E1871. Recognizing Synchronous Cancer in the Head and Neck
  1. Erin Ling; University of California - San Diego
  2. Julie Bykowski; University of California - San Diego
While squamous cell cancer is the most frequent cancer of the head/neck region, patients may present with a synchronous (second primary) mucosal tumor or synchronous neck nodal or osseous metastatic disease which requires separate sampling to determine treatment.

Educational Goals / Teaching Points
This exhibit teaches radiologists and trainees to recognize imaging patterns and patient risk factors for synchronous (coexisting second primary) malignancy, through cases showing non-contiguous head/neck primary lesions, cystic vs solid node morphology, differing patterns of lymphatic involvement, and recognizing osseous involvement as abnormal in otherwise low stage head/neck tumors.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This case-based exhibit uses CT, MR, PET and US imaging findings in patients with synchronous primary head/neck tumors, and head/neck primary tumor synchronous with non-head/neck metastatic involvement in the neck: - Synchronous head/neck mucosal, thyroid, parotid, minor salivary, esophageal and skin masses; - Cystic metastatic nodes vs solid nodes in untreated lymphoma; - Nodal spread distribution between metastatic head/neck SCC and metastatic skin, thyroid, breast and lung cancers; - Head/neck SCC vs non-head/neck skull base and spine bone metastases. Cases will also review risk factors for synchronous primary lesions including immunosuppression, smoking, and genetic conditions.

Radiologists need to be alert to patients presenting with second primary tumors, and patterns of nodal involvement or bone metastases which are inconsistent with usual head/neck primary tumors, to alert the treatment team of the need to fully sample and stage disease for accurate patient care.