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DISTANT METASTASIS - The Hypoglossal Nerve

Now viewing: Case 13

Case 13 -
a.  Adenoid cystic carcinoma of tongue, post-operative status without evidence of recurrence
b.  Exensive perineural metastasis to hypoglossal, spinal accessory, vagus and glossopharygeal nerves

A 52-year-old male had right partial glossectomy and bilateral neck dissection for a tumor mass of the right side of the tongue with pre and post radiation therapy 6 years ago. The pathology revealed adenoid cystic carcinoma of the tongue with extensive invasion to the cervical lymph node and at the right internal jugular vein at the base of the skull. Patient presented with complaints of dysphia involving both liquids and solids. Examination revealed post-operative status of the right tongue without evidence of recurrence. There was paralysis of the right true cord and right soft palate. Admission MRI of the head and neck revealed enhancing soft tissue masses in the region of the right hypoglossal canal and right jugular foramen. The findings are consistent with perineural metastasis to right hypoglossal cranial nerve and IX, X & XI cranial nerves.
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Sagittal T1-weighted MR image (TR 550/TE 16): (6 Years after surgery): post-operative status of the anterior tongue without evidence of recurrence (arrow). Axial post-contrast T1-weighted MR image (TR 500/TE 20) at the level of the clivus 6 years after surgery: soft tissue tumor mass with intermediate signal intensity within the right hypoglossal canal and destruction of the bony boundary of the canal(1). Areas of soft tissue densities with intermediate signal intensities are seen in the area of the right jugular foramen consistent with involvement of IX, X & XI cranial nerves (2). There is extension of the lesion into the cerebello-pontine angle cistern.

2002 The Levit Radiologic - Pathologic Institute
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