Metastatic maxillary sinus cancer. Evaluate response to chemotherapy. Also, please evaluate for perineural spread. The examination is mildly limited by artifact that is most pronounced on the diffusion weighted and fat suppressed sequences.FACE:There has been regression in the destructive right maxillary sinus soft tissue mass and its extension beyond the right maxillary sinus since the prior examination. The bulging into the right nasal cavity has resolved. There is now circumferential soft tissue thickening in the right maxillary sinus that is markedly T2 bright and shows uniform peripheral contrast enhancement, which probably represents mucosal thickening. Similar involvement is present in the right ethmoid sinuses as well. Associated osseous destruction is better assessed on CT scan. While the floor of the right orbit was previously involved, there is no gross extension into the right orbit. Previously described asymmetric contrast-enhancing soft tissue involving the right pterygopalatine fossa is slightly improved, which reflects perineural spread through the right infraorbital nerve. It extends into the right vidian canal and reaches very close to the right foramen rotundum though does not definitely extend into it. The asymmetric increased contrast enhancement/fullness in the anterior aspect of the right cavernous sinus is also now less pronounced. Asymmetric prominence of the right posterior glenoid is unchanged.There is no brain parenchymal or leptomeningeal abnormal contrast enhancement. There is no mass-effect or brain herniation.NECK:The associated right level 2A lymphadenopathy has regressed. The largest lymph node that previously measured 1.4 cm x 2.1 cm now measures 0.8 cm x 1.4 cm. The other lymph nodes are even smaller. The upper right lateral retropharyngeal lymph node that measured 10 mm x 12 mm now is barely visible measuring 0.6 cm x 0.4 cm. There is no new cervical lymph node enlargement. Major salivary glands are unremarkable. Major neck vessels show preserved flow voids. The airway is preserved The cervical spinal cord shows no gross abnormality in the spinal canal is fairly preserved. Less fatty than expected marrow signal in the cervical spine may reflect red marrow reconversion.
1.Significant improvement of the destructive, locally invasive right maxillary sinus cancer. The circumferential soft tissue and now present in the right maxillary sinus probably reflect mucosal thickening. There is no measurable definite tumor mass in the right maxillary sinus region.2.The associated right cervical lymphadenopathy is also improved. Indeed, the residual lymph nodes are subpathologic in size.3.Associated findings of perineural spread are slightly improved.