.
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In this case, it is not effaced.
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Last thing I'd like to finish up with, uh,
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differential diagnoses, which should be
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considered when looking at these tumors.
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And these consist of a tumor primarily originating
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from the palatine tonsil as opposed to the soft palate.
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So it's very important to use your coronal
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and sagittal planes to determine exactly where
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you are in the superoinferior dimension.
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Minor salivary gland malignancy also has a tendency to
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occur in the soft palate, although this is often a diagnosis
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made retrospectively after pathology has been obtained.
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And lastly, expected radiation changes in a
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post-treatment patient can also have a similar
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diffuse enhancing soft tissue thickening,
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which can look like tumor in some settings.
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58 00:03:06,795 --> 00:03:08,704 In our next vignette, I'd like to discuss the
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nodal drainage patterns of soft palate tumors.
Sidney Levy, PhD, MBBS
Radiologist and Nuclear Medicine Specialist
I-MED
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