Synovial sarcoma on Pazopanib therapy; assess for progression of disease Brain: There is no intracranial mass or mass effect. No abnormal parenchymal or meningeal enhancement. There are unchanged foci of susceptibility compatible with chronic microhemorrhage or mineralization in the bilateral frontal, left temporal, as well as the right inferior parietal lobule. No evidence of recent infarct or hemorrhage. Ventricles and sulci are within normal limits. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild scattered paranasal sinus mucosal thickening which again seen, with slight interval increase in anterior ethmoid opacification. There is moderate opacification of the left mastoid air cells and to a lesser degree on the right and slightly increased in the interval on the left.Cervical and Thoracic Spine: Again seen are postoperative findings related to C2-T2 laminoplasty and tumor debulking. Again seen is a residual tumor involving the left-sided neural foramina throughout the cervical and upper thoracic spine. Minimal intraspinal component involving the left lateral epidural space is also again seen and without associated mass effect. Compared to 6/30/2016 there is no significant change in size or appearance of the tumor, again with the enhancement pattern primarily peripheral as opposed to the more solid enhancement appreciated on the earlier study from 3/1/2016. The overall bulkiness of the residual soft tissue is not significantly changed. At the left C3-C4 level, tumor measures approximately 18 x 14 mm, axial T2 image 24 series 1501, which is not changed since prior allowing for slight differences in imaging plane. Again noted is partial encasement of the left vertebral arterySimilar to prior, again seen is patchy heterogeneous marrow replacement throughout the cervical spine and upper thoracic spine, but the vertebral body heights are preserved. There is a kyphotic curvature at the cervico-thoracic junction, but no spondylolisthesis. The spinal canal is significantly narrowed from C5-C7, which is in part attributable to kyphotic curvature, a tight laminoplasty and small posterior disc-osteophyte complexes. No new osseous abnormality, new epidural tumor, or new or enlarging paraspinous soft tissue to suggest disease progression. There is associated mild spinal cord flattening in this region, without definite spinal cord signal abnormality. Please refer to separate report for findings in the chest including small pneumothorax and pulmonary nodules.
1. No evidence of intracranial metastases. Multiple scattered punctate foci of susceptibility compatible with chronic microhemorrhages and similar to recent prior studies. These are nonspecific and may be related to posttreatment changes but would suggest continued attention on follow-up.2. Compared to 6/30/2016, no significant change in size of the treated residual tumor involving the left-sided neural foramina and paraspinous tissues in the cervical and upper thoracic spine. Noted is however diminished central enhancement of the tumor compared to 3/1/2016 which is favored to represent treatment response. 3. No significant change in patchy marrow signal abnormality involving the cervical and thoracic spine compatible with treated metastases. No new enhancing lesions, pathologic compression fractures, or epidural tumor. 4. There is moderate to severe spinal canal stenosis from C5 to C7 particularly on the left with flattening of the cervical cord. Findings are related to combination of disc osteophyte complex and laminoplasty.5. Please refer to separate chest CT report for findings including small pneumothorax and pulmonary nodules.