A 62-year-old man with a prior 10–pack-year history of smoking presented with a 3-cm right level IIa lymph node. Fine-needle aspiration results showed metastatic p16-positive squamous cell carcinoma. No mucosal primary site was identified with positron emission tomography, computed tomography, or a head and neck examination. The patient underwent direct laryngoscopy with directed biopsies and bilateral tonsillectomy. Pathology results revealed a 1.8-cm primary cancer in the right tonsil, and the patient received a stage designation of T1 N1 M0. The tumor was intracapsular, and all surgical margins were negative. Multidisciplinary tumor board discussion concluded that surgical and nonsurgical treatment options were available, and the patient elected to proceed with further surgery, which would entail additional directed biopsies at the primary site with additional resection if necessary and selective neck dissection of levels Ib to IV. In preparation for the neck dissection, computed tomography of the neck with contrast was obtained. Imaging results revealed an enhancing structure at the skull base adjacent to the carotid sheath (Figure).
Tamaki A, Heilingoetter A, Kang SY. Enhancing Skull Base Structure Along the Carotid Sheath in a Patient With Oropharyngeal Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg. 2020;146(10):960–961. doi:10.1001/jamaoto.2020.2260
Artificial Intelligence Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.