Orbital apex mass - primary squamous cell carcinoma of sphenoid sinus


The soft tissue mass involving the right cavernous sinus, the sphenoid air cells, and the orbital apex may represent tumor, infection, or a pseudotumor.

Tumor can be either an SCC or lymphoma.

]A meningioma has to be considered as a differential. Nerve optic glioma usually expands the nerve and does not cause destruction to the adjacent bone.  In this case, the soft tissue mass was seen to surround the nerve but not arise from it.

Metastatic 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