頸動脈との癒着が疑われた頸部リンパ節転移に対する総合画像診断

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On November 1, 1986, a 25-year-old woman visited our clinic with the complaint of an ulcer of the right tongue border and a right neck mass. Induration and the ulcer were present from the right tongue border to the left side. Tongue movement was severely limited. The fixed mass, which measured 40×20 mm, was palpable in the right upper neck. The histological diagnosis based on a tongue biopsy was well-differentiated squamous cell carcinoma. The clinical stage was decided to be T4N3M0. Her clinical course suggested the possibility of distant metastasis, but this was negated by <SUP>67</SUP>Ga scintigraphy, bone scintigraphy and a plain chest X-ray. The metastatic cervical lymph node was large and fixed, so CT and echography were performed to determine the relationship between it and the main cervical vessels. Asadhesion or invasion to the internal carotid artery or the external carotid artery was suspected from CT and echographic findings, carotid angiography was done. Tumor vessels increased in accordance with the neck mass, but no invasive findings or adhesive findings were made by angiography. Treatment was as follows: subtotal glossectomy, right radical neck dissection, right marginal mandibulectomy and immediate reconstruction using PM-MC flap were performed after external irradiation 44 Gy, interstitial irradiation 55 Gy, hyperthermia twice, and chemotherapy (CDDP 140mg, BLM 30mg, PEP 55mg). After postoperative chemotherapy (CDDP 170mg, BLM 25mg, 5-FU 5, 000mg) was completed, she was discharged from the hospital. Now, 1 year and 8 months postoperatively, she is in good health without recurrence or metastasis. In conclusion, imaging diagnosis combined with echography, CT and angiography is helpful in the preoperative diagnosis of the relationship between metastatic lymph nodes and the carotid artery.
社団法人日本口腔外科学会の論文

頸動脈との癒着が疑われた頸部リンパ節転移に対する総合画像診断

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