T4b N2b parotid gland carcinoma with skull base and facial nerve invasion s/p parotidectomy with right radical neck dissection which revealed carcinoma originating from ex-pleomorphic adenoma with positive margins, perineural invasion and 10/50 positive lymph nodes, here for a regular follow up after C5/5 of TFHX completed on 2.28.13. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is mild scattered cerebral white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is persistent fluid within the right mastoid air cells.Neck: There are unchanged post-treatment findings related to radiotherapy, as well as right parotidectomy and neck dissection. There is persistent diffuse enhancement and mild enlargement of the mastoid, tympanic, and geniculate ganglion segments of the right facial nerve. There is an unchanged subcentimeter left thyroid nodule. Otherwise, there is no evidence of measurable mass lesions in the neck or significant cervical lymphadenopathy. The remaining major salivary glands are unremarkable. The major cervical flow voids are grossly intact. There is mild cervical spondyloarthropathy without significant spinal stenosis. There is T2 hyperintense signal within the subcutaneous tissues of the face bilaterally, which likely represents cosmetic filler.
1.Post-treatment findings in the neck with persistent right facial nerve enhancement, which is compatible with perineural tumor involvement.2. No evidence of significant lymphadenopathy in the neck.3. No evidence of intracranial metastases.4. Unchanged nonspecific left thyroid nodule.