Invasive thymoma metastatic to the cavernous sinus
In February 2010, a 41-year-old female presented with a 6-week history of headaches, nasal congestion, epistaxis, difficulty opening her mouth and ptosis of the right eyelid. A magnetic resonance imaging (MRI) scan revealed a complex multilobulated mass centered within the right cavernous sinus, the cavernous internal carotid artery being encased [Figures and ]. Laterally, the tumor extended to the petrous bone and partially encased the right petrous carotid artery. Also noted was tumor extension into Meckel's cave, the right prepontine cistern and masticator space via the course of the second branch of the trigeminal nerve. The differential diagnosis included meningioma, and metastatic disease. The rapid progression of symptoms and the atypical imaging appearance of the lesion strongly suggested the latter. In that the tumor lay just lateral to the pituitary gland, a diagnosis of pituitary adenoma was unlikely.\nTranssphenoidal surgery was undertaken to obtain a tissue diagnosis and to debulk the mass. Postoperative adjuvant chemotherapy was administered (Cytoxan, Adriamycin). The patient is considering adjuvant radiation therapy.