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

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?

A) Direct invasion through the floor of mouth
B) Field cancerization of the oral cavity mucosa
C) Lymphatic drainage to the submandibular lymph nodes
D) Perineural spread through the lingual nerve
E) Sublingual vein to the submandibular gland

Correct Answer:

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