Wk 2, Case 1 - Review

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Report

Patient History
Right neck mass.

Findings
Pre and postcontrast MR was performed from the skull base to the thoracic inlet. The study demonstrates an approximately 2 cm x 1.5 cm mass involving the anterior floor mouth. The mass medially displaces the ipsilateral genioglossus-geniohyoid complex and laterally displaces the right mylohyoid muscle. The posterior aspect of the mass extends to the anterior tongue base. However the mass is contained within the right sublingual space without evidence of tongue base invasion. The mass is high signal on T2, low signal on T1 and homogeneously enhances with contrast.

There is a large right level 2 nodal metastases which extends inferiorly to involve the superior portion of level 3. The mass anteriorly displaces the posterior aspect of the right submandibular gland. The nodal mass contains focal areas of increased T2 signal which is likely due to necrosis. The margins of the nodal mass are ill-defined and abuts the anteromedial portion of the right sternocleidomastoid muscle. In addition, there is enlargement the right sternocleidomastoid muscle. These findings are suggestive of imaging evidence of extra capsular penetration with fixation to the sternocleidomastoid muscle.

There is a 6 mm lymph node located in level 1B on the right. Although this is not larger than accepted size criteria, it is suspicious given that it is in a primary echelon drainage for a right for mouth carcinoma

There are multiple small lesions involving the thyroid gland the largest of which measures approximately 1 cm.

Conclusions
1. Approximately 2 cm x 1.5 cm oval mass involving right 4 mouth with ipsilateral nodal metastases with imaging findings suggestive of extra capsular penetration. Findings are consistent with squamous cell carcinoma involving the right floor of mouth.
2. Multiple thyroid nodules the largest of which is approximately 1 cm. Would refer to appropriate TI-RADS criteria for further management decisions.

Case Discussion

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Suresh K Mukherji, MD, FACR, MBA

Clinical Professor, University of Illinois & Rutgers University. Faculty, Michigan State University. Director Head & Neck Radiology, ProScan Imaging

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Wk 2, Case 1 - Review