讀書報(bào)告會鼻咽纖維血管瘤的影像表現(xiàn)及臨床讀書報(bào)告會鼻咽纖維血管瘤的影像表現(xiàn)及臨床Page2患者：男，26歲主訴：右鼻出血2天圖1CT平掃圖2CT增強(qiáng)Page2患者：男，26歲圖1CT平掃圖2CT增強(qiáng)影像圖像Page3圖3增強(qiáng)矢狀位圖4骨窗影像圖像Page3圖3增強(qiáng)矢狀位圖4骨窗影像圖像Page4圖5MRIT1WI圖6MRIT2WI影像圖像Page4圖5MRIT1WI圖6MRI影像圖像Page5圖7MRIT1WI增強(qiáng)圖8MRIT1WI增強(qiáng)圖9MRIT1WI增強(qiáng)影像圖像Page5圖7MRIT1WI增強(qiáng)圖8MR影像圖像Page6圖10DSA冠狀位圖11DSA矢狀位影像圖像Page6圖10DSA冠狀位圖11DSA矢Page7患者：男，26歲主訴：右鼻出血2天現(xiàn)病史：患者輸2天前無明顯誘因出現(xiàn)右鼻出血，為鮮血，呈滴狀，先從左前鼻孔出，后亦從口中、右鼻流出，數(shù)分鐘后停止，反復(fù)出現(xiàn)多次，總量約為100ml，無鼻塞，流涕，嗅覺正常。無頭痛、發(fā)熱、咳嗽、打鼾，無耳鳴、而鼻塞感，無聽力下降。于當(dāng)?shù)蒯t(yī)院治療，予以鼻腔填塞，癥狀好轉(zhuǎn)。在中山陳星海醫(yī)院，予以電子喉鏡檢查“右鼻腔腫物，性質(zhì)待查”。既往史：否認(rèn)肝炎、結(jié)核、瘧疾病史，否認(rèn)高血壓、心臟病史，否認(rèn)糖尿病、腦血管疾病史，否認(rèn)手術(shù)、外傷、輸血史，否認(rèn)食物、藥物等過敏史，否認(rèn)吸煙、飲酒史，否認(rèn)毒物接觸史。Page7患者：男，26歲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鑒別診斷要點(diǎn)Page171.鼻咽纖維血管瘤：常見于男性青少年，有多次鼻出血病史，影像檢查見鼻咽部軟組織腫塊，多伴有壓迫性骨質(zhì)吸收破壞；增強(qiáng)掃描病灶明顯強(qiáng)化。2.鼻咽癌：最常發(fā)生于中年人，回縮性血涕是其典型早期臨床表現(xiàn)之一，影像檢查見鼻咽部浸潤性腫塊，邊界不清，侵蝕性骨質(zhì)破壞明顯，增強(qiáng)掃描呈輕中度強(qiáng)化，頸部淋巴結(jié)腫大往往為初診的首發(fā)癥狀。3.鼻咽非霍奇金淋巴瘤：以青壯年多見，病變侵犯范圍較廣，增強(qiáng)掃描呈輕度強(qiáng)化，骨質(zhì)破壞少見，轉(zhuǎn)移常見，如轉(zhuǎn)移到皮膚、胃腸道、肝、淋巴結(jié)等。鑒別診斷要點(diǎn)Page171.鼻咽纖維血管瘤：常見于男性青少鼻咽纖維血管瘤的影像表現(xiàn)及臨床課件讀書報(bào)告會鼻咽纖維血管瘤的影像表現(xiàn)及臨床讀書報(bào)告會鼻咽纖維血管瘤的影像表現(xiàn)及臨床Page20患者：男，26歲主訴：右鼻出血2天圖1CT平掃圖2CT增強(qiáng)Page2患者：男，26歲圖1CT平掃圖2CT增強(qiáng)影像圖像Page21圖3增強(qiáng)矢狀位圖4骨窗影像圖像Page3圖3增強(qiáng)矢狀位圖4骨窗影像圖像Page22圖5MRIT1WI圖6MRIT2WI影像圖像Page4圖5MRIT1WI圖6MRI影像圖像Page23圖7MRIT1WI增強(qiáng)圖8MRIT1WI增強(qiáng)圖9MRIT1WI增強(qiáng)影像圖像Page5圖7MRIT1WI增強(qiáng)圖8MR影像圖像Page24圖10DSA冠狀位圖11DSA矢狀位影像圖像Page6圖10DSA冠狀位圖11DSA矢Page25患者：男，26歲主訴：右鼻出血2天現(xiàn)病史：患者輸2天前無明顯誘因出現(xiàn)右鼻出血，為鮮血，呈滴狀，先從左前鼻孔出，后亦從口中、右鼻流出，數(shù)分鐘后停止，反復(fù)出現(xiàn)多次，總量約為100ml，無鼻塞，流涕，嗅覺正常。無頭痛、發(fā)熱、咳嗽、打鼾，無耳鳴、而鼻塞感，無聽力下降。于當(dāng)?shù)蒯t(yī)院治療，予以鼻腔填塞，癥狀好轉(zhuǎn)。在中山陳星海醫(yī)院，予以電子喉鏡檢查“右鼻腔腫物，性質(zhì)待查”。既往史：否認(rèn)肝炎、結(jié)核、瘧疾病史，否認(rèn)高血壓、心臟病史，否認(rèn)糖尿病、腦血管疾病史，否認(rèn)手術(shù)、外傷、輸血史，否認(rèn)食物、藥物等過敏史，否認(rèn)吸煙、飲酒史，否認(rèn)毒物接觸史。Page7患者：男，26歲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