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Updated: Sep 24, 2025
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A Model for Perineural Invasion in Head and Neck Squamous Cell Carcinoma
Published on: January 5, 2017
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Squamous Cell Carcinoma with Clinical Perineural Invasion: Challenges and Review in Single Case Study
Victor Chalfant1, David Semerad2, John Gossen1
1Department of Radiology, CHI Creighton University Medical Center-Bergan Mercy, Omaha, USA.
Journal of Radiology Case Reports
|May 6, 2022
Summary
Perineural invasion in squamous cell carcinoma, though rare, indicates a poor prognosis. Early detection via MRI is crucial for effective treatment and reducing recurrence risk.
Area of Science:
- Oncology
- Radiology
- Neurology
Background:
- Perineural invasion (PNI) is a rare but significant prognostic indicator in squamous cell carcinomas (SCCs).
- PNI is associated with a poorer prognosis and increased risk of recurrence.
- Early identification of PNI is critical for optimizing patient treatment and outcomes.
Observation:
- A case study of a 77-year-old male presenting with a forehead mass.
- T1-weighted MRI revealed findings suggestive of PNI in the right supratrochlear nerve, including nerve thickening and loss of surrounding fat.
- The patient had squamous cell carcinoma and was immunocompromised with positive margins after surgical excision.
Findings:
- MRI findings confirmed perineural invasion of the supratrochlear nerve.
- The patient's immunocompromised status and positive surgical margins necessitated further treatment.
- Adjuvant external beam radiotherapy was administered along the nerve's course.
Implications:
- This case highlights the importance of advanced imaging like MRI in detecting subtle PNI.
- Treatment decisions for PNI must consider patient-specific factors, including immunocompromise and margin status.
- When tumors invade cranial nerves, particularly the trigeminal nerve, the benefits of radiotherapy must be carefully weighed against the risk of radiation-induced optic neuropathy.
