History of pharyngeal squamous cell carcinoma treated with chemoradiation therapy. T1N2b right hypopharyngeal squamous cell carcinoma diagnosed in 2/2013 s/p radical right neck dissection and adjuvant chemoradiation from 5/2013 to 7/2013. A right posterior neck recurrence occurred in 9/2013 and right posterior neck dissection was performed in 12/2013, which yielded well differentiated squamous cell carcinoma, with a second skin recurrence in right supraclavicular region treated via neck dissection, with positive margins, on 4/22/2014. Neck: There are postoperative findings related to right neck dissection without significant change in diffuse enhancement in the right lower neck subcutaneous tissues and paraspinal muscles. There is mild ill-defined diffuse hypopharyngeal swelling and enhancement, but no discernible measurable mass lesion or significant lymphadenopathy in the neck. The thyroid and major salivary glands appear unchanged. The right internal jugular vein appears to have been sacrificed. The other major cervical flow voids appear to be unchanged. The osseous structures are unchanged. There is minimal mucosal thickening within the paranasal sinuses, including a subcentimeter left maxillary mucous retention cyst. Brain: There is no intracranial mass or mass-effect. There is minimal persistent diffuse enhancement of the dura. However, there is no abnormal intraparenchymal enhancement to suggest metastatic disease. There is no evidence of acute ischemia. The ventricles are unchanged in size and configuration. Multiple nonspecific foci of T2 hyperintensity in the bilateral subcortical and periventricular white matter are unchanged. The skull appears unchanged.
1. No significant interval change in diffuse enhancement in the right lower neck subcutaneous tissues and paraspinal muscles, which is likely treatment-related. Otherwise, no discrete mass or significant lymphadenopathy is identified in the neck to suggest disease recurrence. 2. Nonspecific signal abnormality in the bilateral periventricular and subcortical white matter may represent chronic small vessel ischemic disease.3. No evidence of intracranial metastases. 