New Recurence (+3.5 years)

An updating list of tumor locations:

#1 - Left occipital lobe (resected/radiated 2010)
#2 - Left parasagittal parietal (radiated 2010, resected/radiated 2011)
#3 - Right temporal lobe (resected/radiated 2011)
#4 - Left parietal periatrial (radiated 2011)
#5 - Left caudate body and/or corona radiata (radiated 2011)
#6 - Left anterior temporal horn (radiated 2018)
#7 - Right anterior temporal horn (radiated 2018)
#8 - Left posterior lateral ventricle (radiated 2019)  "aka "intraventricular enhancing mass along the medial body of the left lateral ventricle"

#9 - Right temporal horn (new)

Found out #9 at my follow-up appointment today after scans Friday.

Treatment will start next week with, I believe, Ipi + Nivo. Radiation may be happening too. 

A question for me to ask, whenever I speak to a radiation oncologist next: Are #6 thru #9 all "intraventricular masses"? Creepy. From the MRI a couple of weeks before radiosurgery on #8: "Compared with 12/19/2018, there is a new, heterogeneous, 13 mm intraventricular enhancing mass with increased relative cerebral blood flow within the posterior body of the left lateral ventricle, with associated susceptibility and reduced diffusion."

MR BRAIN WITH AND WITHOUT CONTRAST: 9/23/2022 4:12 PM

INDICATION (as provided by referring clinician): No iodinated contrast contraindication

S/p brain surgery for cancer

Other reason than headache, head trauma, multiple sclerosis, Parkinson's, neoplasm, seizures, subarachnoid hemorrhage, TIA, stroke, altered mental status, or syncope

57-year-old man with metastatic melanoma involving the brain and complete response to immunotherapy. Assess recurrence in 3 months.

 

ADDITIONAL HISTORY: History of melanoma involving the left forehead and left neck with intracranial metastases. Off systemic chemotherapy since 2021.

 

COMPARISON: MR brain 6/27/2022.

 

TECHNIQUE: Multiple sequences through the brain were acquired at 3.0 tesla.

 

MEDICATIONS:

Dotarem - 16 mL - Intravenous

 

FINDINGS:

 

Compared to 6/27/2022, a enhancing lesion in the temporal horn of the right lateral ventricle has increased in size, now measuring 9 mm (series 9 image 58), previously 3 mm. This lesion has associated susceptibility.

 

Postoperative changes from prior right temporal and left occipital craniotomies with underlying resection cavities. Similar appearance of nodular enhancement along the medial and posterior aspect of the left occipital resection cavity, and within the central aspect of the right temporal resection cavity. Similar FLAIR signal around the resection cavities.

 

Unchanged FLAIR hyperintensity with encephalomalacia and gliosis involving the bilateral inferior frontal lobes, likely sequela of prior injury.

 

No acute intracranial hemorrhage. No hydrocephalus. No intracranial herniation.

 

IMPRESSION:

 

Compared to 6/27/2022, evidence of disease progression with increased size of an enhancing lesion in the temporal of the right lateral ventricle. No new sites of metastasis.