Presentation
Diffuse facial and orbital swelling.
Patient Data
Large irregular, destructive, and infiltrative soft tissue masses involving the examined facial bones, paranasal sinuses, and the mandible as well as the adjacent extra-osseous planes (cheeks). The mass lesions extend medially to encroach upon the nasal cavities. The lesions also show intra-orbital extensions along the inferomedial aspects of both orbits (extra-conally). Similar smaller separate lesions are seen involving the lacrimal glands and the superior extra-conal aspect of the left orbit. The lesions elicit a low T1 signal and high T2 and STIR signal with diffusion restriction.
Enlarged upper deep cervical lymph nodes are also seen.
Enlarged nasopharyngeal adenoids.
Bone marrow aspirate revealed acute myeloid leukemia.
Case Discussion
Lymphoreticular malignancies account for about 40% of all malignant disorders in children.
MR imaging may show bone marrow infiltration and extraosseous soft-tissue lesions parallel to the bone destruction. Lymphoma demonstrates intermediate to low T2 signal intensity on MR images, with diffusion restriction secondary to high cellularity, which can suggest the diagnosis with a high degree of accuracy
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