Female, 69 years old, with remote history of parapharyngeal space cancer (1995), disease free until 04-2015 when a second primary left tonsillar cancer was detected (tentative staging T4N2c), status post induction chemotherapy. Assess for response. Evidence of prior left neck surgery is demonstrated. Soft tissue thickening with ill-defined associated enhancement within the left parapharyngeal space has not significantly changed even when comparison is made to an MRI from 2009.The immediate prior MRI examination dated 4/15/2015 contains limited sequences and as such an accurate comparison can only be made on the basis of fat-suppressed T2-weighted images. Given this limitation, a mild interval decrease in the thickness of the left oropharyngeal mucosa is seen. A reference measurement on today's examination yields 2 mm (image 15 series 9), while the same area on the prior examination measured proximally 5 mm in thickness. Mucosal thickening extending across the midline to the right has also improved to a similar degree.T2 hyperintensity involving the left pterygoid muscles and the left longus coli muscle is unchanged.A left level II lymph node, immediately subjacent to the region of prior mucoasal thickening, measures 6 mm short axis (image 14 series 9), stable dating back to 2009. Subcentimeter level Ia and Ib lymph nodes also show no significant interval change.No concerning mass or pathologic adenopathy is evident elsewhere in the neck. Bone marrow signal characteristics are within normal limits allowing for cervical spondylosis. T2 hyperintensity filling the left mastoid air cells and middle ear cavity is unchanged.
Comparison with the prior MRI examination dated 4/15/2015 is limited to fat suppressed T2-weighted images. Given this limitation, there seems to have been an interval reduction in thickness of the left oro-pharyngeal mucosa.Soft tissue thickening and ill-defined enhancement within the adjacent left parapharyngeal space shows little if any significant change dating back to 2009 and may be related to the patient's remote history of cancer. T2 hyperintensity involving the left pterygoid and longus coli muscles is unchanged compared to the immediate prior examination and nonspecific, possibly related to ongoing therapy.No definite evidence of pathologic adenopathy is detected in the neck.