A 60-year-old man with HPV+ HNSCC (T3N2M0).

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Presentation transcript:

A 60-year-old man with HPV+ HNSCC (T3N2M0). A 60-year-old man with HPV+ HNSCC (T3N2M0). A, T2-weighted image reveals a left tonsillar tumor (long arrow) with intermediate signal intensity, parapharyngeal space invasion, and bilateral retropharyngeal lymph node metastases (short arrows). B, B1000 and C, gray-scale ADC map show restricted diffusion within the tonsillar tumor (long arrows) and within the lymph node metastases (short arrows). The freehand ROI contoured on the gray-scale ADC map is visible as a blue line. D, Color-coded ADC map (same level as C). Note that this tumor is less heterogeneous (mainly blue areas) than the tumor in Fig 1. E, Histology (hematoxylin-eosin; original magnification, 200×) shows homogeneous tumor consisting of clusters of densely packed, basaloid cells with scant cytoplasm, and without keratinization. Focal necrosis in the center of the tumor cell clusters (comedonecrosis) is present (asterisk). F, Immunohistochemistry for p16 is positive; more than 70% of tumor cells show strong cytoplasmic and nuclear staining indicating HPV positivity (original magnification, 200×). Polymerase chain reaction for HPV DNA further confirmed HPV positivity. T. de Perrot et al. AJNR Am J Neuroradiol 2017;38:2153-2160 ©2017 by American Society of Neuroradiology