Synovial sarcoma. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a persistent effusion within the left mastoid air cells and a small amount of fluid in the right mastoid air cells.Spine: There are postoperative findings related to C2-T2 laminoplasty and tumor debulking. There is perhaps slight interval increase in size and enhancement of the left paraspinal tumor with erosions of the vertebral bodies, encasement of the left vertebral artery at these levels, invasion of the corresponding neural foramina, and extension into the intraspinal epidural space, measuring up to 23 mm in width at the C3-4 level, previously 20 mm. There new and enlarging scattered enhancing bone marrow lesions in the cervical and upper thoracic spine and upper thoracic spine, but the vertebral body heights are preserved. There is a kyphotic curvature in the cervico-thoracic region, but no spondylolisthesis. The spinal canal is narrowed from C4 to T1, which is in part attributable to kyphotic curvature, a tight laminoplasty and small posterior disc-osteophyte complexes. There is associated spinal cord flattening in this region, without spinal cord signal abnormality. There are partly imaged, but extensive mediastinal tumors. There are multiple nodules within the partially imaged right lung. There is a small right apical pneumothorax.
1. Postoperative findings related to C2-T2 laminoplasty and tumor debulking with apparent mild interval increase in size of the residual tumor in the treatment bed on the left side with associated vertebral body erosions, left vertebral artery encasement, and mild encroachment upon the spinal epidural space through the neural foramina. 2. New and enlarging scattered bone marrow lesions in the cervical and upper thoracic spine and upper thoracic spine, which may represent metastases. 3. The spinal canal is narrowed from C3-C7 with associated compression of the lower cervical and upper thoracic spinal cord, which is in part attributable to kyphotic curvature, a tight laminoplasty and small posterior disc-osteophyte complexes. 4. No evidence of intracranial metastases.5. Partially imaged mediastinal tumors, pulmonary metastases, and bilateral small pleural effusions. Please refer to the separate chest CT report for additional details.