鼻腔鼻竇內(nèi)的惡性腫瘤

RoleofCTandMRISignalcharacteristicsofsecretionsPseudo-pneumatizedsinusEnhancementComplicationsofSinusitisBrainabscessMucoceleOrbitalCellulitisandAbscessComplicationofFESS(Functionalendoscopicsinussurgery)Tumorandtumorlikelesions腫瘤及腫瘤樣病變Encephalocele腦膨出Mucocele黏液囊腫Invertedpapilloma內(nèi)翻乳頭狀瘤Malignanttumorsofthesinonasaltract鼻腔鼻竇惡性腫瘤Meningioma腦膜瘤Keratocyst角化囊腫Silentsinus靜竇綜合癥Fibro-osseousLesionsFibrousdysplasiaOsteitisOsteomaMonitoringresponsetotherapy1精選pptRoleofCTandMRISignalcharacteristicsofsecretionsPseudo-pneumatizedsinusEnhancementComplicationsofSinusitisBrainabscessMucoceleOrbitalCellulitisandAbscessComplicationofFESS(Functionalendoscopicsinussurgery)Tumorandtumorlikelesions腫瘤及腫瘤樣病變Encephalocele腦膨出Mucocele黏液囊腫Invertedpapilloma內(nèi)翻乳頭狀瘤Malignanttumorsofthesinonasaltract鼻腔鼻竇惡性腫瘤Meningioma腦膜瘤Keratocyst角化囊腫Silentsinus靜竇綜合癥Fibro-osseousLesionsFibrousdysplasiaOsteitisOsteomaMonitoringresponsetotherapy2精選pptMalignanttumorsofthesinonasaltractMalignanttumorsofthesinonasaltractareextremelyrare.Theclinicalpresentationisnon-specificandoftenmimicsbenigndisease.Asaresultadelayindiagnosisiscommon.75%ofallparanasalsinustumorsareStageT3orT4atthetimeofdiagnosis.Perineuralspreadisamanifestationofadvanceddiseaseandindicatesapoorprognosis.鼻腔鼻竇內(nèi)的惡性腫瘤是非常罕見(jiàn)的。其臨床表現(xiàn)不典型，通常與良性病變表現(xiàn)類似。因此，診斷上的延遲非常常見(jiàn)。大概有75%的鼻腔鼻竇腫瘤在確診時(shí)已經(jīng)達(dá)T3或T4期了。病變沿神經(jīng)播散可作為其為進(jìn)行性的一個(gè)表現(xiàn)，并且提示病變的預(yù)后不良。3精選pptOntheleftanaxialMR-imageshowingamassintheethmoids.

TheMRIshowsnointracranialextension.軸位T1上篩竇內(nèi)可見(jiàn)一腫物，沒(méi)有侵犯顱內(nèi)。下一步就是要進(jìn)行CT檢查。

4精選pptACTisnecessarytodeterminetheintegrityoftheadjacentbone.Noticethebonydestructionofthefoveaethmoidalis.Thisindicatesthatthisisamalignantlesionandbiopsydemonstratedanadenocarcinoma.CT可以判斷病變鄰近骨的完整性。這個(gè)患者的CT上可見(jiàn)篩凹處的骨質(zhì)破壞〔藍(lán)色箭頭〕，提示這是一個(gè)惡性病變，活檢證實(shí)為腺癌。5精選pptRoleofCTandMRISignalcharacteristicsofsecretionsPseudo-pneumatizedsinusEnhancementComplicationsofSinusitisBrainabscessMucoceleOrbitalCellulitisandAbscessComplicationofFESS(Functionalendoscopicsinussurgery)Tumorandtumorlikelesions腫瘤及腫瘤樣病變Encephalocele腦膨出Mucocele黏液囊腫Invertedpapilloma內(nèi)翻乳頭狀瘤Malignanttumorsofthesinonasaltract鼻腔鼻竇惡性腫瘤Meningioma腦膜瘤Keratocyst角化囊腫Silentsinus靜竇綜合癥Fibro-osseousLesionsFibrousdysplasiaOsteitisOsteomaMonitoringresponsetotherapy6精選pptMeningiomaAmeningiomacanspreadtranscranially.

Ontheleftisapatientwithameningioma,whichspreadsalongtheanteriorclinoid(arrow).

腦膜瘤可以向顱內(nèi)播散。這個(gè)患者的腦膜瘤沿著前床突播散。7精選pptMRInicelydemonstrateshowthemeningiomaspreadsdownintothesino-nasalcavity.這是更向前的一張。MRI可以很好的顯示腦膜瘤向鼻腔、鼻竇內(nèi)播散。8精選pptRoleofCTandMRISignalcharacteristicsofsecretionsPseudo-pneumatizedsinusEnhancementComplicationsofSinusitisBrainabscessMucoceleOrbitalCellulitisandAbscessComplicationofFESS(Functionalendoscopicsinussurgery)Tumorandtumorlikelesions腫瘤及腫瘤樣病變Encephalocele腦膨出Mucocele黏液囊腫Invertedpapilloma內(nèi)翻乳頭狀瘤Malignanttumorsofthesinonasaltract鼻腔鼻竇惡性腫瘤Meningioma腦膜瘤Keratocyst角化囊腫Silentsinus靜竇綜合癥Fibro-osseousLesionsFibrousdysplasiaOsteitisOsteomaMonitoringresponsetotherapy9精選pptKeratocystFirstlookattheimagesontheleft.

Fromwhereisthislesionarising?

Thelesionisexpansilewithboneremodellingandthereisanobviousrelationtoatooth.觀察一下這個(gè)病變的起源。病變呈膨脹性改變，周圍骨質(zhì)吸收、變薄，而且病變很顯然與牙齒相關(guān)。10精選pptItisveryimportanttodeterminewhetherornotsinuspathologyhasanodontogenticorigin〔牙源〕,simplybecausethesurgicalapproachisdifferent.Ifodontogentic,thesurgerywillbedonepreferablybyamaxillofacialsurgeon.Ifapproachedbyasino-nasalrouteitwon‘tberemovedentirely.Thisisakeratocyst.判斷鼻竇內(nèi)的病變是否是牙源性的非常重要，因?yàn)槭中g(shù)范圍不一樣。如果是牙源性的，頜面部手術(shù)效果更好，因?yàn)榻?jīng)鼻腔鼻竇切除可能會(huì)切除不徹底。這個(gè)病變是角化囊腫。11精選pptKeratocystOntheleftanothercase.

Thispatientpresentedwithfacialpain.Onthiscontrast-enhancedMRIweseeanon-enhancingexpansilelesionintherightmaxillarysinus.Asitdoesn‘tenhance,weknowwearen’tdealingwithtumor.Itistemptingtocallthisaretentioncystandmoveontothenextcase,butaCTiscalledfortomakethecorrectdiagnosis.

這是另外一個(gè)患者，主訴面部疼痛。冠狀位MRI增強(qiáng)圖像上可見(jiàn)右側(cè)上頜竇內(nèi)膨脹性非增強(qiáng)的病變。因?yàn)椴∽兊牟粡?qiáng)化，所以可以認(rèn)為其不是一個(gè)腫瘤。根據(jù)磁共振上的表現(xiàn)可以認(rèn)為這是一個(gè)儲(chǔ)留囊腫，但是后來(lái)進(jìn)行的CT證實(shí)這是一個(gè)錯(cuò)誤的判斷。12精選pptThecorrespondingCTshowselevationofthemaxillarybone(bluearrow).Theredarrowintherightimageindicatesthecystdissectingaroundtherootofatooth.Thisisalsoakeratocyst.相應(yīng)的CT上顯示右側(cè)上頜骨的升高〔藍(lán)色箭頭〕。紅色箭頭提示囊腫起源于牙根部周圍。這個(gè)病變同樣是一個(gè)角化囊腫。13精選pptRoleofCTandMRISignalcharacteristicsofsecretionsPseudo-pneumatizedsinusEnhancementComplicationsofSinusitisBrainabscessMucoceleOrbitalCellulitisandAbscessComplicationofFESS(Functionalendoscopicsinussurgery)Tumorandtumorlikelesions腫瘤及腫瘤樣病變Encephalocele腦膨出Mucocele黏液囊腫Invertedpapilloma內(nèi)翻乳頭狀瘤Malignanttumorsofthesinonasaltract鼻腔鼻竇惡性腫瘤Meningioma腦膜瘤Keratocyst角化囊腫Silentsinus靜竇綜合癥Fibro-osseousLesionsFibrousdysplasiaOsteitisOsteomaMonitoringresponsetotherapy14精選pptSilentsinusOntheleftapatientwhopresentedwithasymmetriceyes.

Thisfilmwasoriginallyreadasethmoidsinusitisandpost-surgery.However,thispatienthadneverundergonesino-nasalsurgery.

Whatyouinfactsee,isadhesionofthemiddlerightturbinate(redarrow)andtheuncinateprocesstotheflooroftheorbit.

Thereisalsovolumelossoftherightmaxillarysinus.這個(gè)患者雙眼不對(duì)稱。根據(jù)CT得出的最初診斷是篩竇炎和術(shù)后改變。然而，這個(gè)患者從來(lái)沒(méi)有接受過(guò)