Female, 60 years old, history of new primary tonsil cancer (prior history of cT1 N2a squamous cell carcinoma of the left tonsil in 1994, with second primary cT4a Nx at the left base of tongue) status post induction chemotherapy. Assess response. Findings are redemonstrated presumed to represent prior treatment including volume loss in the left submandibular space and scarring which extends from the left oropharynx to the skin surface.An ulcerated mass is redemonstrated centered on the left tongue base extending medially to cross the midline, and laterally to track along the glossotonsillar sulcus and left lateral oral tongue. The left tonsillar pillar is also thickened and likely involved with disease. Anteriorly the lesion extends for some distance into the floor of mouth structures with infiltration of at least the left genioglossus muscle. Inferiorly, the lesion extends to the level of the vallecula.The lesion continues to show ill-defined enhancement, but is less T2 hyperintense and is overall smaller. The maximum dimension of this lesion is obtained in the coronal plane where it measures up to 38 mm (image 18 series 4), previously 45 mm.As on the prior examination, signal abnormality does extend to involve the left masticator space and the adjacent mandibular marrow space without significant interval change. The left aspect of the hypopharynx remains mildly T2 hyperintense, similar to prior, but without discrete mass lesion.No pathologically enlarged nodes are detected by size criteria. As before, though, several small left-sided level II and III lymph nodes show hyperintense T2 signal compared to other cervical nodes.Scarring is evident in the lung apices. No definite concerning marrow replacement is seen in the osseous structures.
1.Interval decrease in the size of a mass involving the left oral tongue, tongue base, and tonsillar pillar.2.No definite pathologic adenopathy by size criteria, and no change in the appearance of T2 hyperintense left cervical lymph nodes.3.Redemonstration of nonspecific findings including abnormal signal involving the left masticator space, left mandibular marrow space, and left hypopharynx.