Base of tongue status squamous cell carcinoma status post chemoradiation for T4Nx left oral tongue cancer, previous history of cT1 N2a squamous cell carcinoma of the left tonsil in 1994. There is an ill-defined 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 4 cm. There are superimposed post-treatment findings in the neck, including diffuse pharyngeal mucosal and retropharyngeal edema, and left tonsillar fossa tissue deficiency, with a defect suggestive of a left pharyngocutaneous fistula. There are secretions in the pharynx and larynx. There is no significant cervical lymphadenopathy based on size criteria. There are unchanged right thyroid nodules. There is diffuse high T2 signal in the hypopharynx and portions of the larynx, without associated discrete mass lesions in this area. There is a posterior disc-osteophyte complex at C5-6 with mild spinal canal stenosis. The imaged portions of the orbits and intracranial structures are grossly unremarkable.
1. Post-treatment findings in the neck with a persistent infiltrating and ulcerated mass involving the oral tongue and tongue base that likely represents recurrent squamous cell carcinoma and superimposed inflammation.2. Suggestion of possible left pharyngocutaneous fistula formation and deficiency of soft tissue overlying the left hyoid bone, likely due to necrosis and perhaps superimposed infection or inflammation.3. No significant cervical lymphadenopathy.4. Secretions in the pharynx and larynx indicate aspiration.