case_images: PMC11807289_01
case_images: Preoperative and postoperative MRI of the brain.
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case_images: PMC11807289_01_cureus-0017-00000077217-i01.jpg
case_images: FIG1
case_images: Postoperative scans revealed a residual mass extending into the right cavernous sinus and the right middle cranial fossa, slightly displacing the right temporal lobe (Figure 1).
case_images: Histopathologic and immunohistochemical slides of the patient's tumour.. (A, B) HE stain: the tumour consists of sheets of undifferentiated cells undermining included respiratory epithelium. (C) MNF-116 pan-keratin immunohistochemistry: strongly labels cells in keeping with carcinoma. (D) INI-1 immunohistochemistry: loss of signal indicating SWI/SNF inactivation in tumour cells, with the surrounding desmoplastic stroma showing retained signal in cell nuclei (internal control). All images: HE and immunohistochemistry magnification (40x).. HE: hematoxylin and eosin; MNF-116: cytokeratin pan monoclonal antibody; SWI/SNF: SWItch/sucrose non-fermentable; INI-1: integrase interactor 1
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case_images: PMC11807289_01_cureus-0017-00000077217-i02.jpg
case_images: FIG2
case_images: Re-staging MRI compared with postoperative imaging.
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case_images: PMC11807289_01_cureus-0017-00000077217-i03.jpg
case_images: FIG3
case_images: MRI of the brain and sinuses revealed rapid interval growth of the residual lesion with new extension into the right temporal lobe, the apex of the right retro-orbital region, and through the posterior wall of the right maxillary sinus (Figure 3).
case_images: Planning scan.. GTV (green), CTV (blue), and PTV (orange). Sparing of the left optic nerve and optic chiasm.. GTV: gross tumour volume; CTV: clinical target volume; PTV: planning target volume
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case_images: PMC11807289_01_cureus-0017-00000077217-i04.jpg
case_images: FIG4
case_images: Repeat CT scan and planning ensued, and the dose was escalated to 66 Gy (additional 26 Gy in 13 fractions) without compromising the dose to the optic chiasm and brainstem (Figure 4).
case_images: MRI of the brain with contrast (four weeks post-radiothrapy completion).. Axial T2-weighted MRI images (A) at the level of the posterior cranial fossa and (B) at the level of sella turcica.. MRI of the brain with contrast performed four weeks after completion of radiotherapy shows a marked reduction in tumour size following treatment.
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case_images: PMC11807289_01_cureus-0017-00000077217-i05.jpg
case_images: FIG5
case_images: Follow-up MRI of the brain and sinuses four weeks post-radiotherapy revealed a marked reduction in tumour volume, with residual volume involving the cavernous sinus and pituitary fossa, extending into the middle cranial fossa, and along the sphenoid wing (Figure 5).
case_images: Follow-up MRI of the brain with contrast.. Axial T2-weighted MRI images (A) at the level of the posterior cranial fossa and (B) at the level of sella turcica.. MRI of the brain with contrast performed four months after the initiation of adjuvant chemotherapy demonstrates further reduction in the size of the residual tumour compared to the MRI obtained four months earlier.
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case_images: PMC11807289_01_cureus-0017-00000077217-i06.jpg
case_images: FIG6
case_images: Hence, the patient was started on nivolumab (480 mg monotherapy administered every four weeks) to which he had a great response (Figure 6).