鼻咽纤维血管瘤的影像表现及临床课件

1、鼻咽纤维血管瘤的影像表现及临床鼻咽纤维血管瘤的影像表现及临床鼻咽纤维血管瘤的影像表现及临床鼻咽纤维血管瘤的影像表现及临床鼻咽纤维血管瘤的影像表现及临床患者：男，26岁主诉：右鼻出血2天图1 CT平扫图2 CT增强Page 2患者：男，26岁图1 CT平扫图2 CT增强Page 2影像图像图3 增强矢状位图4 骨窗Page 3影像图像图3 增强矢状位图4 骨窗Page 3影像图像图5 MRI T1WI图6 MRI T2WIPage 4影像图像图5 MRI T1WI图6 MRI T2WIPa影像图像图7 MRI T1WI增强图8 MRI T1WI增强图9 MRI T1WI增强Page 5影像图像图

2、7 MRI T1WI增强图8 MRI T1WI影像图像图10 DSA冠状位图11 DSA矢状位Page 6影像图像图10 DSA冠状位图11 DSA矢状位Page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

3、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。Page 7患者：男，26岁Page 7Abstract 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

4、intensive contrast enhancement on CT and magnetic resonance imaging (MRI) scans, and abundant vascularity on angiography.Page 8Abstract Nasopharyngeal anBackground(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 neopla

5、sm 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 9Background(NA) is a rare vasIt originates from the posterolateral wall of the nasophary

6、nx 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 10It originates from the posteroNasal tumor underwent CT, which demonstrated homogenous mass, wi

7、th 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 l

8、esion showed intensive contrast。Page 11Nasal tumor underwent CT, whicFig. 1 Computed tomography, coronal plane, shows homogenoustumor mass in the right nasal cavityFig. 2 Magnetic resonance, saggital T1-weighted image after contrastadministration. Page 12Fig. 1 Computed tomography, coHistologic sect

9、ion of the tumor (H&E stain) shows fibrous stroma with ectatic, thin-walled vascular channelsEnhancement 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 art

10、ery. Page 13Histologic section of the tumoEnhancement 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 14Enhancement on CT and MRI as wHistopath

11、ological 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 characteris

12、tic 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 . DiscussionPage 15Histopathological appearance tSelective angiography is a

13、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 16Selective angiography is a use鉴别诊断要点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