Wk 6, Case 3 - Review

Patient History
61-year-old male with right-sided tongue pain.

Findings
Pre- and postcontrast CT of the oral cavity and oropharynx shows an approximately 4.5 cm mass (longest dimension measuring coronal plane) involving the right tongue base extending laterally to involve the right glossotonsillar sulcus. The medial aspect of the mass extends to the midline and slightly crosses midline. The inferior aspect of the mass extends deeply into the tongue and into the region of the root of tongue and medially displaces the attachment of the genioglossus muscle to the tongue base. The superior aspect of the mass extends superiorly along the right palatoglossus muscle to where the muscle inserts to the soft palate. The mass is associated with ulceration at the right glossotonsillar sulcus.

No evidence of aggressive lesions involving the nasopharynx, larynx or hypopharynx.

Incidental note is made of a right vallecular cyst. No abnormally enlarged lymph node based on standard size criteria. No evidence of enlarged retropharyngeal lymph nodes.

Polypoid mucosal thickening involving alveolar recess of right maxillary sinus.

Conclusions
1. Aggressive 4.7 cm mass (measuring coronal plane) involving the right tongue base extending inferiorly to involve the root of the tongue. Findings are most consistent with squamous cell carcinoma involving the right tongue base which would be staged as T4 due to radiological evidence involving the root of the tongue. Other considerations in the differential diagnosis include lymphoma or advanced minor salivary gland tumor.
2. No evidence of enlarged lymph nodes using standard size criteria.
3. Right vallecular cyst.