Head & Neck Cancer Case 01


Clinical History

70-year-old male presented with a large mass in the right neck. An initial staging CT scan of the neck failed to reveal a muscosal primary. A PET/CT scan was ordered for further evaluation.

Imaging Findings
INITIAL PET/CT FINDINGS: There was a large area of intense radiopharmaceutical uptake in the right neck corresponding to large nodal mass. In addition, the PET/CT scan revealed a primary mucosal lesion with focal intense uptake that did not have a definite CT correlative abnormality.

Pathology
Part 1: Wide base of tongue invasive squamous cell carcinoma, moderate to poorly differentiated.
Part 2: Right oropharynx squamous cell carcinoma moderate to poorly differentiated.

Treatment
The patient underwent resection of the primary mucosal lesion and a radical right neck dissection. This was followed by external beam radiation and chemotherapy.

Imaging Findings
FOLLOW-UP PET/CT FINDINGS: The PET/CT scan showed no evidence of glucose-avid malignancy. The abnormalities previously noted on the PET/CT scan five months earlier were no longer present on the follow-up study.

Discussion
This is a very good illustration of the ability of PET/CT imaging to identify primary head and neck malignancies when they might not be detected by other imaging modalities. This patient initially had a CT scan of the neck after feeling an enlarged mass and failing a trial of antibiotics. The CT easily identified the abnormal necrotic node, but did not definitively identify the mucosal primary in the right oropharynx. In fact, it suggested that the primary mucosal lesion was on the left side. After an exam by an otolaryngologist and a FNA of the right neck mass, which was positive for metastatic squamous cell carcinoma, the patient was sent for a PET/CT scan.

PET/CT aided the physician in identifying both the metastatic lesion as well as the primary mucosal lesion. The follow-up PET/CT after resection, chemotherapy and radiation was negative. Since then, two additional PET/CT studies have remained negative.

Data courtesy of Dr. Todd Blodgett, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

* Any of the protocols presented herein are for informational purposes and are not meant to substitute for clinician judgment in how best to use any medical devices. It is the clinician that makes all diagnostic determinations based upon education, learning and experience.