PMC6514476_01
MRI orbit 5/2018. 5.2 x 4.3 x 4.2 cm (AP, TR, SI) T1/T2 isointense mass lesion with mildly heterogeneous enhancement and diffusion restriction centered at posterior ethmoidal air cells, and extension into posterior cerebral nasal cavity including superior turbinates, sphenoidal sinuses, bilateral orbital medial walls and anterior cranial fossa.
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F1
T2-intermediate, enhancing, diffusion restricting mass centered in the ethmoid sinuses with extension into the nasal cavity, stenosis of bilateral orbital apices, encasement of bilateral optic nerves, and mass effect in the bilateral medial rectus muscles (Fig. 1). A CT chest/abdomen/pelvis was negative for metastatic disease. The patient was staged at IVB, and the case was subsequently discussed at a Multidisciplinary tumor board given the complex nature of the case.
Pathology slides for Patient TV confirming Sinonasal Undifferentiated Carcinoma.
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F3
August 2018 showed an interval decrease in the size of the previously described sinonasal lesion now measuring approximately 4.2 x 4.1 x 3.2 cm (AP, TR, SI), previously 5 x 4.5 x 4.5 cm (AP, TR, SI). Aspects of the mass lesion had improved significantly with decreased extension into the left medial orbital wall, left orbital apex and left posterior ethmoidal air cells and sphenoidal sinus, and there was near complete resolution of the mass effect on the left optic nerve and bilateral medial rectus muscles (Fig. 2).
MRI Orbit 8/2018. Since 05/30/2018, interval decrease in the size of the previously described sinonasal lesion now measuring approximately 4.2 x 4.1 x 3.2 cm (AP, TR, SI), previously 5 x 4.5 x 4.5 cm (AP, TR, SI). Left aspect of the mass lesion has decreased significantly with decreased extension into the left medial orbital wall, left orbital apex and left posterior ethmoidal air cells and sphenoidal sinus. Near complete resolution of the mass effect on the left optic nerve and bilateral medial rectus muscles.
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F2
ER with a head CT which was significant for a 4.7 cm x 4.1 cm x 3.9 cm ethmoid/sphenoid sinus mass. ENT performed an urgent biopsy confirming a poorly differentiated malignant neoplasm with positive pankeratin staining, consistent with carcinoma (Fig. 3).