鼻咽纤维血管瘤的影像表现及临床课件

读书报告会鼻咽纤维血管瘤的影像表现及临床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Page2患者：男，26岁图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Page4图5MRIT1WI图6MRI影像图像Page5图7MRIT1WI增强图8MRIT1WI增强图9MRIT1WI增强影像图像Page5图7MRIT1WI增强图8MR影像图像Page6图10DSA冠状位图11DSA矢状位影像图像Page6图10DSA冠状位图11DSA矢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。Page7患者：男，26岁AbstractNasopharyngealangiofibroma(NA)isarare,vasculartumoraffectingdolescentmales.Duetoaggressivelocalgrowth,skullbaselocationandriskofprofoundhemorrhage,NAisachallengeforsurgeons.AngiofibromastumorshowedintensivecontrastenhancementonCTandmagneticresonanceimaging(MRI)scans,andabundantvascularityonangiography.Page8AbstractNasopharyngealan

Background

(NA)isararevasculartumor,whichrepresents0.05%ofallheadandnecktumors.Atthesametime,itisthemostcommonbenignneoplasmofthenasopharynx.NAoccurspredominantlyinadolescentmales.Althoughhistologicallybenignitshowslocallyaggressivegrowthwithbonedestructionandspreadthroughnaturalforaminaandfissures.Page9

Background

(NA)isararevasItoriginatesfromtheposterolateralwallofthenasopharynxandfromthissiteusuallyextendstothenasopharynx,nasalcavity,paranasalsinuses,sphenoid-palatineforamenandinfratemporalfossa.In10–20%ofthecasestumorinvadesthecranialcavity。Page10ItoriginatesfromtheposteroNasaltumorunderwentCT,whichdemonstratedhomogenousmass,withcontrastenhancementrangingfromstrongtointermediate(Fig.1).Inonecase,signsofbonydestructionwithtumorinvasiontotheethmoidsinuswerevisible.ThepatientwiththetumoroftheinfratemporalfossaunderwentCT,(MRI)andcarotidarteriographywithpreoperativeembolization.Thelesionshowedintensivecontrast。Page11NasaltumorunderwentCT,whicPage12Fig.1Computedtomography,coronalplane,showshomogenoustumormassintherightnasalcavityFig.2Magneticresonance,saggitalT1-weightedimageaftercontrastadministration.Page12Fig.1ComputedtomograPage13Histologicsectionofthetumor(H&Estain)showsfibrousstromawithectatic,thin-walledvascularchannelsEnhancementonCTandMRIaswellassignal-voidareasonMRimages,typicalforhighflowvessels(Fig.2).Arteriographyrevealedabundantvascularitywithmainbloodsupplyfromtheinternalmaxillaryartery.Page13HistologicsectionoftEnhancementonCTandMRIaswellassignal-voidareasonMRimages,typicalforhighflowvessels(Fig.2).Arteriographyrevealedabundantvascularitywithmainbloodsupplyfromtheinternalmaxillaryartery.Page14EnhancementonCTandMRIaswHistopathologicalappearancetypicalforNAconsistsofnumerouswide,irregularvesselswithasinglelayerofendothelialcells,embeddedinfibrousstroma.Theabundantvascularcomponentisresponsibleforexcessivebleedingduringsurgeryorfollowingbiopsies.ItalsocontributestocertaincharacteristicradiologicalfeaturesofNAs,includingstrongcontrastenhancementonCTandMRimages,signal-voidareasrepresentingtumorvesselsvisibleonMRimages,aswellasintensivevascularblushdemonstratedonangiography.Page15DiscussionHistopathologicalappearancetSelectiveangiographyisausefuldiagnosticmethodtodemonstratetumorvascularcompositionandconfirmsthediagnosis.Italsoallowstumorembolization,whichreducesintraoperativebleeding.Duetoariskofprofoundhemorrhage,inapresenceofcharacteristicclinicalsymptomsandclassicradiologicalfindings,preoperativebiopsyisnotrecommendedinthemanagementofNAs.Page16Selectiveangiographyisause鉴别诊断要点Page171.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。鉴别诊断要点Page171.鼻咽纤维血管瘤：常见于男性青少鼻咽纤维血管瘤的影像表现及临床课件读书报告会鼻咽纤维血管瘤的影像表现及临床读书报告会鼻咽纤维血管瘤的影像表现及临床Page20患者：男，26岁主诉：右鼻出血2天图1CT平扫图2CT增强Page2患者：男，26岁图1CT平扫图2CT增强影像图像Page21图3增强矢状位图4骨窗影像图像Page3图3增强矢状位图4骨窗影像图像Page22图5MRIT1WI图6MRIT2WI影像图像Page4图5MRIT1WI图6MRI影像图像Page23图7MRIT1WI增强图8MRIT1WI增强图9MRIT1WI增强影像图像Page5图7MRIT1WI增强图8MR影像图像Page24图10DSA冠状位图11DSA矢状位影像图像Page6图10DSA冠状位图11DSA矢Page25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。Page7患者：男，26岁AbstractNasopharyngealangiofibroma(NA)isarare,vasculartumoraffectingdolescentmales.Duetoaggressivelocalgrowth,skullbaselocationandriskofprofoundhemorrhage,NAisachallengeforsurgeons.AngiofibromastumorshowedintensivecontrastenhancementonCTandmagneticresonanceimaging(MRI)scans,andabundantvascularityonangiography.Page26AbstractNasopharyngealan

Background

(NA)isararevasculartumor,whichrepresents0.05%ofallheadandnecktumors.Atthesametime,itisthemostcommonbenignneoplasmofthenasopharynx.NAoccurspredominantlyinadolescentmales.Althoughhistologicallybenignitshowslocallyaggressivegrowthwithbonedestructionandspreadthroughnaturalforaminaandfissures.Page27

Background

(NA)isararevasItoriginatesfromtheposterolateralwallofthenasopharynxandfromthissiteusuallyextendstothenasopharynx,nasalcavity,paranasalsinuses,sphenoid-palatineforamenandinfratemporalfossa.In10–20%ofthecasestumorinvadesthecranialcavity。Page28ItoriginatesfromtheposteroNasaltumorunderwentCT,whichdemonstratedhomogenousmass,withcontrastenhancementrangingfromstrongtointermediate(Fig.1).Inonecase,signsofbonydestructionwithtumorinvasiontotheethmoidsinuswerevisible.ThepatientwiththetumoroftheinfratemporalfossaunderwentCT,(MRI)andcarotidarteriographywithpreoperativeembolization.Thelesionshowedintensivecontrast。Page29NasaltumorunderwentCT,whicPage30Fig.1Computedtomography,coronalplane,showshomogenoustumormassintherightnasalcavityFig.2Magneticresonance,saggitalT1-weightedimageaftercontrastadministration.Page12Fig.1ComputedtomograPage31Histologicsectionofthetumor(H&Estain)showsfibrousstromawithectatic,thin-walledvascularchannelsEnhancementonCTandMRIaswellassignal-voidareasonMRimages,typicalforhighflowvessels(Fig.2).Arteriographyrevealedabundantvascularitywithmainbloodsupplyfromtheinternalmaxillaryartery.Page13HistologicsectionoftEnhancementonCTandMRIaswellassignal-voidareasonMRimages,typicalforhighflowvessels(Fig.2).Arteriographyrevealedabundantvascularitywithmainbloodsupplyfromtheinternalmaxillaryartery.Page32EnhancementonCTandMRIaswHistopathologicalappearancetypicalforNAconsistsofnumerouswide,irregularvesselswithasinglelayerofendothelialcells,embeddedinfibrousstroma.Theabundantvascularcomponentisresponsibleforexcessivebleedingduringsurgeryorfollowingbiopsies.ItalsocontributestocertaincharacteristicradiologicalfeaturesofNAs,includingstrongcontrastenhancementonCTandMRimages,signal-voidareasrepresentingtumorvesselsv