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 Page2 患者 男 26岁主诉 右鼻出血2天 图1CT平扫 图2CT增强 影像图像 Page3 图3增强矢状位 图4骨窗 影像图像 Page4 图5MRIT1WI 图6MRIT2WI 影像图像 Page5 图7MRIT1WI增强 图8MRIT1WI增强 图9MRIT1WI增强 影像图像 Page6 图10DSA冠状位 图11DSA矢状位 Page7 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 Nasopharyngealangiofibroma NA isarare vasculartumoraffectingdolescentmales Duetoaggressivelocalgrowth skullbaselocationandriskofprofoundhemorrhage NAisachallengeforsurgeons AngiofibromastumorshowedintensivecontrastenhancementonCTandmagneticresonanceimaging MRI scans andabundantvascularityonangiography Page8 Background NA isararevasculartumor whichrepresents0 05 ofallheadandnecktumors Atthesametime itisthemostcommonbenignneoplasmofthenasopharynx NAoccurspredominantlyinadolescentmales Althoughhistologicallybenignitshowslocallyaggressivegrowthwithbonedestructionandspreadthroughnaturalforaminaandfissures Page9 Itoriginatesfromtheposterolateralwallofthenasopharynxandfromthissiteusuallyextendstothenasopharynx nasalcavity paranasalsinuses sphenoid palatineforamenandinfratemporalfossa In10 20 ofthecasestumorinvadesthecranialcavity Page10 NasaltumorunderwentCT whichdemonstratedhomogenousmass withcontrastenhancementrangingfromstrongtointermediate Fig 1 Inonecase signsofbonydestructionwithtumorinvasiontotheethmoidsinuswerevisible ThepatientwiththetumoroftheinfratemporalfossaunderwentCT MRI andcarotidarteriographywithpreoperativeembolization Thelesionshowedintensivecontrast Page11 Page12 Fig 1Computedtomography coronalplane showshomogenoustumormassintherightnasalcavity Fig 2Magneticresonance saggitalT1 weightedimageaftercontrastadministration Page13 Histologicsectionofthetumor H Estain showsfibrousstromawithectatic thin walledvascularchannels EnhancementonCTandMRIaswellassignal voidareasonMRimages typicalforhighflowvessels Fig 2 Arteriographyrevealedabundantvascularitywithmainbloodsupplyfromtheinternalmaxillaryartery EnhancementonCTandMRIaswellassignal voidareasonMRimages typicalforhighflowvessels Fig 2 Arteriographyrevealedabundantvascularitywithmainbloodsupplyfromtheinternalmaxillaryartery Page14 HistopathologicalappearancetypicalforNAconsistsofnumerouswide irregularvesselswithasinglelayerofendothelialcells embeddedinfibrousstroma Theabundantvascularcomponentisresponsibleforexcessivebleedingduringsurgeryorfollowingbiopsies ItalsocontributestocertaincharacteristicradiologicalfeaturesofNAs includingstrongcontrastenhancementonCTandMRimages signal voidareasrepresentingtumorvesselsvisibleonMRimages aswellasintensivevascularblushdemonstratedonangiography Page15 Discussion Selectiveangiographyisausefuldiagnosticmethodtodemonstratetumorvascularcompositionandconfirmsthediagnosis Italsoallowstumorembolization whichreducesintraoperativebleeding Duetoariskofprofoundhemorrhage inapresenceofcharacteristicclinicalsymptomsandclassicradiologicalfindings preoperativebiopsyisnotrecommendedinthemanagementofNAs Page16 鉴别诊断要点 Page17 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