case_images: PMC11798650_01
case_images: Primary disease at the first examination. An unsmooth ulcer on the left side of the tongue on the first examination (A). Contrast-enhanced magnetic resonance imaging (MRI) showing an enhanced tumor in left side of tongue (arrow head) (B).
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case_images: FIG1
case_images: After evaluating the patient with contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography/CT (PET/CT), the patient was diagnosed with T2N0M0 squamous cell carcinoma of the left tongue (Fig. 1A, 1B).
case_images: Imaging findings of late lymph node metastasis. Contrast-enhanced computed tomography (CT) showing enlarged lymph node suspicious for central necrosis in level II lesion (arrow head).
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case_images: FIG2
case_images: Three months postoperatively, late lymph node metastasis was observed, after which a neck dissection was performed (Fig. 2).
case_images: Image findings of rib bone metastasis. CT showing the osteolytic lesion in the left third rib (arrow head) in April 2020.
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case_images: FIG3
case_images: In May 2020, the irradiated lung tumor was stable, although a new metastasis was observed on the posterior side of the left third rib with pain upon motion (Fig. 3).
case_images: Image findings exacerbated distant metastasis .  CT showing exacerbation of the left third rib (arrow head) and lung metastasis with significant tumor enlargement in February 2021.
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case_images: FIG4
case_images: The response was initially considered good; however, regrowth of the left third rib and lung tumor (Fig. 4) and new metastases were observed in the mediastinal lymph nodes in February 2021.
case_images: Image findings of metastatic tumors extended into the vertebral canal.. Contrast-enhanced CT showing the metastatic third rib tumor extending into the vertebral canal through the intervertebral foramen between the second and third thoracic vertebrae (arrow head) (A). The magnification imaging of Fig. 5A shows the tumor mass compression of the spinal cord (arrow head) (B).
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case_images: FIG5
case_images: In particular, the metastatic tumor on the third rib showed significant growth and had extended into the vertebral canal through the intervertebral foramen between the second and fourth thoracic vertebrae (Fig. 5A, 5B).