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Forum Name: Head and Neck Cancer

Question: Base of the tongue mass bilateral adenopathy - not cancer?


 MaherC - Sat Nov 01, 2008 3:26 pm

I'm a 42 years old male, about 5 month ago, I had a severe sore throut very hi fever that would not come down with Motrine Tylonol. fever mantained 40 C degrees and with motrain will stay at 39.5 C. It all started on Thursaday with a feeling of havenies in my throut and by friday morning I woke up with chilles hight fever and sore throut that will radiate to my ears wehn trying to swallow. I spent all friday and all night with hight fever and sore throut. on Saturday I went to doctor and they did a culture for streo throut that came out negative, the throut was red but no other findings. the DR gave me an antibiotics shut and pills for ten days and asked to come back the next day if things stay the same. fever went down to 38.5 C with 3 pilles of motrain at a time. The next day i went back for the second antibiotics shut and gradully by monday the fever started to subside but the sore throut took about 2 weeks to get better. since then and for about a month I always had pain in my right side of my front neck that is vertical and into my jaw and occanssional dull ache in my ear with stiff neck and ache throut.

about four weeks after this, I went to my doctor for the pain that I'm having so she orderd a CT scan for my neck. the result of the ct scan showed Mildly enlarged Lymph nodes scattered on both sides of the neck roughly equally on both sides and are present in the submandibular region, the largest node on the left measuers about 1.05 CM and is seen anterior to the Jugular vein at the level of the hyoid. There is also soft tissue prominence in the area of the valleculae.
The conclusion of this scan was: Some Cervical adenopathy is present and appears to be fairly symmetric side to side, there is also soft tissue Fullness at the region of the base of the tongue and Valleculae, this may also relate to lymphoid hyperplasia, althought it is difficult to exclude a mass in this region, Correlation with direct visulization is recomanded.

My Dr reffered me to ENT and I was seen by his asisstance who preformed a endoscopy of my nose and throut and told me that she can see some fullness and the area is irretated. after telling her that I have reflux and I take omeparzol for it she gave me a dose of 2 weeks Amoxilene 825mg and asked me that I take my reflux medication and repeat the CT scan after 3 weeks.

I so did, after 4 weeks I repeated the CT scan in a different facillaty then the first sacn. and was scheduled for an appoitment with the ENT after two weeks, the 2nd scan result showed the following:

Base of the tongue mass which occupies the vallecula bilaterally althought silghtly larger on the right. The mass mesaures 2.5 CM in transverse X 2.0 CM in AP dimension.

Bilateral level II to level IV lymphadenopathy. the largest on the left jugulodigastric lymph node measures 1.6 CM and the largest on the right mesaures 1.6 cm, several subcentimeter level V nodes also noted bilaterally. small posterior neck nodes are noted the largest on the left measureing 1.0 CM

Conclusion was :

1- Base of the tongue/vallecular lesion consistent with head and neck squamous cell Carcinoma, Lymphoma is also a possible differential consideratin, Biopsy is Recommended.

My ENT DR called me and asked me to make may visite to his office this week rather then in 2 weeks.

I went and he took another look and he told me that he is not 100% convenced that it is cancer and he wantetd me to go for a biobsy in 2 weeks. when I asked him what is persantge he said 50/ 50 %.

So if possible if the MD in this forum can make sence to me on this.

Thanks
 Dr. Safaa Mahmoud - Mon Nov 03, 2008 5:44 pm

User avatar Hello,

At the initial presentation your symptoms were very suggestive of infection in the upper aerodigestive tract (throat, and tonsils that spread to the ear). However, the fact that it lasted all of this period is not reassuring. In this case doctors would think of an abscess formation, chronic inflammatory condition from chronic irritation or a malignancy as the underlying cause of this chronic pain.

Nasopharyngoscopes allows a thorough visualization of the upper aerodigestive tract in the clinic and is very useful to see lesions in the base of the tongue. Your first CT results were suggestive of reactionary lymph node enlargement (post infection) and an inflammation in the base of the tongue and your throat (complicated).

Your physician is absolutely right to recommend another FU CT scan to exclude serious causes like malignancy. A contrast enhanced is a reliable technique to detect both the presence of neoplasms, and its spread to surrounding spaces as well as to lymph nodes but it is never diagnostic.

Although the tongue lesion became more prominent as well as the involved lymph nodes, this could be due to chronic inflammation or infection in the upper aerodigestive tract. The fact that you have GERD makes this a likely scenario although it GERD a risk factor for developing malignant tumours in the upper GI tract.

The only way to confirm the nature of this lesion is by histopathological examination for a biopsy.

I advise you to follow up with your doctor, only by thorough history and clinical examination the proper management can be reached.

Please keep us updated.
Best regards.
 MaherC - Mon Nov 03, 2008 7:31 pm

Thank you Dr. Safaa for your input. I hope you don't mind asking you a couple of questions.

1 - is there a history where the CT Scan report indecated malignancy and the biobpsy was negative?

2- from what my ENT DR. indecated that there is a 50/50 % chance that it is maligant does that mean that the apperance of the Lession is not convencing to him that it is SCC?
 Dr. Safaa Mahmoud - Tue Nov 04, 2008 1:49 pm

User avatar Hello,

You are welcome.
The CT scan can only take pictures of different parts of the body describing characters of a mass; where it sees a mass, its boundaries and possible intralesional changes like break down etc. So its value is in making physician more suspicious about an aetiology and as a guidance to his next step in investigations.

So the idea is not that the CT reports a malignant mass and it turns out to be benign, but it suggests that this mass warrants more investigations to exclude malignancy. And this is what your doctor is doing regardless how likely the mass could be malignant.

Your physician said his estimate based on your clinical course of the disease and the CT findings, so he can not be certain unless he sees the histopathology report.

Hope you find this is useful.
Please keep us updated.
Best regards.
 MaherC - Tue Nov 04, 2008 6:07 pm

Again thank you for the usefull information.

I'm hopping for the best, tomorrow will have the biopsy done and insha2 allah will be benign.

I will let you know the outcome.


Thanks and wish me luck
 MaherC - Wed Nov 05, 2008 3:13 pm

Had the biopsy this morning, for some reason did not freeze it and will not know the result until my next appoitement in 2 weeks. so basicly I have another 2 weeks to wait.

Shouldnt they looked at it under the microscope today? why did nt they do that?

Thanks
 Dr. Safaa Mahmoud - Thu Nov 06, 2008 4:20 pm

User avatar Hello,

Fresh frozen sections are done if immediate results are needed and immediate surgical resection is highly possible and planned.

Doctors usually send specimens to be kept in a preservative (paraffin) for subsequent preparation of thinner slides for histolopathological studies.

Unfortunately, you will have to wait sometime till the results are out.

Please keep us updated.
Best regards.
 MaherC - Wed Nov 19, 2008 11:51 pm

Today I got the Biopsy results back, it is Squamous papilloma so no cancer at this time, the bad news is that while I was waiting for my results, my wife was diognosed with Multiple myeloma and she is in hospital unable to walk with sever back pain.

DR safa I would appreciate if you can shade some light on this.

thanks
 Dr. Safaa Mahmoud - Sat Nov 22, 2008 5:48 pm

User avatar Hello
Hope your wife is getting better.

First I would like to mention some information about Squamous paplilloma of the tongue. It is a benign proliferation of squamous cells that is thought to be due to infection with certain type of virus known as human papillomavirus (HPV).

They are treated with conservative surgical excision and some physicians may leave it under follow up since there are no reports that suggested its transformation into malignant disease.

Regarding multiple myeloma, it is a disseminated malignancy of monoclonal plasma cells (blood cells). The plasma cells accumulate in the bone marrow resulting in bone marrow failure and bone destruction. These two sites are the main sites affected by the disease. Thus patients usually present with anemia, recurrent infections and bone pains. Renal functions are frequently affected in this disease by different mechanisms.

Patients are usually diagnosed based on different laboratory blood and urine tests, skeletal survey and bone marrow aspirate and biopsy.
Laboratory tests include CBC, LFT, KFT, Serum and Urine electrophoresis and immunofixations. LDH and B2 microglobulin are routinely requested and are indicatives for the tumor burden.

Based on laboratory tests and clinical findings, patients are divided into those with indolent or active disease that needs treatment.

Treatment of multiple myeloma has been in progress in the last few years although none of the available approaches is considered curative. The disease however is very responding to treatments.

It would be more helpful if you can provide us with her results and the possible treatment recommended by her doctor.

Please keep us updated.
Best regards.

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