Dhillon Manvinder, Mackie Gavin, Singh Dalveer
School of Medicine, University of Queensland, Herston, QLD 4006, Australia.
Qscan Radiology Clinics, Hobart, TAS 7000, Australia.
Radiol Case Rep. 2022 Apr 12;17(6):2106-2110. doi: 10.1016/j.radcr.2022.03.080. eCollection 2022 Jun.
We present a case of a 78-year-old male with a primary parotid squamous cell carcinoma which spread via the left facial, trigeminal and greater auricular nerves. The patient presented with left facial droop and paraesthesia. Initial MRI scans demonstrated involvement of the trigeminal and facial nerves with no sign of a primary lesion. Abnormal enhancement within the left parotid substance on FDG PET-CT demonstrated the primary malignancy which was confirmed on histology by core biopsy. There was also focal avidity along the course of the left greater auricular nerve consistent with perineural infiltration, extending from the posterior aspect of the parotid to the left cervical plexus at C2/C3. To our knowledge, this is the second case of squamous cell carcinoma perineural spread to the greater auricular nerve imaged on FDG PET-CT scanning. This case highlights the importance of multimodality imaging correlation in the workup of primary head and neck malignancies and associated perineural spread, which is essential in adjuvant radiation therapy planning to reduce local recurrence, improve prognosis and overall survival.
我们报告一例78岁男性原发性腮腺鳞状细胞癌患者，该肿瘤经左侧面神经、三叉神经及耳大神经扩散。患者表现为左侧面部下垂及感觉异常。最初的MRI扫描显示三叉神经和面神经受累，未发现原发性病变迹象。FDG PET-CT上左侧腮腺实质内的异常强化显示了原发性恶性肿瘤，经组织芯活检组织学确诊。沿左侧耳大神经走行也有局灶性放射性浓聚，符合神经周围浸润，从腮腺后缘延伸至C2/C3水平的左侧颈丛。据我们所知，这是第二例经FDG PET-CT扫描成像显示鳞状细胞癌神经周围扩散至耳大神经的病例。该病例凸显了多模态影像相关性在原发性头颈部恶性肿瘤及相关神经周围扩散检查中的重要性，这对于辅助放疗计划以减少局部复发、改善预后及总体生存率至关重要。
