Orbital squamous cell carcinoma

Case contributed by Dr Smita Deb

Presentation

Right medial canthus discharge. ?Recurrence of previously resected cancer

Patient Data

Age: 85
Gender: Male

• Soft tissue mass 2.5cm at the right margin of the nasofacial resection bed which is inseparable from the adjacent medial rectus muscle and is in broad continuity with the medial wall of the globe.

• The mass extends inferiorly into nasal cavity to the base of the inferior concha.

• The mucosal spaces of the neck are unremarkable.

• No bony lesions or lymphadenopathy.

MRI

• Surgical defect involving the nasal bridge, anterior ethmoid sinuses and medial aspect of the left orbit.

• Superimposed, an irregular mass is centred on the medial canthus of the right orbit and right anterior ethmoid air cells. Likely residual or recurrent tumour.

• The mass infiltrates the insertion of the medial rectus muscle and also abuts the globe. It extends inferiorly in the region of the right nasolacrimal duct.

• A small focus of magnetic susceptibility with phase corresponding to blood product is noted at the anterior aspect of the right lentiform nucleus, compatible with a previous microhaemorrhage, likely hypertensive in aetiology. A tiny focus of magnetic susceptibility is noted in the left occipital region, close to the tentorium cerebelli; the differential includes a microhaemorrhage, tiny cavernoma and tentorial calcification.

• Loss of the flow void in the right internal carotid artery below its supraclinoid segment is compatible with occlusion

• The right anterior and middle cerebral arteries str recanalised via the circle of Willis.

Case Discussion

Case submitted by Dr Smita Deb and A/Prof Pramit Phal.

Previously resected right orbital SCC. Due to the history of ESRF no contrast was used in the scans. The patient was found to have a recurrence near the previous resection bed which is likely a recurrence or residual tumour.

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Case information

rID: 31175
Case created: 22nd Sep 2014
Last edited: 27th Sep 2015
System: Head & Neck
Inclusion in quiz mode: Included

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