[The interesting case -- case number 61].
A 58-year-old patient presented after having undergone radiation therapy, afterloading therapy and chemotherapy of a T4 nasopharynx carcinoma. On the basis of the MRI findings, local tumour recurrence was suspected. The samples taken from the nasopharynx and the left maxillary sinus confirmed this diagnosis. Neuroradiological imaging showed that the tumour extended into the area around the left skull base and also revealed an irregular formation located in the left temporal flap. Therefore not only tumour resection (Fisch approach type C) but also a temporal craniotomy was indicated in order to determine the degree of intracerebral tumour extension. The dura mater, which had been intact, was intraoperatively opened and revealed vital brain tissue, i. e. tumour infiltration had not reached the brain. It was concluded that the radiological findings probably indicated a postradiogenic necrosis of the temporal flap. The presented case illustrates the rare differential diagnostic procedure carried out in a patient with radiogenic necrosis while taking into account the possibility of local tumour infiltration into the brain parenchyma.
Teschner
M
M
Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Medizinische Hochschule Hannover.
Lenarz
Th
T
Stöver
T
T
D001918:Brachytherapy; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000532:radiotherapy*; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000473:pathology / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000175:diagnosis* / Q000473:pathology; D019292:Skull Base Neoplasms / Q000175:diagnosis; D013702:Temporal Lobe / Q000473:pathology / Q000528:radiation effects*