PMC8140788_01
MRI with contrast:(A) before pazopanib (December 2016) and (B) after pazopanib (April 2017). Imaging report: (A) December 2016, Cerebral parenchyma: interval increase in vasogeneic edema in bilateral frontal lobes in the background of gliosis, right greater than left. Extra-axial spaces: interval increase in size of dural-based masses seen in bilateral anterior cranial fossa floor. The right anterior cranial fossa lesion measures 2.0 x 2.2 cm2 (previously 1.7 x 1.4 cm2). It extends through the nearby craniotomy defect into the right anterior forehead scalp, which also demonstrates interval increase in size as well. The left anterior cranial fossa lesion measures 1.5 x 1.6 cm2 (previously 1.3 x 2.3 cm2). Calvarium or sinuses: interval increase in size of right buccal space and masticator space mass along the lateral wall of the right maxillary sinus extending along the right temporalis muscle. It demonstrates hypointense T1 and hyperintense T2 signals with solid enhancement. The lesion measures approximately 7.2 x 3.7 x 4.7 cm3 (previously 6.2 x 3.3 x 3.5 cm3). Interval increase in size of similar mass in left masticator space along temporalis muscles measuring 2.4 x 1.0 cm2 (previously 1.8 x 0.8 cm2). Interval increase in size of enhancing scalp lesion near the left anterior pinna measuring 1.8 x 0.5 cm2 (previously 1.4 x 0.7 cm2). (B) April 2017, Cerebral parenchyma: enhancing right frontal lobe lesion involves the brain parenchyma, dura, calvarium, and scalp, and has significantly decreased in size and currently appears non-mass-like. Similar-appearing lesion in the left frontal lobe has also decreased in size. Both of these lesions on the prior study were well-defined masses. Extra-axial spaces: no extra-axial collection. Calvarium or sinuses: nodular contrast enhancement within both inferior temporal fossa, decrease in size of the craniocaudal extent, the superficial muscular component on the right measures up to 3.4 cm in the AP dimension (previously about 4.4 cm). AP, anteroposterior; MRI, magnetic resonance imaging.
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fig1
An MRI in December 2016 revealed increasing size of masses in the right buccal and masticator space, left masticator space, scalp, as well as increased size of a dural-based mass in the bilateral anterior cranial fossa floor and vasogenic edema in bilateral frontal lobes (Fig 1A). Follow-up MRI brain showed significant response at her disease sites consistent with partial response (Fig 1B).
Clinical timeline. MRI, magnetic resonance imaging; NED, no evidence of disease; PET, positron emission tomography; PR, partial response; RT, radiotherapy.
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fig2
A timeline of her disease course and treatments is included in Figure 2.