PMC7422746_01
images of the nasofibroscopy performed on the patient following the reappearance of the epistaxis showing the reappearance of the tumor process as indicated by the blue arrows
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F1
A nasofibroscopy done in the patient who showed a recurrence of his tumor process (Figure 1).
MRI sections in the axial (A+B+C+D+E) + coronal (F) plane sequences T1 with gadolinium injection showing the tumour process on the right side (pterygo-palatine angiofibroma), as shown by the brown arrows
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F2
The exploration was completed by MRI of the facial mass (Figure 2, Figure 3) which revealed the presence of an ethmoidonasal tumour process measuring 70x50x40 mm, heterogeneous with a double cystic and fleshy component, extending into the right maxillary sinus and the homolateral para-pharyngeal space, with extra-axial intracranial extension in the right temporal region.
the patient's angio-MRI showing the tumour blush and feeder pedicles, indicating the hyper-vascularization of this tumour (the angiofibroma) as shown by the blue arrows
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F3
The exploration was completed by MRI of the facial mass (Figure 2, Figure 3) which revealed the presence of an ethmoidonasal tumour process measuring 70x50x40 mm, heterogeneous with a double cystic and fleshy component, extending into the right maxillary sinus and the homolateral para-pharyngeal space, with extra-axial intracranial extension in the right temporal region.
disposition of multiple IMRT beams on the three plans (axial, sagittal and coronal) as shown by the blue arrows
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F4
We were able to keep the tolerance doses of organs at risk such as the optic chiasma, optic nerves, retina, pituitary and parotids within normal limits and at the same time deliver the intended dose of radiation to the tumor site (Figure 4, Figure 5).
three plans view of the conformity of the prescribed dose to the target volume in blue as shown by the blue arrows and the respect of the organs at risk as shown by the red arrows (right eye, brain stem, cerebellum and right parotid gland)
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F5
We were able to keep the tolerance doses of organs at risk such as the optic chiasma, optic nerves, retina, pituitary and parotids within normal limits and at the same time deliver the intended dose of radiation to the tumor site (Figure 4, Figure 5).
control scan sections (A+B+C+D), in the axial plane showing a marked regression of the tumor process and exophthalmos as shown by the blue arrows
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F6
A CT scan of the facial mass and cerebral area performed at two months after the end of irradiation which showed a clear reduction in tumor mass (Figure 6).