Male, 62 years old, with history of T4 N2 cM0 squamous cell carcinoma of the oral tongue, left base of tongue and floor of mouth status post induction chemotherapy. Since the prior examination, there has been a substantial reduction in the size of the previously demonstrated extensively infiltrating tumor involving the left oral tongue, base of tongue and floor of mouth. A maximal lesion measurement in the coronal plane yields 39 mm (image 24 series 12), previously 75 mm. Reference lesion measurements in the axial plane yield 28 x 18 mm (image 26 series 11), previously 60 x 35 mm.The tumor component which was previously seen to cross to the right of midline at the base of tongue is no longer clearly visualized. Likewise areas of suspected tumor involvement of the supraglottic larynx are no longer clearly appreciated. The airway remains patent.A reference right level II lymph node measures 20 x 11 mm (image 44 series 6), previously 22 x 16 mm. A reference left level Ib lymph node now measures 12 x 7 mm (image 31 series 6), previously 22 x 15 mm. Multiple left intraparotid lymph nodes have also decreased in size and no new or growing pathologic nodes are detected.The salivary glands and thyroid are otherwise unremarkable. The osseous structures of the spine show normal signal characteristics. A lobular homogeneously enhancing tumor involving the left IAC and CP angle is redemonstrated showing no definite change in size.
1.Significant interval reduction in the size of the previously demonstrated left oral tongue, base of tongue and floor of mouth tumor.2.Interval reduction in the size of several reference pathologic lymph nodes.3.Grossly stable left IAC and CP angle tumor which is favored to represent an incidental vestibular schwannoma. Dedicated MR imaging of the brain can be considered for further evaluation. 