Poorly differentiated sinonasal squamous cell carcinoma

There is a heterogeneously enhancing mass centred within the ethmoid air cells, eccentric toward the left, measuring approximately 5.6 x 3.1 x 4.3 cm (AP x TV x CC). This erodes through the left lamina papyracea and extends into the extraconal left orbit anteriorly extending into the medial canthal region with involvement of the left nasolacrimal duct and possibly the lacrimal sac. Anteriorly, the mass erodes through the nasal bridge, frontal processes of the maxilla on the left side, and upper nasal bones, more so on the left side. Additionally, the tumour involves the superior and middle turbinates, predominately om the left. Superiorly, the tumour extends through the cribriform plate intracranially to about the frontal lobes of the brain, more so on the left side. Along the superior margin, there are small cystic components of the tumour. There is mild associated mass effect upon the anteroinferior left frontal lobe gyrus rectus and medial gyrus. There is some superimposed oedema in the left gyrus rectus and medial orbital gyrus, which could be related to the mass effect or possibly pial tumour invasion. The tumour also extends into the frontal sinuses (left greater than right). There is associated severe mucosal thickening and fluid filling the right frontal sinus. There is moderate to severe mucosal thickening of the left frontal sinus. There is moderate mucosal thickening of the left maxillary sinus. There are retention cysts about the alveolar recesses of the maxillary sinuses. The tumour involves the right lateral wall of the nasal cavity without definitive extension into the right orbit.

There is some dural enhancement along the anterior frontal convexities, particularly along the anterior cranial fossa. This could be related to dural tumour involvement or dural reaction.

There are mildly enlarged bilateral level Ib lymph nodes measuring up to 1.3 cm in length. These could be reactive or possibly related to nodal metastases.

Other findings include bilateral lens replacements and an old lacunar infarct of the pons on the right side. There is mild diffuse cerebral volume loss. There are scattered foci of T2/FLAIR hyperintensities within the cerebral white matter, which are nonspecific but most likely related to mild chronic microangiopathic changes in this age group.