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Squamous Cell Carcinoma - Base of Tongue

  •  Also known as lingual tonsil squamous cell carcinoma (SCCa)
  •  Epithelial tumor of epidermoid origin arising in the lingual tonsilar area of the oropharyngeal mucosal space
  •  Lingual tonsils are part of the Waldeyer lymphatic ring located just posteriorly to the circumvallate papilla of the tongue
  •  Symptoms from this tumor occur late, so tumor is often large (>4 cm) at presentation
  •  Lesion can either be exophytic, invasive, or both
  •  Spread patterns:
    •  Anterior: sublingual space, oral tongue root, or floor of mouth
    •  Posteriolateral: anterior tonsillar pillar
    •  Inferior: supraglottic larynx and hypopharynx space
  •  On CT: Mucosal asymmetry and moderate enhancement with contrast, difficult to assess superficial spread, deep spread easily noted
  •  On MR: On T1 lesions are isointense to muscle and spread easily noted; on T2 lesions are iso- to hyperintese; post-contrast T1 shows enhancement
  •  Smoking and alcohol are known risk factors
  •  Most common nodal involvement is level II nodes
  •  Men and those over 40 are most commonly affected
  •  Lungs more so than bones more so than liver are the organs where metastasis is most commonly noted

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