Small cell neuroendocrine carcinoma of nasopharynx/sinus with extension to the skull base, s/p cisplatin/etoposide + concurrent RT completed in November 2014, now with leptomeningeal only disease recurrence. The patient is status post resection of the bilateral superior and middle turbinates, and nasal septum. There is prominent mucosal thickening in the bilateral maxillary sinuses, which has decreased slightly on the left. Trace fluid is identified within the mastoid air cells, left greater than right. There is diffuse hyperenhancement of the nasopharyngeal mucosal space, but no evidence of discrete mass lesion or upper cervical lymphadenopathy. There is a T2 hyperintense, enhancing lesion within the left inferior colliculus which restricts diffusion, compatible with increased cellularity. This measures 0.9 x 0.9 cm, previously 0.7 x 0.5 cm. There is an enhancing lesion within the mid to inferior right frontal lobe measuring 0.8 x 0.7 cm, previously 0.5 x 0.4 cm. There is unchanged enhancement and thickening of the pituitary infundibulum, measuring up to 5 mm in diameter. There is increased leptomeningeal disease, which now appears more confluent and extends along the cerebellum, midbrain, bilateral sylvian fissures, olfactory bulbs, trigeminal nerves (right greater than left), and cranial nerves VII and VIII. November median sulci also demonstrate diffusion restriction consistent with hypercellular leptomeningeal tumor.
1.Post treatment findings in the nasopharyngeal and sinonasal regions, with no measurable mass lesion within the sinuses.2.Progression of leptomeningeal disease involving the cerebellum, bilateral sylvian fissures, multiple cranial nerves and midbrain, with diffusion restriction noted along the cerebellar vermin sulci.3.Increased size of enhancing lesions within the inferior colliculus and right frontal lobe, consistent with metastatic disease.