History of Merkel cell cancer on right cheek, with metastasis to right orbit: protosis and restrictive eye movement on right. There is a low T2 signal, enhancing, somewhat infiltrative mass in the inferior right orbit that measures up to 16 mm in thickness and 35 mm in length. The mass is inseparable from the right inferior rectus muscle and appears to invade the right medial and lateral rectus muscles. The mass also abuts the optic nerve. The left orbit is unremarkable. There is a 5 mm diameter enhancing nodule in the left Meckel cave and a punctate enhancing nodule within the right Meckel cave. There is a partially imaged mass in the right cheek subcutaneous tissues, measuring up to 9 mm in thickness. There is mild mucosal thickening in the right maxillary sinus with a small amount of fluid. There is partly imaged diffuse periventricular white matter T2 hyperintensity, which may represent chronic small vessel ischemia.
1. An infiltrative massa in the inferior right orbit measures up to 35 mm likely represents metastatic Merkel cell carcinoma.2. Nodules in the bilateral Meckel caves, left larger than right, may also represent metastatic Merkel cell carcinoma versus schwannomas.3. The subcutaneous mass in the right cheek corresponds to the treated recurrent Merkel cell carcinoma.4. Findings suggestive of right maxillary sinusitis.