Recurrent SCC post-induction protocol 12-1554. Additional history per EMR: Multiple recurrences of H&N SCC s/p multiple partial glossectomies/ND, two courses of EBRT, and brachytherapy, now with biopsy proven right tongue SCC on IRB 121554. There is an ill-defined, heterogeneous posterior left floor of mouth/tongue base region tumor measuring up to approximately 25 mm, with hypermetabolism on the concurrent PET. In addition, there is a small area of nodular enhancement with corresponding hypermetabolism more anteriorly in the left floor of mouth. There is also an enhancing lesion in the right anterior oral tongue that measures up to approximately 9 mm, with hypermetabolism on the concurrent PET. There are several prominent and abnormal appearing left cervical lymph nodes, with hypermetabolism on the concurrent PET. For example, a necrotic left supraclavicular lymph node measures 9 x 11 mm in axial cross-section and a left level 5B lymph node measures 7 x 10 mm. There is no convincing right cervical lymphadenopathy. The right anterior belly of the digastric muscle, submandibular gland, and sternocleidomastoid muscle are surgically absent. The left submandibular gland is atrophic. The right thyroid gland is either atrophic or has been partly resected. There is severe narrowing of the right internal and external carotid artery flow voids at the origins. There is mild degenerative cervical spondylosis. There are also bilateral temporomandibular joint degenerative changes. There is mild esophageal wall edema. The airways are patent. There are bilateral maxillary sinus retention cysts. The imaged intracranial structures are unremarkable.
1. Post-treatment findings in the oral cavity with an ill-defined, heterogeneous posterior left floor of mouth/tongue base region tumor measuring up to approximately 25 mm, with hypermetabolism on the concurrent PET is compatible with recurrent squamous cell carcinoma. A small area of nodular enhancement with corresponding hypermetabolism more anteriorly in the left floor of mouth may also represent recurrent tumor. 2. A subcentimeter lesion in the right anterior oral tongue, with hypermetabolism on the concurrent PET, is compatible with the known additional squamous cell carcinoma. 3. Multiple left neck lymph nodes with corresponding hypermetabolism on PET are compatible with metastatic disease. 