0:01

So this is a classic example of one of the most

0:03

common tumors that you'll be seeing in your practice.

0:06

This is a classic example of an oropharyngeal

0:10

carcinoma that's arising from the left tonsil.

0:13

Now, when we talked about our normal anatomy,

0:15

there were three parts of the tonsil.

0:16

There was an anterior tonsillar pillar, a

0:19

posterior tonsillar pillar, and the regular tonsil,

0:22

which is the palatine or the faucial tonsil.

0:25

This tumor is arising right in the middle of the

0:28

tonsil, so this is a classic example of squamous cell

0:30

carcinoma involving the palatine/faucial tonsils.

0:35

So we have a very large mass here that's centered,

0:38

and we can see this very, very enlarged lymph

0:40

node mass and conglomerate lymph node mass.

0:43

So this is what you would typically see in

0:45

an HPV-positive squamous cell carcinoma.

0:48

On the coronal images, we can see this

0:50

large mass that extends just about to the

0:53

level of the soft palate inferiorly to

0:55

just at the level of the glossotonsillar sulcus.

0:59

And again, this very, very large nodal mass.

1:02

Now, when we look at the, uh, axial images, I

1:05

wanna point out this area just deep to this, this

1:08

triangular space is the parapharyngeal space.

1:11

When a surgeon initially sees a cancer like this,

1:14

what they're thinking about is, is it possible for

1:16

me to resect this using some type of robotic surgery?

1:20

So they will look at this and what they're

1:21

really interested in is what is this deep extent?

1:24

In this particular case, we can see that this cancer

1:26

has extended deeply into the parapharyngeal space,

1:30

and this really makes it very difficult for the

1:32

surgeon to resect this using the robotic surgery.

1:35

So especially now in 2020, we have the

1:39

capability to look at this deep extent

1:41

in a patient's HPV-positive squamous cell

1:44

carcinoma of the tonsil, with this deep extent.

1:46

Then these patients are typically treated with

1:49

combined chemotherapy and radiation therapy.

1:52

The image on the bottom left-hand

1:53

side is just a PET/CT in general.

1:56

Now, in the United States, if someone

1:58

does have squamous cell carcinoma, many

2:00

institutions just go ahead and do PET/CTs.

2:02

I'm not sure if there's really evidence base for

2:04

it, but it is being performed and just demonstrates

2:07

a high activity involving this left primary tonsillar

2:10

carcinoma and this very, very large conglomerate

2:13

mass in the left neck. And on the sagittal images,

2:16

these parasagittal images again

2:18

demonstrate this very, very large mass

2:20

involving the left tonsil.

2:22

So this is a left tonsil squamous cell carcinoma,

2:26

that's HPV-positive, probably one of the most

2:29

common tumors that you'll see in your practice.