Hematology Oncology Question 103

A 44-year-old woman is evaluated for a 2-month history of a painless right neck mass. Medical history is unremarkable, and she takes no medications. She is a lifelong nonsmoker.

On physical examination, vital signs are normal. A 5-cm right anterior neck mass is palpated. The remainder of the examination is unremarkable.

An initial CT scan of the neck shows a 4.5-cm, partially necrotic, right-sided lymph node. Asymmetric thickening of the right base of the tongue is also seen. Subsequent laryngoscopy shows an ulcerated mass involving the right base of the tongue. Biopsy of the tongue mass identifies poorly differentiated invasive squamous cell carcinoma. PET/CT scans show no evidence of distant metastases.

Which of the following studies should be performed next?

A Bone scan

B Human papillomavirus immunohistochemistry testing

C MRI of the brain

D Right cervical lymph node biopsy

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