CASE 76 Published on 16.01.2000
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Recurrence of a tumour of the lip with deep extension and involvement of the trigeminal nerve

Section

Head & neck imaging

Case Type

Clinical Cases

Authors

Lemort M, Leurquin M

Connected authors
Patient

60 years, male

Categories
No Area of Interest ; Imaging Technique MR, MR, MR, MR
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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.
Differential Diagnosis List
Recurrence of a squamous cell carcinoma of the lip with perineural spread
Final Diagnosis
Recurrence of a squamous cell carcinoma of the lip with perineural spread
Case information
URL: https://www.eurorad.org/case/76
DOI: 10.1594/EURORAD/CASE.76
ISSN: 1563-4086
Figure 1

T1W SE coronal images before contrast

T1W SE coronal images before contrast
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.
T1W SE coronal images before contrast
Relationships between tumour and the wall of the maxillary sinus is not clearly defined on these low resolution images(<256², unfiltered).
T1W SE coronal images before contrast
In this more posterior slice, see the large infiltration of the masticator space.
T1W SE coronal images before contrast
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

T2W FSE coronal images
This shows the high signal of the mucosal thickening of the maxillary sinus, the low signal of the tumour itself.
T2W FSE coronal images
Note a higher signal in the peritumoral, oedematous areas. There is a lower signal tissue in the left maxillary sinus on this slice.
T2W FSE coronal images
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)

Post Gd T1W coronal images, low resolution (< 256²)
There is a frank, homogeneous enhancement of the tumour. Note a suspicion of disruption of the lateral wall of the sinus.
Post Gd T1W coronal images, low resolution (< 256²)
There is no appearance of skull base or cavernous sinus involvement
Figure 4

PostGd T1W coronal images, high resolution (400²)

PostGd T1W coronal images, high resolution (400²)
Note that the lamellar bone of the outer wall of the maxillary sinus is now well depicted.
PostGd T1W coronal images, high resolution (400²)
On this slice, there is a disruption of the sinus wall and extension of the tumour in the left maxillary sinus