Findings:
A large, well-defined right level IIA necrotic and cystic lesion with heterogenous enhancement is seen measuring approximately 3.5 x 4 x 6 cm. Further enlarged lymph nodes are noted in the right upper and middle jugular regions (level IIB and III), measuring up to 1.2 cm.
A few, primarily non-specific lymph nodes are also seen on the left.
There is also an asymmetrical enlargement of the ipsilateral palatine tonsillar, which measures approximately 2 x 2.3 x 3 cm. No infiltration of the surrounding structures. The parapharyngeal fat space is normal.
The glottic region is unremarkable.
The parotid, submandibular and thyroid glands are normal.
The imaged brain is unremarkable. Partially empty sella is noted.
Mild mucosal thickening is seen in the ethmoid and maxillary sinuses bilaterally. The mastoid air cells are clear.
Metallic artefacts overlaying the lower cervical spine due to previous ACDF.
Conclusion:
Features likely compatible with right-sided tonsillar carcinoma with ipsilateral lymph node metastases; If p16 negative this would be T2N2b, if p16 positive T2N1.