Apocrine adenocarcinoma. New onset memory deficit, incoordination and left hemiparesis. This is a motion degraded exam. There is a lobulated heterogeneously enhancing mass measuring approximately 5.2 x 4.0 cm in maximum transaxial dimension and 5.9 cm in craniocaudal dimension involving the anterior right temporal lobe. There is enhancement extending along the adjacent dura. There is extensive perilesional vasogenic edema. There is mass effect with effacement of the right lateral ventricle and midline shift about 10 mm towards left. The temporal horn of the right lateral ventricle is displaced superiorly and medially. There is effacement of the right sylvian fissure and right sided cortical sulcal sulci. There may be erosion of the overlying right temporal bone.There is approximately 4.2 x 2.6 cm enhancing mass in the left paravertebral region extending anteriorly and invading posterior to the carotid space and adjacent paraspinal musculature. The major deep cervical vessels are intact.The major cerebral flow voids are intact.
1. Findings consistent with a 5.2 cm right temporal lobe metastasis with extensive vasogenic edema, mass effect and midline shift as described. There are findings suggesting adjacent dural invasion and perhaps erosion of the right temporal bone.2. Interval increase in size of left paravertebral mass with involvement of the paraspinal muscles also consistent with metastasis.Findings were discussed with Dr Maitland by Dr Kumar at 11:20 hours on 1/8/2016.