Reason: Sinus cancer compare to last CT. Measure 1) Soft tissue mass in left nasal cavity, 2) soft tissue mass R. orbit medial rectus muscle, 3) Soft tissue L. orbit, 4) left level 2 lymph node, 5) right level 2 lymph node, 6) 2nd right level 2 lymph node. History: post 2 cycles of therapy. Neck CT:There is interval progression of abnormal soft tissue centered within the left nasal cavity which displaces the nasal septum to the right and abuts the left maxillary antrum. The soft tissue abnormality measures 4.3 x 2.8 cm (series 80280, image 25) compared to prior measurement of 4.1 x 2.2 cm in extent (image 17, series 80288). There is increased tumor filling the left nasal cavity causing increased obliteration of the nasal cavity, and further extension into the left maxillary antrum causing increased trapped secretion within the left maxillary sinus.The soft tissue mass erodes through the lamina papyracea to invade both extraconal orbital spaces. Soft tissue within the right orbit is inseparable from the medial rectus muscle and measures 4.1 x 1.3 cm (series 8034, image 10) compared to prior measurement of 3.8 x 1.6 cm (image 13, series 4) on the prior exam. Soft tissue within the left orbit displaces the medial rectus muscle medially and probably also involves the muscle directly. It measures 2.7 x 1.7 cm compared to prior measurement of 3.0 x 1.4 cm (image 13, series 4) on the prior exam. The slight differences in measurements may be related to differences in sampling.Abnormal soft tissue fills both orbital apices. There is evidence of impingement of the optic nerves bilaterally. Small foci of erosion within the superior orbital walls bilaterally are unchanged. Tumor extends through these cranial defects, particularly on the left where there is evidence of intracranial involvement, better seen on the patient's prior MRI. Soft tissue invasion with bone erosion involves the sphenoid sinuses as well as the sella, foveae ethmoidalis and cribriform plate, similar to the prior examination. Soft tissue invasion of the left sphenopalatine foramen, pterygopalatine fossa and pterygomaxillary fissure appears similar to the prior exam.Postsurgical change involving the anterior aspect of the right maxillary bone is again seen. The patient has undergone right partial maxillectomy, antrostomy and ethmoidectomy. Mucosal thickening within the remaining right maxillary sinus appears similar to the prior exam.Reference lymph node measurements are as follows:Left level 2 (image 8034, series 39): 1.1 cm in short axis, compared to 1.2 cm previously. Right level 2 (image 41, series 8034): 1.3 cm in short axis, compared to 1.2 cm previously.Right level 2 (image 43, series 8034): 1.1 cm in short axis, compared to similar measurement previously.Scattered additional pathological cervical lymph nodes are again seen. There is irregular right level 5 node which demonstrates increased infiltration of surrounding fat and is suggestive of progression of lymphadenopathy with extracapsular extension. There is increased soft tissue stranding and fat reticulation, which may be related to post-treatment effect.The epiglottis, valleculae, piriform sinuses, glottis and suglottic airway are normal.The parotid and submandibular glands, as well as the thyroid, are unremarkable. The cervical vessels are patent. The lung apices show no significant abnormality. Sclerosis within the C5 and C6 vertebral bodies, suspicious for metastatic disease, is unchanged.
1.Interval progression of left nasal cavity mass with extension into the left maxillary sinus and cribriform plate.2.Soft tissue mass invasion of the extraconal orbital spaces unchanged. There is extension into orbital apices causing optic nerve impingement.3.Extensive skull base invasion appears similar to the prior examination.4.Stable size of numerous pathological cervical lymph nodes with reference measurements as above. However, a right level 5 node demonstrates increased infiltration of surrounding fat and is suggestive of progression of lymphadenopathy with extracapsular extension. 5.Stable bony sclerotic lesions suggestive of metastatic disease in the cervical spine.