EURORAD ESR

Case 111

Recurrence of a malignant fibro-histiocytoma in the masticator space with perineural spread

Author(s)
M.Leurquin, M.Lemort, J.M.Cucchi
 
Patient
male, 36 year(s)

Clinical History

Clinical signs of deep relapse in a patient treated 4 years before for a malignant fibro-histiocytoma of the right maxillary sinus

Imaging Findings

This patient was operated on 4 years ago for a malignant fibro-histiocytoma of the right maxillary sinus (total right maxillar resection including the orbital floor and the hard palate and the pterygoid processes). An osseous reconstruction was performed in a second time. One year later, apparition of a local relapse involving the base of the skull treated by chemo- and radiotherapy. Status quo during 2 years. Now the patient consults for apparition of a trismus; the clinical examination shows a local re-evolution. MRI is done with the following sequences: T1w SE axial and coronal pre and post Gd DOTA.

Discussion

The relapse involves massively the pterygo-maxillary fossa including the lateral and medial pterygoidsmuscles causing the trismus.There is a perineural extension along the ways of the V2 (enlarging the foramen rotundum) and V3 (foramen ovale) up to the Meckel's cave. Unfortunately, in spite of multiple chemotherapies, the evolution was bad and the patient is now in end-stage of disease.

Final Diagnosis

Perineural extension of a relapsing malignant fibro-histiocytoma
 

MeSH

  1. Paranasal Sinuses [A04.531.621]
    Air-filled extensions of the respiratory part of the nasal cavity into the frontal, ethmoid, sphenoid, and maxillary cranial bones. They vary in size and form in different individuals and are lined by the ciliated mucous membranes of the nasal cavity.

Citation

M.Leurquin, M.Lemort, J.M.Cucchi (2000, Jan 17).
Recurrence of a malignant fibro-histiocytoma in the masticator space with perineural spread, {Online}.
URL: http://www.eurorad.org/case.php?id=111
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  • Figure 1
    T1W SE axial before (1a) and after (1b) Gd IV
    a b  

    Postoperative status with sequel of maxillectomy and metallic material inducing susceptibility artefacts. The masticator space is filled with an intermediate signal tissue.

    There is a frank and homogeneous enhancement of the tumour in the masticator space.

     
  • Figure 2
    T1W SE coronal before contrast
    a b  

    There is a filling of the right masticator space by a tissue of intermediate signal intensity

    Note the obtrusion of the fat spaces around the foramen ovale on the right side

     
  • Figure 3
    T1W SE coronal after Gd IV
    a b c  

    (Note: the grid-like artefacts are RF artefacts due to an external interference) There is a filling of the masticator space and the area of the right inferior orbital fissure by enhancing tumour tissue.

    The cavernous sinus and Gasser ganglion are widened and enhance. The Meckel's cave is obtruded on the right.

    There is a widening of the foramen ovale and tumour all around the way of the inferior maxillary nerve.

     
Figure 1

T1W SE axial before (1a) and after (1b) Gd IV

Figure 1a
Postoperative status with sequel of maxillectomy and metallic material inducing susceptibility artefacts. The masticator space is filled with an intermediate signal tissue.
 
Figure 1b
There is a frank and homogeneous enhancement of the tumour in the masticator space.
 
Figure 2

T1W SE coronal before contrast

Figure 2a
There is a filling of the right masticator space by a tissue of intermediate signal intensity
 
Figure 2b
Note the obtrusion of the fat spaces around the foramen ovale on the right side
 
Figure 3

T1W SE coronal after Gd IV

Figure 3a
(Note: the grid-like artefacts are RF artefacts due to an external interference) There is a filling of the masticator space and the area of the right inferior orbital fissure by enhancing tumour tissue.
 
Figure 3b
The cavernous sinus and Gasser ganglion are widened and enhance. The Meckel's cave is obtruded on the right.
 
Figure 3c
There is a widening of the foramen ovale and tumour all around the way of the inferior maxillary nerve.
 
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