EURORAD ESR

Case 75

MRI of a tumour of the right tonsil

Author(s)
Lemort M, Leurquin M
 
Patient
male, 40 year(s)

Clinical History

Large tumour of the right tonsil extending into the soft palate and uvula

Imaging Findings

Patient, male 40y old, consults for a pain in the right tonsilar region. The clinical examination shows a 2 cm lesion of the right tonsil spreading in the anterior tonsillar pillar ( palatoglossus muscle). One 2cm ADP is palpated in the sub-mandibular homolateral aera. A MRI examination is done using the following sequences : T1w SE axial pre and post Gd DOTA, T2w FSE coronal. What is the T stage of this tumour ?

Discussion

It is a T4 tumour because of its extension into the deep muscles of the tongue. Staging criteria for primary squamous cell carcinoma of the oropharynx: T1: tumour is 2 cm or less in its greatest dimension. T2: tumour is more than 2 cm but not more than 4 cm in its greatest dimension. T3: tumour is more than 4 cm in its greatest dimension. T4: tumour invades adjacent structures, including bone (mandible or maxilla), soft tissues of the neck, or deep (extrinsic) muscles of the tongue. A biopsy showed a squamous cell carcinoma of the right tonsil. The patient was treated by chemo- and radiotherapy and presented with a total remission after one year follow-up.

Final Diagnosis

Squamous cell carcinoma of the right tonsil, stage T4
 

MeSH

  1. Tonsillar Neoplasms [C04.588.443.665.710.684.800]
    Tumors or cancer of the TONSIL.

Citation

Lemort M, Leurquin M (2000, Jan 17).
MRI of a tumour of the right tonsil, {Online}.
URL: http://www.eurorad.org/case.php?id=75
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  • Figure 1
    T1W SE axial slices before (1a-1b) and after (1c) contrast enhancement
    a b c  

    There is thickening of the uvula, the right lateral and posterior walls of the oropharynx.

    There is a massive thickening of the tonsilar area and the right pillars of the soft palate. The tumour shows a homogeneous, intermediate signal.

    There is a strong, homogeneous enhancement after Gd injection. The limits of the lesion in the pharyngeal wall are more clearly shown. Note the crossing of the midline as the invasion of the anterior part of the paratonsilar space.

     
  • Figure 2
    T2W FSE coronal images
    a b  

    Note the well depicted invasion of the soft palate and uvula. However, oedema may contribute to the thickening and high signal in the tumour area. So the extent has to be compared with the T1W post contrast scans.

    This more anteriorly situated slice shows the invasion of the tongue muscles, the tumour crossing the amygdalo-glossus groove.

     
Figure 1

T1W SE axial slices before (1a-1b) and after (1c) contrast enhancement

Figure 1a
There is thickening of the uvula, the right lateral and posterior walls of the oropharynx.
 
Figure 1b
There is a massive thickening of the tonsilar area and the right pillars of the soft palate. The tumour shows a homogeneous, intermediate signal.
 
Figure 1c
There is a strong, homogeneous enhancement after Gd injection. The limits of the lesion in the pharyngeal wall are more clearly shown. Note the crossing of the midline as the invasion of the anterior part of the paratonsilar space.
 
Figure 2

T2W FSE coronal images

Figure 2a
Note the well depicted invasion of the soft palate and uvula. However, oedema may contribute to the thickening and high signal in the tumour area. So the extent has to be compared with the T1W post contrast scans.
 
Figure 2b
This more anteriorly situated slice shows the invasion of the tongue muscles, the tumour crossing the amygdalo-glossus groove.
 
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