Answer for CoW 17 Dec 2017
Findings
Obliteration of fossa of rosenmuller with soft tissue thickening predominantly on right side Significant soft tissue thickening involving the bilateral cavernous sinus
Discussion
This is a case of HPE proven nasopharyngeal carcinoma with perineural spread to the cavernous sinus through foramen of ovale NPC can spread intracranially via the foramen lacerum or foramen ovale or through both the foramen ovale and foramen lacerum , and also it can also spread by direct erosion which results in multiple cranial deficits . Perineural spread through the foramen ovale is an important route, which explains the involvement of cavernous sinus involvement. PERINEURAL SPREAD OF HEAD & NECK CANCER: • Squamous cell carcinoma is the most common type of head and neck cancer. • Tumors of the head and neck may spread by a variety of mechanisms, including direct extension, hematogenous dissemination, or lymphatic dissemination. In addition, certain tumors are able to use peripheral nerves as a direct conduit for tumor growth away from the primary site by a process known as perineural spread. • Among patients with PNS, 40% are asymptomatic, which puts the onus on the radiologist to be vigilant to its presence. If symptomatic, the patients present with pain, numbness, burning, and dysesthesia along the course of the affected nerve, and motor denervation changes. The latter is most commonly manifested as weakness of the muscles of mastication or facial paralysis. Another common presentation is multiple cranial neuropathies, which indicate involvement of the cavernous sinus and is an ominous sign. • The common head and neck tumors that spread via the perineural route include cutaneous malignancies, mucosal primaries such as squamous cell carcinoma and salivary gland malignancies (especially adenoid cystic carcinoma), desmoplastic melanoma, nasopharyngeal carcinoma, myeloma, lymphoma, and leukemia. • Perineural tumor spread (PNS) is most common along branches of the trigeminal and facial nerves. • MR imaging signs of perineural spread : obliteration of fat within skull base foramina enlargement and enhancement of the involved nerves enlargement and destruction of the bony foramina enhancement of the neural foramen, or Meckel’s cave enlargement of the cavernous sinus
Obliteration of fossa of rosenmuller with soft tissue thickening predominantly on right side Significant soft tissue thickening involving the bilateral cavernous sinus
Discussion
This is a case of HPE proven nasopharyngeal carcinoma with perineural spread to the cavernous sinus through foramen of ovale NPC can spread intracranially via the foramen lacerum or foramen ovale or through both the foramen ovale and foramen lacerum , and also it can also spread by direct erosion which results in multiple cranial deficits . Perineural spread through the foramen ovale is an important route, which explains the involvement of cavernous sinus involvement. PERINEURAL SPREAD OF HEAD & NECK CANCER: • Squamous cell carcinoma is the most common type of head and neck cancer. • Tumors of the head and neck may spread by a variety of mechanisms, including direct extension, hematogenous dissemination, or lymphatic dissemination. In addition, certain tumors are able to use peripheral nerves as a direct conduit for tumor growth away from the primary site by a process known as perineural spread. • Among patients with PNS, 40% are asymptomatic, which puts the onus on the radiologist to be vigilant to its presence. If symptomatic, the patients present with pain, numbness, burning, and dysesthesia along the course of the affected nerve, and motor denervation changes. The latter is most commonly manifested as weakness of the muscles of mastication or facial paralysis. Another common presentation is multiple cranial neuropathies, which indicate involvement of the cavernous sinus and is an ominous sign. • The common head and neck tumors that spread via the perineural route include cutaneous malignancies, mucosal primaries such as squamous cell carcinoma and salivary gland malignancies (especially adenoid cystic carcinoma), desmoplastic melanoma, nasopharyngeal carcinoma, myeloma, lymphoma, and leukemia. • Perineural tumor spread (PNS) is most common along branches of the trigeminal and facial nerves. • MR imaging signs of perineural spread : obliteration of fat within skull base foramina enlargement and enhancement of the involved nerves enlargement and destruction of the bony foramina enhancement of the neural foramen, or Meckel’s cave enlargement of the cavernous sinus
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
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Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!