History of cT1N2a squamous cell of the left tonsil in 1994 status post definitive radiation, now with a second primary cT4aNx malignancy of the left base of tongue. There are post-treatment findings in the left oropharyngeal region. There is an enhancing ulcerative mass involving the left tongue base and oral tongue with extension across the midline and left glossotonsillar sulcus. Overall, the mass measures up to approximately 45 mm. There is also abnormal signal in the medial left masticator space and left mandibular body and ramus. Although not significantly enlarged by size criteria, left level 1 and level 3 lymph nodes display signal characteristics that appear to be different from the other lymph nodes in the neck. There is high diffuse T2 signal in the hypopharynx and portions of the larynx, without associated discrete mass lesions. There is a posterior disc-osteophyte complex at C5-6 with mild spinal canal stenosis. The imaged portions of the orbits, intracranial structures, and thorax are grossly unremarkable.
1. A mass involving the left tongue base and oral tongue with extension across the midline and left glossotonsillar sulcus is compatible with the clinically reported squamous cell carcinoma. 2. Although not significantly enlarged by size criteria, left level 1 and level 3 lymph nodes display signal characteristics that appear to be different from the other lymph nodes in the neck. This is nevertheless nonspecific and may represent metastatic disease versus an inflammatory or reactive process.3. Abnormal signal in the hypopharynx and portions of the larynx, as well as in the left masticator space without associated discrete mass lesions likely represents treatment effects or inflammation. 