The soft issue mass involving the right cavernous sinus, the sphenoid air cells and the orbital apex may represent tumour, infection or a pseudotumour.
Tumour can be either a SCC or lymphoma.
Primary tumours of the optic nerve, such as meningioma and glioma have to be considered. In this case the soft tissue mass was seen to surround the nerve but not arise from it.
Matastatic disease or an aggressive meningioma arising from the cavernous sinus can give an enhancing soft tissue mass in this region
Infection is important to consider in any patient who is diabetic or immunosuppressed, as aspergillosis, mucormycosis are common organisms in these patients. High density material within a sinus can be a helpful imaging sign.
Pseudolymphoma and pseudotumors may have a similar radiological appearance, these patients often present with orbital pain.
The presence of bone destruction seen on CT favors malignancy and or infection.
Biopsy was needed to establish a diagnosis of a primary SCC arising in the right sphenoid, spreading to the cavernous sinus and into the orbital apex