鼻咽纤维血管瘤的影像表现及临床.ppt

读书报告会 鼻咽纤维血管瘤的影像表现及临床 Page 2 患者 ：男， 26岁 主诉： 右鼻出血 2天 图 1 CT平扫 图 2 CT增强 影像图像 Page 3 图 3 增强矢状位 图 4 骨窗 影像图像 Page 4 图 5 MRI T1WI 图 6 MRI T2WI 影像图像 Page 5 图 7 MRI T1WI 增强 图 8 MRI T1WI 增强 图 9 MRI T1WI 增强 影像图像 Page 6 图 10 DSA冠状 位 图 11 DSA矢状位 Page 7 患者 ：男， 26岁 主诉： 右鼻出血 2天 现病史： 患者输 2天前无明显诱因出现右鼻出血，为鲜血，呈滴状，先从左前鼻 孔出，后亦从口中、右鼻流出，数分钟后停止， 反复出现多次，总量约为 100ml， 无鼻塞，流涕，嗅觉正常。无头痛、发热、咳嗽、打鼾，无耳鸣、而鼻塞感， 无听力下降。于当地医院治疗，予以鼻腔填塞，症状好转。在中山陈星海医院， 予以电子喉镜检查“右鼻腔肿物，性质待查”。 既往史： 否认肝炎、结核、疟疾病史，否认高血压、心脏病史，否认糖尿病、 脑血管疾病史，否认手术、外伤、输血史，否认食物、药物等过敏史，否认吸 烟、饮酒史，否认毒物接触史。 Abstract Nasopharyngeal angiofibroma (NA) is a rare,vascular tumor affecting dolescent males. Due to aggressive local growth, skull base location and risk of profound hemorrhage, NA is a challenge for surgeons.Angiofibromas tumor showed intensive contrast enhancement on CT and magnetic resonance imaging (MRI) scans, and abundant vascularity on angiography. Page 8 Background (NA) is a rare vascular tumor, which represents 0.05 % of all head and neck tumors. At the same time, it is the most common benign neoplasm of the nasopharynx . NA occurs predominantly in adolescent males. Although histologically benign it shows locally aggressive growth with bone destruction and spread through natural foramina and fissures. Page 9 It originates from the posterolateral wall of the nasopharynx and from this site usually extends to the nasopharynx, nasal cavity, paranasal sinuses, sphenoid-palatine foramen and infratemporal fossa. In 1020 % of the cases tumor invades the cranial cavity 。 Page 10 Nasal tumor underwent CT, which demonstrated homogenous mass, with contrast enhancement ranging from strong to intermediate (Fig. 1).In one case, signs of bony destruction with tumor invasion to the ethmoid sinus were visible. The patient with the tumor of the infratemporal fossa underwent CT, (MRI) and carotid arteriography with preoperative embolization. The lesion showed intensive contrast。 Page 11 Page 12 Fig. 1 Computed tomography, coronal plane, shows homogenous tumor mass in the right nasal cavity Fig. 2 Magnetic resonance, saggital T1-weighted image after contrast administration. Page 13 Histologic section of the tumor (H&E stain) shows fibrous stroma with ectatic, thin- walled vascular channels Enhancement on CT and MRI as well as signal-void areas on MR images, typical for high flow vessels (Fig. 2). Arteriography revealed abundant vascularity with main blood supply from the internal maxillary artery. Enhancement on CT and MRI as well as signal-void areas on MR images, typical for high flow vessels (Fig. 2). Arteriography revealed abundant vascularity with main blood supply from the internal maxillary artery. Page 14 Histopathological appearance typical for NA consists of numerous wide, irregular vessels with a single layer of endothelial cells, embedded in fibrous stroma. The abundant vascular component is responsible for excessive bleeding during surgery or following biopsies. It also contributes to certain characteristic radiological features of NAs, including strong contrast enhancement on CT and MR images, signal-void areas representing tumor vessels visible on MR images, as well as intensive vascular blush demonstrated on angiography . Page 15 Discussion Selective angiography is a useful diagnostic method to demonstrate tumor vascular composition and confirms the diagnosis. It also allows tumor embolization, which reduces intraoperative bleeding. Due to a risk of profound hemorrhage, in a presence of characteristic clinical symptoms and classic radiological findings, preoperative biopsy is not recommended in the management of NAs. Page 16 鉴别诊断要点 Page 17 1.鼻咽纤维血管瘤 ：常见于 男性青少年 ，有多次鼻出血病 史，影像检查见鼻咽部软组织肿块，多伴有 压迫性骨质吸收破 坏 ；增强扫描病灶 明显强化 。 2.鼻咽癌 ：最常发生于 中年人 ， 回缩性血涕 是其典型早期临 床表现之一，影像检查见鼻咽部浸润性肿块，边界不清， 侵蚀 性骨质破坏 明显，增强扫描呈 轻中度强化 ， 颈部淋巴结肿大 往 往为初诊的首发症状。 3.鼻咽非霍奇金淋巴瘤 ：以 青壮年 多见，病变侵犯范围 较广，增强扫描呈 轻度强化 ， 骨质破坏少见，转移常见 ，如转 移到皮肤、胃肠道、肝、淋巴结等。