EURORAD ESR

Case 76

Recurrence of a tumour of the lip with deep extension and involvement of the trigeminal nerve

Author(s)
Lemort M, Leurquin M
 
Patient
male, 60 year(s)

Clinical History

Recurrence of a tumour of the superior lip and gingiva with clinical signs of involvement of the inferior maxillary nerve

Imaging Findings

This patient was treated with chemo- and radiotherapy for a SCC of the inferior lip and gingiva, followed by a relapse treated by surgery. A local relapse in the superior lip was treated by limited resection. She presents now with pain in the left V territory and a suspicious burgeoning lesion in the left jugal area. MRI is done with the following sequences : T1w SE axial and coronal, T2w FSE with long TR, T1w SE post Gd with standard and high resolution.

Discussion

The extension towards the infratemporal fossa is patent and may explain the involvement of the V3. The tumour fills the left buccal vestibula and deeply infiltrates its jugal side. But there is also extension towards the maxillary side with effraction of the maxillary sinus outer wall, best depicted by the high resolution slices. More anteriorly, inflammatory changes develop in the maxillary sinus. Biopsy confirmed the relapse. A new chemotherapy was given, but did not success and the patient died 8 months later.

Final Diagnosis

Recurrence of a squamous cell carcinoma of the lip with perineural spread
 

MeSH

  1. Lip Neoplasms [C04.588.443.591.550]
    Tumors or cancer of the LIP.

Citation

Lemort M, Leurquin M (2000, Jan 17).
Recurrence of a tumour of the lip with deep extension and involvement of the trigeminal nerve, {Online}.
URL: http://www.eurorad.org/case.php?id=76
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  • Figure 1
    T1W SE coronal images before contrast
    a b c d  

    There is an intermediate signal tumour on the vestibular side of the left gingival groove. Note that there is a lateral extension towards the left jugal tissues. Mucosal thickening is seen in the left maxillary sinus.

    Relationships between tumour and the wall of the maxillary sinus is not clearly defined on these low resolution images(<256², unfiltered).

    In this more posterior slice, see the large infiltration of the masticator space.

    Same comments as 1c. Note that postoperative changes are also visible on these slices, with a skin retraction in the scar areas.

     
  • Figure 2
    T2W FSE coronal images
    a b c  

    This shows the high signal of the mucosal thickening of the maxillary sinus, the low signal of the tumour itself.

    Note a higher signal in the peritumoral, oedematous areas. There is a lower signal tissue in the left maxillary sinus on this slice.

    Note the higher signal of the masticator muscles, this is one of the changes related to the denervation state accompanying the involvement of the inferior maxillary nerve (V3).

     
  • Figure 3
    Post Gd T1W coronal images, low resolution (<256²,
    a b  

    There is a frank, homogeneous enhancement of the tumour. Note a suspicion of disruption of the lateral wall of the sinus.

    There is no appearance of skull base or cavernous sinus involvement

     
  • Figure 4
    PostGd T1W coronal images, high resolution (400²)
    a b  

    Note that the lamellar bone of the outer wall of the maxillary sinus is now well depicted.

    On this slice, there is a disruption of the sinus wall and extension of the tumour in the left maxillary sinus

     
  • Figure 5

     
Figure 1

T1W SE coronal images before contrast

Figure 1a
There is an intermediate signal tumour on the vestibular side of the left gingival groove. Note that there is a lateral extension towards the left jugal tissues. Mucosal thickening is seen in the left maxillary sinus.
 
Figure 1b
Relationships between tumour and the wall of the maxillary sinus is not clearly defined on these low resolution images(<256², unfiltered).
 
Figure 1c
In this more posterior slice, see the large infiltration of the masticator space.
 
Figure 1d
Same comments as 1c. Note that postoperative changes are also visible on these slices, with a skin retraction in the scar areas.
 
Figure 2

T2W FSE coronal images

Figure 2a
This shows the high signal of the mucosal thickening of the maxillary sinus, the low signal of the tumour itself.
 
Figure 2b
Note a higher signal in the peritumoral, oedematous areas. There is a lower signal tissue in the left maxillary sinus on this slice.
 
Figure 2c
Note the higher signal of the masticator muscles, this is one of the changes related to the denervation state accompanying the involvement of the inferior maxillary nerve (V3).
 
Figure 3

Post Gd T1W coronal images, low resolution (<256²,

Figure 3a
There is a frank, homogeneous enhancement of the tumour. Note a suspicion of disruption of the lateral wall of the sinus.
 
Figure 3b
There is no appearance of skull base or cavernous sinus involvement
 
Figure 4

PostGd T1W coronal images, high resolution (400²)

Figure 4a
Note that the lamellar bone of the outer wall of the maxillary sinus is now well depicted.
 
Figure 4b
On this slice, there is a disruption of the sinus wall and extension of the tumour in the left maxillary sinus
 
Figure 5

 
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