Presentation
Biopsy proven squamous cell carcinoma of tongue.
Patient Data
an ill-defined, large lesion involving the entire left anterior 2/3rd of the tongue which appears hypo intense on T1, hyperintense on T2/STIR sequences, showing diffusion restriction on DWI, and near homogeneous post-contrast enhancement
the lesion involves bilateral superior and inferior longitudinal muscles, left genioglossus, left mylohyoid, and with loss of fat plane with left geniohyoid muscle
the lesion invades the base of the tongue on the left side with mild suspicious extension in the left vallecula and abuts the anterior tonsillar pillar; no extension in the glossoepiglottic folds was noted
inferior: the lesion extends to the anterior floor of the mouth
laterally: the lesion is extending in the left inferior alveolar process of the mandible adjacent to 2nd and 3rd molars with suspicious extension to the adjacent gingival mucosa and left retro mandibular trigone (RMT)
multiple sub-cm sized enhancing rounded cervical nodes with few of them showing restriction diffusion suggesting metastatic nodes
Depth of invasion-2.62 cm and 4.8 cm in greatest dimension.
Lesion crossing the mid-line.
Case Discussion
Biopsy-proven case of squamous cell carcinoma (oral cavity) with involvement of intrinsic and extrinsic muscles of the tongue, left retromandibular trigone, the floor of the tongue, with metastatic cervical lymph nodes suggesting advanced/T4 stage lesion.
This is a case in a relatively young patient who was a chronic tobacco chewer.
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