Head and Neck Cancer - 70-year-old male with long history of tobacco abuse

History
70-year-old male with long history of tobacco abuse. In 1999, he was diagnosed with true right vocal cord, squamous cell carcinoma. The patient underwent surgical extirpation. After a right neck lymph node was diagnosed in 2000, the patient subsequently underwent a right radical neck dissection. The patient developed submental recurrence and was found to have a T2 lesion on the laryngeal surface of the patient’s epiglottis. A biopsy of the epiglottis proved to be squamous call carcinoma.

CT Findings
The midline nasopharyngeal soft tissue appears to be abnormally asymmetric with slightly more fullness on the left than on the right. The soft tissue planes in the neck are difficult to separate, but do not have the impression of being gross cervical adenopathy. There is a very slight thickening along the left lateral wall of the oropharynx. There is slight asymmetric thickening at the base of the area of epiglottic folds. A portion of the asymmetry may be related to slight rotation and tilting of the neck. Marked hypertrophic spurring of the cervical spine and facets is noted with multilevel narrowing of the intervertebral foramina. There is no obvious cord lesion identified.

PET Findings
There is a 2 cm abnormal uptake in the submental space, just below the genioglossus muscle consistent with malignant lymphadenopathy/mass. This corresponds to abnormal soft tissue mass seen on CT scan. In addition, the patient has smaller foci of malignancy extending towards the neck posteriorly. The epiglottic mass is not visible on PET. Additional malignancy is appreciated in the right thoracic inlet, adjacent to the trachea. They range in size from 5mm –1 cm. Two hypermetabolic foci are also seen adjacent to the trachea on the left, measuring 1-2 cm. Discrete lymph nodes or masses cannot be identified on the CT exam, but the PET findings are highly suspicious for malignancy. There are numerous areas of increased uptake in the mediastinum and left hilum. The radiotracer activity is not as intense as those seen in the neck. This could be inflammatory uptake, although metastatic disease is not entirely excluded. No abnormal uptake is present in the abdomen or pelvis. The skull base is within normal limits.

Dosage
16.2 mCi FDG

Imaging
CTI REVEAL XL

Courtesy of
Thompson Cancer Survival Center