History of pT4aN1 right conjunctival squamous cell carcinoma with recurrent disease, s/p CRT, eval response Again seen are postsurgical changes of right orbital exenteration, right parotidectomy, and right neck dissection. Previously seen enhancing nodule measuring 19 x 16 x 22 mm in the AP, transverse and craniocaudal dimensions along the superior aspect of the right zygomatic arch is no longer appreciated. Slightly more inferior to the zygomatic arch, previously seen enhancing nodule measuring 17 x 11 x 15 mm and extending along the surface of the right masseter muscle is no longer appreciated. Previously seen nodular area of enhancement measuring 15x10 mm in the pre-auricular region is no longer appreciated. There is more diffuse enhancement in the right parotid space and the soft tissues overlying the masseter muscle and adjacent to the zygomatic arch likely representing posttreatment change. No new enhancing nodule or mass is seen on the current study. Abnormal enhancement is again noted along the medial and posterior aspect of the right orbital exenteration site at the level of the optic canal and superior and inferior orbital fissures which may represent granulation tissue.Intracranially, there is no intracranial mass or mass effect. No abnormal parenchymal or meningeal enhancement is seen to suggest metastatic disease. There are multiple foci of T2/FLAIR hyperintensity in the supratentorial periventricular and subcortical white matter which are nonspecific but compatible with chronic small vessel ischemic disease. No evidence of acute infarct, hemorrhage, or extra-axial collections. No hydrocephalus.There is opacification of the right anterior ethmoid air cells and mild mucosal thickening in the right maxillary sinus which is likely inflammatory. Evaluation of the neck demonstrates no other masses or evidence of pathologic enhancement. There are scattered subcentimeter lymph nodes which are nonspecific. No pathologically enlarged or necrotic lymph nodes are seen. No suspicion osseous lesions are seen. Degenerative changes in the cervical spine with disc osteophyte complexes at C4-C5, C5-C6, and C6-C7 are again seen with associated mild narrowing of the spinal canal.
1. Previously seen enhancing nodules adjacent to the right zygomatic arch, right masseter muscle, and preauricular region are no longer appreciated and consistent with treatment response. No discrete measurable lesion is identified on the current study.2. Status post orbital exenteration and right parotidectomy. Enhancement involving the right parotid space, right masticator space, as well as nodular thickening along the medial and posterior aspect of the orbital exenteration remains unchanged and may represent posttreatment change.3. Status post right neck dissection. No suspicious cervical lymphadenopathy is appreciated.4. No intracranial metastatic disease.