Teaching Case

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

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 ?

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.