Clinical History
Patient with a long history of "sinusitis" developing a
cavernous sinus syndrome
Imaging Findings
Long lasting signs of chronic sinusitis, developing signs
of cavernous sinus syndrome with motor ocular disturbances
and retro-orbital pain on the right. A MRI is done; T1W SE
images before and after Gd injection are shown.
Could you stage this tumour, and give the most probable
way(s) of intracranial extension, if any ?
Discussion
This is a huge tumour developed from the posterior part of
the right maxillary sinus and invading the masticator
space, including the pterygo-palatine fossa. The tumour
enhances smoothly with subtle inhomogeneous character.
The skull base is also invaded and there is certainly an
invasion trough the foramen ovale, to the right cavernous
sinus, the cavum of Meckel, and the anterior part of the
right temporal fossa. There is also an infiltration of the
superior orbital fissure and the apex of the orbit, as the
posterior ethmoid cells on the right.
Massive extension to the skull base is probably both
perivascular and perineural. Note that there is a sequel
of a right inferior turbinectomy.
This tumour is obviously a T4 stage.
This is an illustration of the degree of extent these
lesions of the paranasal sinuses may sometimes reach
before the diagnosis is done.
Differential Diagnosis List
SCC of the right maxillary sinus, T4, with intracranial invasion
Final Diagnosis
SCC of the right maxillary sinus, T4, with intracranial invasion