cT4bN2c left tonsil squamous cell carcinoma. There is an infiltrative mass centered in the left palatine tonsil, with extension into the soft palate and inferior nasopharynx, which overall measures up to at least 4 cm. There is a cystic component of the tumor that measures up to 12 mm and indents the adjacent left medial pterygoid muscle. There are partially cystic or necrotic bilateral level 2 cervical lymph nodes with ill-defined margins. For example, a left level 2A lymph node measures 16 x 21 mm in axial cross-section and a right level 2A lymph node measures 15 x 22 mm. There is also a heterogeneous left level 3 lymph node that measures 9 x 16 mm. In addition, there is an ill-defined mass centered in the left retropharyngeal space that measures up to 17 x 21 mm in axial cross-section, which infiltrates the lateral aspect of the left longus coli muscle, extends to the jugular foramen, and appears to encase the left internal carotid artery, as well as compress the internal jugular vein. There are associated denervation changes involving the left vocal cord. The thyroid and salivary glands appear unremarkable. The osseous structures are intact, aside from a small posterior disc-osteophyte complex at C5-6. The imaged intracranial structures and orbits are unremarkable.
A left oropharyngeal mass with nasopharyngeal extension measuring up to at least 4 cm and associated bilateral lymphadenopathy, including a left retropharyngeal mass with signs of extracapsular extension is compatible with squamous cell carcinoma and metastatic lymphadenopathy.