Wk 8, Case 4 - Review

Patient History
Left-sided mandible lesion. Prior MRA demonstrated no hypervascularity within the mass.

Findings
There is a mass involving the left pterygopalatine fossa extending laterally along the masticator space to involve the left mandible. This abnormality expands the pterygopalatine fossa and homogeneously enhances. The mass appears to superiorly displace the internal maxillary artery. The lesion appears to arise in the left pterygopalatine fossa and extends laterally and erodes the inner cortex of the mandible with extension into the medullary cavity. There is enhancement involving the region of the left mandibular notch and the lesion appears to surround the expected location of the inferior alveolar nerve within the ramus of the mandible. The superior aspect of the lesion extends to the condylar neck. No obvious involvement is identified involving the left masseter muscle.

Imaging of the neck demonstrates some asymmetrically prominent left-sided lymph nodes. There also appears to be slight asymmetrical enhancement involving the left submandibular gland. Significance of this is unclear. No evidence of obstructive lesions identified within the floor of mouth.

Conclusions
1. Diffusely homogeneously enhancing mass involving the left pterygopalatine fossa extending laterally along the masticator space to involve the mandible. The lack of hypervascularity makes juvenile angiofibroma less likely. Differential diagnosis includes low-grade mesenchymal tumor, neurogenic tumor, fibromatosis, IgG4 associated disease, or, less likely, lymphoma.
2. Asymmetrically enlarged left level 2 and level 5 lymph nodes.
3. Findings suggestive of asymmetrical enhancement involving the left submandibular gland.