T1W SE axial before (1a) and after (1b) Gd IV
Clinical signs of deep relapse in a patient treated 4 years before for a malignant fibro-histiocytoma of the right maxillary sinus
This patient was operated on 4 years ago for a malignant fibro-histiocytoma of the right maxillary sinus (total right maxillar resection including the orbital floor and the hard palate and the pterygoid processes). An osseous reconstruction was performed in a second time. One year later, apparition of a local relapse involving the base of the skull treated by chemo- and radiotherapy. Status quo during 2 years. Now the patient consults for apparition of a trismus; the clinical examination shows a local re-evolution. MRI is done with the following sequences: T1w SE axial and coronal pre and post Gd DOTA.
The relapse involves massively the pterygo-maxillary fossa including the lateral and medial pterygoidsmuscles causing the trismus.There is a perineural extension along the ways of the V2 (enlarging the foramen rotundum) and V3 (foramen ovale) up to the Meckel's cave. Unfortunately, in spite of multiple chemotherapies, the evolution was bad and the patient is now in end-stage of disease.
Differential Diagnosis List
Perineural extension of a relapsing malignant fibro-histiocytoma