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Case Challenge: Brain Tumors MRI Cases


Case Review Power Pack – Brain Tumors Pre-Course Activities
1 topic
Brain Tumors, Vol. 1
20 topics | 10 quizzes
Course Evaluation
1 topic

4b - Answer: 29-year-old male presents with history of adenoid cystic carcinoma

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 29-year-old male presents with history of adenoid cystic carcinoma and left parotid surgery one year prior with proton radiation, presents with double vision for 4-5 days.

(QUIZ ANSWER) IN THIS CASE, THE MASS HAS: 

Enlarged in size.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

COMPARISON:

Comparison from one month prior.

FINDINGS: 

When compared to the MR brain from one month prior, now seen is a mass centered just anterior to the left Meckel's cave in the region of the pterygopalatine fossa which has enlarged currently measuring 3.1 x 3.5cm (AP x CC), previously measuring 2.4 x 2.7 cm (AP x CC).

Enhancing soft tissue extends through the left foramen ovale which is markedly widened, fills the pterygopalatine fossa and extends into the vidian canal and foramen rotundum.

Subtle enhancing soft tissue also tracks along the left cavernous sinus laterally and also extends into the left hemi sphenoid sinus which is filled.

Findings likely account for the patient's symptoms and are consistent with the patient's known diagnosis of adenoid cystic carcinoma.

Left mastoid effusion is similar in extent.

Postsurgical changes along the left parotid gland are similar.

Brain parenchyma is otherwise normal.

No diffusion restriction is present to suggest acute or subacute ischemia.

Basilar cisterns, ventricles, and sulci are normal in size and configuration.

Foramen magnum is normal without intramedullary mass at the level of the medulla or anomaly of the opisthion, basion, or atlantodental interval. C1-C2 junction is anatomically aligned. Visualized cervical spinal canal is patent.

Pituitary gland is normal in size. Orbits are normal. Visualized intracranial arterial flow voids appear normal. Calvarium is normal.

CONCLUSION:

1. When compared to the MR brain from one month prior, now seen mass centered just anterior to the left Meckel's cave in the region of the pterygopalatine fossa which has enlarged currently measuring 3.1 x 3.5cm (AP x CC), previously measuring 2.4 x 2.7cm (AP x CC). Enhancing soft tissue extends through the markedly widened left foramen ovale, fills the pterygopalatine fossa, and extends into the vidian canal and foramen rotundum compatible with perineural spread. Subtle enhancing soft tissue also tracks along the left cavernous sinus laterally and also extends into the left hemisphenoid sinus which is filled. Findings likely account for the patient's symptoms and are consistent with the patient's known diagnosis of adenoid cystic carcinoma.

2. Similar left mastoid effusion.

LESSON 2, TOPIC 12

Case Challenge: Brain Tumors MRI Cases

Case Challenge

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Content reviewed: November 3, 2021

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