PMC6128267_01
Laryngoscopy image showing a tender mass in the left tonsil (arrow).
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At admission, a physical examination revealed a tender mass in the left tonsil (Figure 1) and a 1.1x1.3 cm lymph node at the left-side level II upon careful neck palpation.
Oropharyngeal magnetic resonance images obtained before (A) and after (B) treatment. The images depict a complete regression of the left tonsillar mass after 1 month of chemotherapy (arrows).
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Magnetic resonance imaging (MRI) of the oropharyngeal region revealed a well-defined oval-shaped mass lesion measuring 2.5x2x1.2 cm on the left tonsil, as well as metastatic enlargement of the cervical lymph nodes (Figure 2A). MRI of the oropharyngeal region verified an excellent tumor response after 1 month of treatment (Figure 2B).
Positron emission tomography scans obtained before (A) and after (B) chemotherapy reveal decreases in hypermetabolism in the primary lesion and metastases (arrows).
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Additionally, positron emission tomography (PET)-CT identified a heterogeneously enhanced and highly metabolic mass lesion on the left tonsil, as well as metastatic spread to the right lung, mediastinal lymph nodes, left cervical lymph node, and fourth lumbar (L4) vertebra body (Figure 3A).
Pathological findings of hematoxylin and eosin-stained tumor sections.. Notes: (A) The tumor formed scattered irregular nests (magnification: 200x). (B) The tumor comprised cells with crowded nuclei and scant cytoplasm (400x).
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Histologically, the biopsy specimens of the primary lesion revealed small round-to-oval-shaped tumor cells scattered in irregular nests (Figure 4A). At high magnification, these malignant neoplasms were found to have crowded nuclei with hyperchromatism and scant cytoplasm (Figure 4B).
The tumor cells exhibited positive immunoreactivity for (A) CD56 and (B) synaptophysin (magnification: 200x).
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The immunohistochemistry findings were as follows: the cells showed positivity for synaptophysin, CD56, and cytokeratin 8/18 and negativity for vimentin, S-100, CD10, and P63 (Figure 5), as well as a Ki-67 proliferation index of >50% (+).