Per EPIC, patient presented with a right neck lump in 2011 found to have squamous cell cancer of the right tonsil and underwent CRT in 2011. In 9/2013, he had a biopsy of the right pharynx which revealed SCCA, P16+. Underwent salvage right oropharyngectomy and right LN dissection in 2/2014. Completed reconstruction with supraclavicular flap. Pathology revealed a pT1N0 posterior oropharyngeal wall residual focus of p16+ SCC measuring 1.0 cm and extending within 4 mm of the deep margin. He developed a second local recurrence in 9/2014 at the right neck. He underwent a salvage surgery (12/10/14) with pathology revealing a 2.4 cm poorly differentiated non-keratinizing SCC of the right oral cavity. On 6/8/15, a mass is noted in the right nasopharynx (biopsy showed SCC). BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is mild mucosal thickening of the right frontal sinus and moderate mucosal thickening of the right maxillary sinus. There is partial opacification of the anterior ethmoid air cells. There is partial opacification of the right mastoid air cells. NECK SOFT TISSUE: There is an ill-defined and infiltrative enhancing mass centered within the right lateral and posterior nasopharynx with effacement of the fossa of Rosenmuller, which extends anteriorly to the right pterygoid plates, laterally into the masticator space, posteriorly to the carotid space and superiorly to the skull base. The exact dimensions are difficult to delineate. The right mandibular condyle is inferiorly displaced relative to the left side, which may be degenerative versus tumor infiltration. The lesion surrounds the right V3 nerve but does not demonstrate definite intracranial perineural extension.Redemonstrated are postoperative findings related to resection of posterior right hemimandible as well as flap reconstruction of the right-sided pharyngeal soft tissues. There are postoperative findings related to right neck dissection. A screw plate extending from the mandibular symphysis along the right anterior mandibular body is better seen on prior CT. There is no evidence of significant cervical lymphadenopathy. The thyroid gland is unremarkable. The right internal jugular vein is not visualized. The airways are patent.
1. An ill-defined, infiltrative and heterogeneously enhancing lesion within the right nasopharynx extending anteriorly to the pterygoid plates, laterally into the masticator space, posteriorly to the carotid space and superiorly to the skull base with possible tumor infiltration at the right temporomandibular joint is consistent with known recurrent squamous cell carcinoma. No significant cervical lymphadenopathy.2. The lesion surrounds the extracranial right V3 nerve, but there is no definite evidence of intracranial extension.