A 64-year-old man comes to the office because of difficulty swallowing due to mouth ulcer. He also reports a swelling in his neck which increase in size during over the past 7 months. He has a long history of using chewing tobacco. On examination, there is an ulcerative lesion in the left floor of mouth. There is also a firm, palpable, nontender left submandibular mass. Biopsy of the submandibular mass is shown in the exhibit. Which of the following is the most likely route of spread from the floor of mouth to the submandibular mass?

Question

A 64-year-old man comes to the office because of difficulty swallowing due to mouth ulcer. He also reports a swelling in his neck which increase in size during over the past 7 months. He has a long history of using chewing tobacco.  On examination, there is an ulcerative lesion in the left floor of mouth.  There is also a firm, palpable, nontender left submandibular mass.  Biopsy of the submandibular mass is shown in the exhibit.  Which of the following is the most likely route of spread from the floor of mouth to the submandibular mass?

Quizplus · Accepted Answer

Eductional Objective: Head and neck squamous cell carcinomas typically spread first to the anterior cervical lymph nodes via the lymphatics.  The involvement of anterior cervical lymph nodes affects the staging of the disease.

A 64-Year-Old Man Comes to the Office Because of Difficulty