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Clinical Problem Solving: Radiology
Sep 2012

Radiology Quiz Case 2

Arch Otolaryngol Head Neck Surg. 2012;138(9):869. doi:10.1001/archoto.2012.1675

A 45-year-old white man reported hoarseness with intermittent dyspnea, coughing, and wheezing. He was diagnosed as having stage III N0M0 squamous cell carcinoma of the left supraglottis based on the findings of baseline diagnostic contrast-enhanced fludeoxyglucose F 18 (FDG) positron emission tomography and computed tomography (PET/CT). One month after diagnosis, he underwent an endoscopic supraglottic laryngectomy and bilateral modified radical neck dissections. Five months after diagnosis, he presented with recurrent disease in the left cervical lymph nodes and underwent a revision modified radical neck dissection followed by chemoradiotherapy with intensity-modulated radiotherapy and cisplatin. Eleven months after diagnosis, restaging PET/CT scans revealed an FDG avid mass in the left parotid gland, with a fine-needle aspirate showing metastatic squamous cell carcinoma. The patient underwent a left total parotidectomy followed by adjuvant treatment with a frameless robotic radiosurgery system (Cyberknife; Accuray Inc). Fifteen months after diagnosis, PET/CT scans demonstrated FDG avid submental and left supraclavicular lymph nodes, and the patient underwent surgical resection followed by 4 cycles of adjuvant chemotherapy with carboplatin and docetaxel.

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