Perineural tumor extension through the foramen ovale: evaluation with MR imaging.

Laine, Fred J.; Braun, Ira F.; Jensen, Mary E.; Nadel, Lyn; Som, Peter M.

doi:10.1148/radiology.174.1.2152985

Cited by 139 publications

(49 citation statements)

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“…Perineural spread is a well-known property of head and neck tumors that invade the skull base. Tumor can selectively follow a nerve or the sheath of a nerve to reach and ultimately pass through a foramen of the skull base; this feature is well known in lymphoma (10). Another feature in this patient that deserves mention is the presence of a long dural tail.…”

Section: Discussionmentioning

confidence: 79%

Gastric Mucosa-Associated Lymphoid Tissue Lymphoma: Implications of Animal Models on Pathogenic and Therapeutic Considerations — Mouse Models of Gastric Lymphoma

Lee

O’Rourke

Enno

2000

Gastrointestinal Lymphoma

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Summary:We report the MR features in a previously healthy patient with mucosa-associated lymphoid tissue lymphoma of the pituitary gland. The MR images showed a homogeneously enhancing solid mass in the sellar region and both parasellar regions; this mass extended through the bilateral foramina ovale along the third branches of the trigeminal nerves. The mass completely encircled the cavernous segments of both internal carotid arteries without narrowing the lumen. Gadopentetate dimeglumine-enhanced T1-weighted MR images showed homogeneous, strong enhancement of the mass.The number of primary CNS lymphomas have increased in both immunocompromised and immunocompetent subjects. However, only four cases of pituitary lymphoma have been previously reported: one case in a patient with acquired immunodeficiency syndrome, one case of T-cell lymphoma, and two cases of B-cell lymphoma (1-4). To our knowledge, no cases of mucosa-associated lymphoid tissue (MALT) lymphoma of the pituitary gland are reported. MALT lymphoma is an extranodal type of malignant lymphoma of B-cell origin. It tends to arise within tissues involved by chronic inflammatory disorders of autoimmune or infectious origin and remains localized for prolonged periods at the site of origin (5). We describe the MR features of MALT lymphoma that manifested as a sellar and parasellar mass extending through both foramina ovale along the third branches of the trigeminal nerves in a previously healthy patient. Case ReportA 42-year-old man who had had no previous illnesses was admitted to the hospital because of blurred vision and a foreign-body sensation on his left eye lasting for 3 months. In addition, he also complained of the loss of libido of 2 month's duration. Findings on physical examination were normal except for a visual-field defect on the temporal side of his left eye. No abnormalities were found in his bilateral ocular movement, facial sensory function, or motor function. His blood count and biochemical profile were normal. Results from the basal hormonal studies suggested panhypopituitarism with a slight elevation of the serum prolactin level and a decreased serum thyroid-stimulating hormone (TSH) level despite a low serum testosterone level.MR examination was performed to evaluate a suspected parasellar lesion. MR imaging demonstrated a sellar mass with supra-and parasellar extension. This mass was isointense to gray matter on T1-weighted images (Fig 1A), slightly hypointense on T2-weighted images (Fig 1B), and homogeneously enhancing on contrast-enhanced T1-weighted images (Fig 1C). The optic chiasm was displaced in a cephalic direction, and both cavernous segments of the internal carotid arteries were completely encased by the mass, with mild narrowing of the lumen of the left internal carotid artery. It also extended extracranially along the mandibular branches of the trigeminal nerve through the widened foramina ovale. Additionally, coronal MR images demonstrated focal bony erosion due to the mass on the left side of the sphenoid body. Contrast-...

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Section: Discussionmentioning

confidence: 79%

Gastric Mucosa-Associated Lymphoid Tissue Lymphoma: Implications of Animal Models on Pathogenic and Therapeutic Considerations — Mouse Models of Gastric Lymphoma

Lee

O’Rourke

Enno

2000

Gastrointestinal Lymphoma

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“…Spread occurs in the CNs at intracranial and extracranial sites as well as in skin and ENT tumors. The spread can occur inside the skull, outside the skull, or pass through the basal foramina 40,41 and thus have a portion both inside and outside of the skull.…”

Section: Mechanisms Of Nerve Invasionmentioning

confidence: 99%

Cancer around the brain

Grisold

2014

Neuro-Oncology Practice

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Background Neuro-oncologists are familiar with primary brain tumors, intracerebral metastases meningeal carcinomatosis and extracerebral intracranial tumors as meningeoma. For these conditions, and also some other rare tumor entities several treatment options exist. Cancer can also involve structures around the brain as the dura, the base of the skull, the cavities of the skull and tissue around the bony skull, the skin, the tissue of the neck. and either compress, invade or spread in the central or peripheral nervous system. Methods A systematic literature research was conducted determining symptoms and signs, tumor sites of nerve invasion, tumor types, diagnostic techniques, mechanisms of nerve invasion, and important differential diagnosis. Additional cases from own experience were added for illustration. Results The mechanisms of tumor invasion of cranial nerves is heterogenous and not only involves several types of invasion, but also spread along the cranial nerves in antero- and retrograde fashion and even spread into different nerve territories via anastomosis. In addition the concept of angiosomas may have an influence on the spread of metastases. Conclusion In addition to the well described tumor spread in meningeal carcinomatosis and base of the skull metastases, dural spread, lesions of the bony skull, the cavities of the skull and skin of the face and tissue of the neck region need to be considered, and have an impact on therapeutic decisions.

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“…Although SCC is the most common head and neck cancer, the strongest association with perineural tumor extension is with ACC [7]. Additional tumor types that have been reported to spread perineurally include: malignant melanoma, lymphoma, mucoepidermoid carcinoma and sarcomas [1,2,5,6].…”

Section: Pathologv and Clinical Featuresmentioning

confidence: 99%

“…Although contrast enhanced non fat-suppressed TI-WSE MR images might be sufficient, wc advocate their use only as an alternative when failure of fat-suppression interferes with interpretation of the study, because with fat-suppression lesion detectability and reader level of confidence was improved. MRI signs of perineural tumor involvement include: abnormal nerve thickening with enhancement after intravenous administration of contrast material; concentric expansion of the skull base tbramina and extracranial nerve canals; replacement of the normal trigeminal cistern hypointensity on T l-weighted images or hyperintensity on T2-weighted images by an isointense mass or enhancement of a mass in the Meckel's cave/GG area; lateral bulging of the cavernous sinus dural membranes and denervation atrophy of the masticator muscles [7].…”

Section: Hnagingmentioning

confidence: 99%

“…The third division of the trigeminal nerve has numerous sensory and motor branches supplying deep and superficial facial structures and is a common route for perineural extension. The close relationship of the auriculotemporal division of the mandibular nerve to the parotid gland permits perineural spread by tumors such as adenoid cystic carcinomas of the parotid gland [7]. These tumors also commonly involve the mastoid segment of the facial nerve (VII).…”

Section: Introductionmentioning

confidence: 99%

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Perineural tumor extension along the trigeminal nerve: magnetic resonance imaging findings

Majoie

Hulsmans

Verbeeten

et al. 1997

European Journal of Radiology

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General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. AbstractObjectice: 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...

show abstract

Perineural tumor extension through the foramen ovale: evaluation with MR imaging.

Cited by 139 publications

References 0 publications

Gastric Mucosa-Associated Lymphoid Tissue Lymphoma: Implications of Animal Models on Pathogenic and Therapeutic Considerations — Mouse Models of Gastric Lymphoma

Gastric Mucosa-Associated Lymphoid Tissue Lymphoma: Implications of Animal Models on Pathogenic and Therapeutic Considerations — Mouse Models of Gastric Lymphoma

Cancer around the brain

Perineural tumor extension along the trigeminal nerve: magnetic resonance imaging findings

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