TAMMY CARMONA

FINDINGS

BRAIN AND EXTRA-AXIAL SPACES: In the interval, there is significant enlargement in the multifocal areas of enhancement in the medial right temporal lobe since the previous exam of 04/23/2018. There is a dramatic increase when compared back to 01/22/2018. The inferior component of enhancement is without significant change measuring 1.3 x 1.8 cm (transverse by AP), as seen previously. However the superior component measures 1.6 x 2 cm and previously this measured 0.9 x 1.5 cm. In addition there is a more anterior component of enhancement that measures 1.3 x 1.1 cm that previously measured 0.8 x 0.4 cm. Thus, there is significant increasing enhancement in the medial temporal lobe. Surrounding edema in the right temporal lobe extends back little more posteriorly than previously. Perfusion images however do not show significant increased perfusion. Perfusion images suggest that these changes are related to radiation necrosis. However given the significant progression, I am concerned this is progressive neoplasm at this site..

The 2 mm focus of enhancement laterally in the right cerebellum on image 23 of series 10 is unchanged. The small focus of hemorrhage superiorly in the left superior cerebellum is unchanged.

No new areas of enhancement are visualized.

VENTRICLES: Normal in size and configuration.

SELLA/PARASELLAR REGIONS: Partially empty sella is again visualized.

VESSELS: Normal flow related enhancement in the major vessels of the circle of Willis and the major dural venous sinuses.

CALVARIUM AND SKULL BASE: No calvarial abnormalities are identified. PARANASAL SINUSES/MASTOID AIR CELLS: The paranasal sinuses, middle ear cavities and mastoid air cells are well-aerated.

ORBITS: Within normal limits

CRANIOCERVICAL JUNCTION: Within normal limits

OTHER FINDINGS: No other significant findings are seen.

IMPRESSION:

1. Interval significant increase in enhancing multifocal areas in the medial right temporal lobe since the previous exams of 4/23/2018 and 1/22/2018. Although this could still be radiation necrosis, recurrent neoplasm is an increasing concern.. MR cannot definitely differentiate these.

2. Unchanged tiny punctate focus of enhancement in the right cerebellum and small focus of hemorrhage in the left cerebellum.

3. No new areas of abnormality.

I love my radiology oncologist. She’s always honest with me. She’s says this is not good. We are not sure if it’s cancer or necrosis from radiation. There will be a meeting on my case on Monday. Then we will have a new plan. Right now the plan is to add another drug to my Xeloda and rescan in 2 months. If the progression is still as fast as it has been the past two months then brain surgery is my option. This plan may change after the board meeting. They will also consider some clinical trials. It seems to be another wait and see.

For now, I’m going to enjoy summer! I’m still going to the beach for a week and then the 🍒 on top is Lynard Skynard in September!😂. This has already been an eventful summer! I tell myself daily that I am blessed to be here and still be making memories! I have watched as T.J. got his first job, his first checking/ savings account, and finished drivers ed! He will be driving me around next week! I told him one day he will wish he didn’t have to work. I said don’t you want to hang by the pool, kayak and do things like that this summer? He said “Mom, I’m building my resumé”. 😂. How do you say no to that? I’ve also had so much quality time with my precious grand babies! You know I’m including pictures!

Thank you all for your love and support. You all bring sunshine to my life! I may make cancer look easy, but it’s not. When you see my adventures on Instagram or Facebook, know that I’m in bed on pain meds the next day. It’s so worth the memories I’m making! Life is so good! Get out and enjoy it and make some memories!!!!!Sending love to each and everyone of you!💕💕💕💕