1. Carcinoma of tongue 2. Carcinoma of unknown primary 3. Carcinoma of buccal mucosa

1. NADKARNI’S 21ST CENTURY HOSPITAL,
TUMOR BOARD
CASES PRESENTED BY
DR PRATIK AGRAWAL, FHNO FELLOW
MODERATOR: DR SANDEEP ISHI- MEDICAL ONCOLOGIST
DR SIDDHARTH NAGSHET- RADIATION ONCOLOGIST
CASES:
1. CARCINOMA OF TONGUE
2. CARCINOMA OF UNKNOWN PRIMARY
3. CARCINOMA OF BUCCAL MUCOSA

2. Case No.1: CARCINOMA OF TONGUE:
Clinical History: A 35 years old male
patient reported with ulcerative non
healing growth in right tongue from since
5-6 months
Biopsy: keratinizing, Squamous cell
carcinoma, grade II
Medical history: no any co morbidities
CECT : Ulcerative lesion in right lateral
border tongue,
extrinsic muscles-not involved
FOM & BOT- not involved
No significant lymph nodes
Dx: Carcinoma of right tongue
Clinical staging:
Planned: Surgical resection + plastic
reconstruction

3. PREOPERATIVE PICS

4. Surgery: Right hemi glossectomy+ bilateral
modified radical neck dissection from
level 1 to level 4+ plastic
reconstruction by free radial forearm
flap
HPE:Keratinizing, squamous cell
carcinoma, grade II
pT:3cm, DOI: 1.3cm, WPOI- 5 is seen
PNI-present/ LVI- negative
Margins and base- free of tumour
pN- 2/31 nodes-positive
Pathological staging: TNM : pT3pN2b
Adjuvant treatment proposed by tumour
board: Adjuvant CT+RT

5. POSTOPERATIVE PICS

9. CASE NO 2.:CARCINOMA OF UNKNOWN PRIMARY
Clinical history: A 55 year old male patient
reported to the clinic with huge mass
in left cervical neck region from since
6-7 months
O/E: oral cavity-NAD/ Laryngoscopy- NAD
Medical history: no any co-morbidities
FNAC: Metastatic squamous cell
carcinoma
DX: Carcinoma of unknown primary
Planned: Surgical resction of left cervical
huge mass+ B/L MRND+ plastic
reconstruction by PMMC flap

10. PREOPERATIVE PICS:

11. Surgery: composite resection of left cervical
neck mass + left modified radical neck
dissection+ plastic reconstruction by PMMC
flap
HPE: Large metastatic poorly differentiated
carcinoma with sarcomatoid areas( probably
squmous).
size of tumor-14cm in largest dimension
extranodal extension present
pN- 1/5 positive nodes in left mrnd
- 1/16 positive nodes in right mrnd
Adjuvant treatment proposed by Tumor
board:
ADJ. CT RT

12. POSTOPERATIVE PICS:

19. 3. CARCINOMA OF LEFT BUCCAL MUCOSA
Clinical history: A 62 years old
male patient reported with
ulcerative growth in left buccal
mucosa from since 8-9months
medical history: HIV positive,
diabetic on medications
o/e: ulcerative growth of
approx4*5cm in size clinically in
left buccal mucosa, left level Ib
node palpable and enlarged
bx: squmaous cell carcinoma
Dx: ca left buccal mucosa
plan: surgical resection+ mrnd+
plastic reconstruction

20. PREOPERATIVE PICS:

21. PREOPERATIVE
RADIOLOGICAL
Examination

25. Surgery: left composite
resection of buccal mucosa
growth+ mrnd+ extra oral skin
infiltration gropwth excision+
bipaddle pmmc flap
HPE: keratinizing sq.cell ca.grade
II
maximal thickness-2.6 cm,DOI-
1cm,WPOI-3 is seen
PNI-present, LVI- present
pN-4/28- nodes-positive
pathological staging: pT2pN3b
adjuvant tx proposed by the
tumor board: ADJ.CT RT

26. POSTOPERATIVE PICS: