Q. MRI of head and neck shows enlarged adenoids. I the enlargement benign or malignant?

Answered by
Dr. Ismail Kabakus
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Aug 27, 2020

Hello doctor,

I am a 32-year-old male. I went to the doctor last week and they told me I have an enlarged adenoid. They took a biopsy from it to rule out malignancy. A few weeks earlier, I have had an MRI of the head and neck. Can you look at the footage and let me know if there are signs of an enlarged adenoid on the images. Also, could you tell me what the enlargement could be? Benign or malignant?



Welcome to icliniq.com.

I have seen the MRI (attachment removed to protect patient identity).

There is a very mild adenoid hypertrophy. Adenoids are a patch of tissue that is high up in the throat. They, along with the tonsils are part of the lymphatic system. The lymphatic system clears away infection. The adenoids and tonsils work by trapping germs coming in through the mouth and the nose.

There are many benign processes, mostly infectious, that may result in adenoid hypertrophy. Considering your young age and having no risk factor, it is very unlikely you to adenoid cancer.

I reviewed the MR images showing adenoid without any discrete suspicious lesion. No pathologic enhancement. There is a small cyst, Tornwaldt cyst (also spelled as a Thornwaldt cyst or Thornwald cyst) is a common incidental benign midline nasopharyngeal mucosal cyst.

I hope this helps.

Thank you doctor,

I have special anxiety regarding the picture that I attached. To me, it looks like a mass is growing in the left prevertebral flexor muscle and perhaps even into the clivus. What are your thoughts on this?

Also, to me, it looks like the post-contrast fat suppressed images suggest a heterogenous enhancement instead of a homogenous enhancement which, if I am correct, indicates a malignant process? Perhaps you can put my mind to rest regarding these additional questions.



Welcome back to icliniq.com.

I have seen the attachment (attachment removed to protect patient identity).

If you look at post-contrast series, both fat sat and non-fat sat, you will see both sides of the adenoid has a heterogeneous enhancement, which is normal. Image 13 is pre-contrast T1 weighed images you are talking about pre-vertebral midline hyperintense structure slightly asymmetric to the left. There is no corresponding pathologic hypo or hyper enhancement. Additionally, cancer is almost always hypointense in the pre-contrast T1 weighted series.

I hope this helps.

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