History of pT4aN1 right conjunctival squamous cell carcinoma with local recurrence.. There are postsurgical changes of right orbital exenteration, right parotidectomy, and right neck dissection. There is an 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. No obvious osseous destruction, but can be better assessed by CT. Slightly more inferior to the zygomatic arch, there is a enhancing nodule measuring 17 x 11 x 15 mm which extends along the surface of the right masseter muscle. Abnormal enhancement extends posteriorly to the right parotid space which may represent granulation tissue and can be compare with prior MRI if available. There is however a more nodular area measuring 15x10 mm in the pre-auricular region which is suspicious. Abnormal enhancement is also 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 is favored to be inflammatory. Major flow-voids are preserved.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.
1. Enhancing nodule along the superior surface of the right zygomatic arch, one inferior to the zygomatic arch along the masseter muscle surface, and one posteriorly in the pre-auricular region are highly suspicious for tumor recurrence. Abnormal enhancement involving the parotid space more diffusely as well as along the medial and posterior margins of the right orbital exenteration site is nonspecific and may represent granulation tissue. Relatively mild FDG uptake is noted within these regions on recent PET. Comparison with prior MRI would be helpful if available.2. Status post orbital exenteration and right parotidectomy.3. Status post right neck dissection. No suspicious cervical lymphadenopathy is appreciated.4. No intracranial metastatic disease.