Wk 7, Case 5 - Review

Patient History
Right nasal mass.

Findings
Pre- and postcontrast MR was performed of the brain and sinonasal cavity.

Brain: Sagittal T1-weighted images demonstrate corpus callosum to be intact. No evidence of Chiari malformation. No abnormal pineal region masses. Pituitary gland is not enlarged. Diffusion imaging demonstrates no evidence of recent infarct. Contrast-enhanced images show no abnormal intraaxial or extraaxial enhancing masses.

Sinonasal cavity:Pre- and postcontrast images demonstrate a slightly enhancing mass involving the floor of the right nasal cavity. The mass measures approximately 3.5cm (AP) x 2.5cm (CC). The mass extends anteriorly through the right piriform aperture to involve the posterior aspect of the right nasal vestibule. The mass extends posteriorly to approximately the midportion of the right nasal cavity. The mass extends superiorly and involves the right inferior turbinate. The mass is isointense to muscle on T1 and slightly enhances with contrast. The mass is slightly high signal on T2 weighted images. There is evidence of erosion of the right maxillary spine. The right hard palate is intact. The mass extends and abuts the right side of the incisive canal. However, no evidence of retrograde perineural spread is identified involving the nasopalatine nerve. The pterygopalatine fossa and greater or lesser palatine nerves are intact.

Conclusions
1. Approximately 3.5cm x 2.5cm mass involving the right nasal cavity. Findings are most likely due to squamous cell carcinoma. However, the relative paucity of bone erosion suggests other etiologies which include minor salivary gland tumor, lymphoma, schwannoma and melanoma.