My dad got diagnosed with squamous cell mouth cancer in September 2012. Surgery was done leading to extraction of third lower molar and about 2 cm margin and removal of three lymph nodes. Buccal fat pad was used for reconstruction of the retromolar triangle defect post resection. Post surgery the biopsy reports suggested positive posterior margin and rest everything was clear.
Hence radiotherapy was advised and during marker CT for radiotherapy they noticed "an irregularly marginated soft tissue density lesion with necrosis in right molar trigone". Hence a biopsy was performed which said - "chronic granulation tissue with mild to moderate dysplasia in overlying epithelium. Definite evidence of malignancy NOT seen in biopsy received."
Hence radiotherapy was done on face and neck region - 60 gray in 30 seatings. 6 weeks after radiotherapy we had the MRI done yesterday which shows - " ill defined mildly enhancing soft tissue lesion in right retromolar trigone. mass appears to be adherent with pterygoid muscles.Possibility of residual neoplasm can be considered. Correlate histopathologically."
Now, we will meet our radio-oncologist with these reports next week and we expect he will advice a biopsy or FNA.
My questions -
Is it possible to differentiate dysplasia and neoplasia on MRI?
Could this soft density lesion seen pre and post radiotherapy be due to buccal fat pad?
Is it progressing from dysplasia to neoplasia?
What should be the line of treatment in this case?