Adenoid cystic carcinoma with left maxillary lesion and liver metastasis. Neck CT:Extensive post-treatment changes are again present involving the left orbit, maxillary region and upper neck. Again noted are enhancing soft tissue lesion involving the left orbit, extending to the orbital apex, superior and inferior orbital fissure. There is extension into the region of the left pterygopalatine fossa and left cavernous sinus. There is lesion at the left nasolacrimal sac and canal. There is lesion involving anterior maxilla with very minimally increased bony erosion, measuring 26 mm (series 8035, image 52), with similar measurement on prior study. There is lesion involving the left nasopharyx and sphenopalatine foramen, with bony destruction at the floor of the sphenoid sinus and bone destruction of the left basisphenoid. There is soft tissue lesion involving the left temporalis muscle. The lesion at the left lacrimal fossa measures 19 x 7 mm (image 14, series 4) compared to prior measurement of 21 x 5 mm (image 12, series 3), not significantly changed in size. There is increased erosion of the lateral wall of the left orbit. There is soft tissue lesion overlying and lateral to the ramus of the left mandible. An enhancing lesion involving the anterior pole of the left temporal lobe is unchanged compared to MRI of 11/16/2010. Enhancement in the left foramen ovale seen on the prior MRI is not as well appreciated on this CT study and may be related to technical difference.There is patchy opacity in the right lung apex, which may represent inflammatory change. Degenerative disease of cervical spine is noted.
1. Enhancing lesions involving the left and anterior maxillary region and left orbit with extension into the left nasopharynx, left masticator space, sphenoid sinus, skull base, and left cavernous sinus as described above. There is subtle interval increase of bone erosion associated with the lesions at the left lacrimal fossa and anterior maxilla, but the soft tissue components of the lesions demonstrate no significant interval change in size.2. Enhancing lesion in anterior pole of the left temporal lobe seen on prior MRI study is not significantly changed. This could potentially represent post radiation necrosis versus tumor brain parenchymal involvement. 