Report, pathology Case #: N19-3016 Collected: 7/8/2019
PATHOLOGIC DIAGNOSIS: A: Lymph Node FNA - right neck level 2a - Malignant.
The findings are consistent with metastatic Squamous Cell Carcinoma of the right tonsil with metastasis to the right lymph node, a type of head and neck cancer. I had a radical tonsillectomy and right neck dissection. Tuma size was 3 cm with a lymphovascular invasion on A5 and A6 to be 4.4 cm.
Transoral Robotic Surgery (TORS). No Chemo or RAD was necessary
Report, Surgical Pathology Case: Collected: 01/06/2022
Recurrence:
A: Neck FNA - right - Malignant - Squamous cell carcinoma - p16 immunostaining is POSITIVE -
Few malignant squamous cells are seen on the smears and in the cell EXAM: CT SOFT TISSUE OF NECK W CONTRAST
EXAM DATE AND TIME: 6/3/2022 12:00 PM
HISTORY: Neck mass. History of oropharyngeal cancer.
COMPARISON: Correlation is made to PET/CT dated December 30, 2019.
TECHNIQUE: CT scan of the neck was performed. 75 mL of Isovue-370 IV contrast were administered. Coronal and sagittal reformats were provided.
FINDINGS:
Surgical clips are noted in the right level 2 region, from prior lymph node resection. There is lobular enhancing mass surrounding the surgical clips and extending to the right parapharyngeal fat. The mass abuts the posterior margin of the right submandibular gland and the medial margin of the right parotid tail. It measures 2.2 x 1.8 x 2.7 cm. The right internal jugular vein traverses through the posterior aspect of the mass and is likely severely narrowed or invaded. There is also possible obliteration of the right external carotid artery.
Resection of the right palatine tonsils is noted.
The nasopharynx, oropharynx, hypopharynx, glottic, and subglottic airway are patent.
The major salivary glands are grossly unremarkable. The thyroid is small and homogeneous.
The lung apices demonstrate no focal infiltrate or nodule. The osseous structures demonstrate no suspicious lytic or blastic lesions. There are degenerative changes in the cervical spine.
IMPRESSION:
1. Ill-defined enhancing mass in the right level 2 region, surrounding the surgical clips and extending to the right parapharyngeal space, suspicious for recurrent tumor or adenopathy. There is severe stenosis or possible invasion of the right internal jugular vein and right external carotid artery.
Report, Surgical Pathology Case: NWS23-000732 Collected: 01/06/2023
Lung, left upper lobe, wedge resection:- invasive squamous cell carcinoma, keratinizing, with the following features: - single focus, 1.7 cm maximum dimension - moderately differentiated (grade 2) - negative for lymphovascular invasion - negative for visceral pleural invasion - margins negative for invasive carcinoma - closest margin, parenchymal, negative by 8 mm - one lymph node negative for metastatic carcinoma (0/1) - PD-L1 positive by immunohistochemical stain - positive for high risk HPV group by in situ hybridization - p16 positive- additional findings: pleural scars- see comment
The current lung squamous cell carcinoma and the patient's previously diagnosed right tonsillar HPV-mediated squamous cell carcinoma have similar morphologic and immunohistochemical characteristics. In addition, the lung squamous cell carcinoma is positive for high risk HPV group by in situ hybridization (performed at Quest Diagnostics). Given these results, the lung squamous cell carcinoma most likely represents a metastasis from the patient's oropharyngeal HPV-mediated squamous cell carcinoma.
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