Perineural spread of epidermoid Carcinoma in the infraorbital nerve: Case report (original) (raw)
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Perineural tumor extension along the trigeminal nerve: magnetic resonance imaging findings
European Journal of Radiology, 1997
Objectice: To evaluate the magnetic resonance imaging (MRI) findings of 15 patients with perineural tumor extension along the trigeminal nerve in correlation with clinical data. ,~Iethods: The clinical records and MRI studies of 15 patients with perineura.l tumor extension along the trigeminal nerve were retrospectively reviewed. Imaging studies included plain and contrast-enhanced thin section Tl-weighted spin echo (T1-WSE) MRI with and without fat-suppression. The studies were compared to determine which sequence provided greatest tumor conspicuity and best depiction of tumor extent. The conspicuity of these tumors was assessed on the available sequences by two observers by consensus. Results: The contrast-enhanced Tl-weighted spin echo fat-suppressed images (TI-WSECEFS) demonstrated greatest tumor conspicuity and best depiction of tumor extent in the extracranial head and neck and skull base region. The conventional Tl-weighted spin echo pre-and postcontrast images were, however, diagnostic of perineural tumor extension in 11 patients due to the presence of considerable tumor bulk and extension well above the skull base. In the other four patients the perineural tumor was poorly visualized on the conventional TI-WSE images and well visualized on the fat-suppressed images. The mandibular division of the trigeminal nerve (V3) was most commonly involved (n = 10), followed by the maxillary. (V2; n = 5) and ophthalmic (VI; n = 2) division. Two patients had both mandibular as well as maxillary nerve involvement. The finding of perineural tumor extension had significant impact on patient management: based on the MR imaging study, the primary tumor was considered inoperable (n = 13), the extent of surgery was expanded (n = 2) and radiation therapy (RT) ports were extended (n = 12). Conclusion: Complete trigeminal nerve imaging is recommended when evaluating (suspected) head and neck malignancies with a high risk for perineural extension. In these cases thin section axial and coronal precontrast T1-WSE MR images and postcontrast TI-WSE MR images with fat-suppression should be obtained. In the rare event that artifacts degrade the quality of the fat-suppressed images, contrast-enhanced TI-WSE sequences without fat-suppression can additionally be used. ~ 1997 Elsevier Science Ireland Ltd.
Perineural Invasion of the Facial Nerve by a Cutaneous Squamous Cell Cancer: A Case Report
Ear, Nose & Throat Journal, 2004
We report a case of perineural invasion of the facial nerve by a cutaneous squamous cell carcinoma in a 59-year-old man who presented with a slowly progressive facial paralysis. We performed a distal facial nerve dissection and a simple mastoidectomy with facial recess exposure for resection to negative margins. We also performed a simultaneous facial reconstruction and reanimation procedure with excellent results. External-beam radiation completed the treatment regimen. In addition to describing this case, we review current concepts in diagnosis and therapy, as well as the historical background of malignant perineural invasion of the cranial nerves.
Radiologia brasileira
Perineural tumor spread refers to the migration of tumor cells along nerve tissues. It worsens the prognosis, increases the recurrence rate, and diminishes 5-year survival by up to 30%. It is an important finding on imaging tests employed in the staging of patients with head and neck cancers, because it cannot be assessed by the surgeon alone. Nevertheless, it is frequently overlooked. In this study, we reviewed the literature regarding the imaging and pathophysiological aspects of this type of dissemination. We also analyzed ten imaging tests, obtained from a teaching hospital in Brazil, in which there were radiological signs of perineural tumor spread.
Imaging the cranial nerves in cancer
Cancer Imaging, 2004
The cranial nerves are often involved in head and neck malignancies. Some malignancies have a strong propensity to show perineural spread. Cranial nerve palsy may be the presenting sign of metastatic disease to the skull base. Like metastatic disease to the lungs or liver, the cranial nerves themselves may be the site of metastatic disease. In addition, cranial nerves can be injured by radiation therapy or sacrificed during surgical treatment. This paper focuses on the imaging features of perineural infiltration, skull base neural foramen involvement and metastatic disease in the cranial nerves. It will also highlight the complications of radiation therapy, in particular radiation-induced optic neuritis.
CNS oncology, 2017
Leiomyosarcomas are malignant tumors displaying strong smooth muscle differentiation. They can often develop within the GI tract and myometrium, but are particularly rare in the head and neck. Perineurial spread of head and neck cancer is observed in patients with neoplasms of the skin (squamous cell carcinoma, melanoma) or skin appendages (adenoid cystic carcinoma). We report the case of a woman who presented with diplopia and headaches. MRI showed an infratemporal mass lesion and faint enhancement tracking along the mandibular nerve into the wall of the right cavernous sinus. A nerve biopsy revealed leiomyosarcoma. We review the medical literature to provide further insight into the diagnosis and management of this tumor and its peculiar pattern of spread. A similar case was unidentifiable in the literature.
Perineural Tumor Spread Along the Auriculotemporal Nerve
Ajnr American Journal of Neuroradiology, 2002
BACKGROUND AND PURPOSE: Evaluation of images of perineural tumor spread in patients with head and neck malignancies is essential for planning treatment and determining the patient's prognosis. Although the communications between the facial and trigeminal nerves are not widely known, they may provide a route for tumor growth. The purpose of this study was to elucidate the course of the auriculotemporal nerve, as well as the clinical and imaging findings that suggest involvement of the communication between the facial nerve and the mandibular division (V 3) of the trigeminal nerve. METHODS: Images in 15 patients with clinical or radiologic findings suggestive of perineural tumor spread along the auriculotemporal nerve were reviewed. Involvement of the main trunk of the facial nerve, auriculotemporal nerve, V 3 , trigeminal cistern, and ganglion and adjacent anatomic structures were noted in each patient. RESULTS: The course of the auriculotemporal nerve was described in detail. More than 50% of patients with perineural tumor spread along the auriculotemporal nerve had clinical signs of auriculotemporal nerve dysfunction, including periauricular pain and temporomandibular joint (TMJ) dysfunction or tenderness. Images in 13 of 15 patients with such tumor spread demonstrated findings of tumor growth along V 3.. CONCLUSION: Knowledge of the course of the auriculotemporal nerve is critical in evaluating images for findings of tumor spread along this nerve. Periauricular pain, TMJ dysfunction or tenderness, and imaging signs of V 3 involvement are important indicators of potential involvement of the auriculotemporal nerve.
American Journal of Ophthalmology Case Reports, 2017
We report the case of a patient with cavernous sinus syndrome associated with biopsyconfirmed metastasis from colorectal cancer. Observations: A patient known for laryngeal carcinoma and metastatic colorectal carcinoma presented with symptoms of left trigeminal neuralgia and progressive, near-complete ophthalmoplegia. Magnetic resonance imaging (MRI) revealed a mass in the left cavernous sinus, extending into Meckel's cave with perineural spread along the mandibular branch of the left trigeminal nerve. A transsphenoidal biopsy was performed and demonstrated metastatic colon adenocarcinoma. We review the existing literature on colorectal cancer associated cavernous sinus syndrome. Conclusions and importance: Cavernous sinus metastasis from colorectal cancer is exceedingly rare. We report the second case of this entity with histopathologic confirmation, and the first case with concurrent perineural spread involving the trigeminal nerve. Cavernous sinus metastasis may represent a poor prognostic factor in colorectal cancer.