 BRAIN AND ORBITS: There is interval enlargement of heterogeneously enhancing lobulated sinonasal mass that extends into the bilateral pterygopalatine fossae, as well as the medial right masticator space, with further posterior extension toward the nasopharynx and inferior spread into the superior oropharynx/palate. There is further invasion into the right maxillary ostium, new extension into the left maxillary ostium, as well as more mass effect with bowing into the right medial orbit. There is subtle increased mass effect with convexity into the left medial orbit. There is increased ill-defined enhancement of the right pterygoid muscles which may be reactive, although this is nonspecific. There is more nodular enhancement suspected to be tumor in the right masticator space/right retro-maxillary fat region.Overall, the confluent mass measures up to 33 x 34 mm at the level of the orbits, previously 28 x 28 mm. At the level of the nasal cavity, the mass measures up to 35 mm wide compared to 28 mm by previously. There is new restricted diffusion consistent with cellular tumor present along the right lateral portion of the mass. Previously seen intrinsic high T1 signal secretions at the periphery of the mass have now been replaced by enhancing soft tissue tumor. There is more extensive mass opacifying the left nasal cavity as compared to prior exam, with increased extension into the inferior meati. The enhancement characteristics have changed with more internal enhancement in numerous areas of internal necrosis. There is persistent opacification of the bilateral maxillary and sphenoid sinuses with proteinaceous material likely secondary to obstruction at the sinus outflow tracts. There is stable hyperintense central skull base osseous marrow signal involving the sphenoid wings and pterygoids.Again seen is dural enhancement along the anterior cranial fossa floor as seen on series 17 image 15 with cortical loss, which likely represents tumor invading through the floor of the anterior cranial fossa.There are unchanged postsurgical findings related to frontal craniectomy with mesh cranioplasty. There is subjacent dural thickening and enhancement as noted before. There is no acute infarct, suspicious enhancement, or cerebral edema. There is an unchanged small focus of susceptibility effect in the right parietal lobe. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is nonspecific high T2 signal in the mastoids on the right as noted before.
1.Marked interval enlargement of bulky mass in the nasal cavity with bulging into the bilateral medial orbits, invading the bilateral maxillary ostia (right greater than left), invading the bilateral pterygopalatine fossae, with further posterior and inferior extension along the nasal cavity toward the posterior nasopharynx, and along the palate into the oropharynx.2.Findings suggesting possible tumor invasion of the anterior cranial fossa floor with cortical loss, although this is similar to the prior exam.3.No brain parenchymal enhancing lesions.