鼻腔鼻窦内的恶性肿瘤PPT课件.ppt

1,RoleofCTandMRISignalcharacteristicsofsecretionsPseudo-pneumatizedsinusEnhancementComplicationsofSinusitisBrainabscessMucoceleOrbitalCellulitisandAbscessComplicationofFESS(Functionalendoscopicsinussurgery)Tumorandtumorlikelesions肿瘤及肿瘤样病变Encephalocele脑膨出Mucocele黏液囊肿Invertedpapilloma内翻乳头状瘤Malignanttumorsofthesinonasaltract鼻腔鼻窦恶性肿瘤Meningioma脑膜瘤Keratocyst角化囊肿Silentsinus静窦综合症Fibro-osseousLesionsFibrousdysplasiaOsteitisOsteomaMonitoringresponsetotherapy,2,RoleofCTandMRISignalcharacteristicsofsecretionsPseudo-pneumatizedsinusEnhancementComplicationsofSinusitisBrainabscessMucoceleOrbitalCellulitisandAbscessComplicationofFESS(Functionalendoscopicsinussurgery)Tumorandtumorlikelesions肿瘤及肿瘤样病变Encephalocele脑膨出Mucocele黏液囊肿Invertedpapilloma内翻乳头状瘤Malignanttumorsofthesinonasaltract鼻腔鼻窦恶性肿瘤Meningioma脑膜瘤Keratocyst角化囊肿Silentsinus静窦综合症Fibro-osseousLesionsFibrousdysplasiaOsteitisOsteomaMonitoringresponsetotherapy,3,Malignanttumorsofthesinonasaltract,Malignanttumorsofthesinonasaltractareextremelyrare.Theclinicalpresentationisnon-specificandoftenmimicsbenigndisease.Asaresultadelayindiagnosisiscommon.75%ofallparanasalsinustumorsareStageT3orT4atthetimeofdiagnosis.Perineuralspreadisamanifestationofadvanceddiseaseandindicatesapoorprognosis.鼻腔鼻窦内的恶性肿瘤是非常罕见的。其临床表现不典型，通常与良性病变表现类似。因此，诊断上的延迟非常常见。大概有75%的鼻腔鼻窦肿瘤在确诊时已经达T3或T4期了。病变沿神经播散可作为其为进行性的一个表现，并且提示病变的预后不良。,4,OntheleftanaxialMR-imageshowingamassintheethmoids.TheMRIshowsnointracranialextension.轴位T1上筛窦内可见一肿物，没有侵犯颅内。下一步就是要进行CT检查。,5,ACTisnecessarytodeterminetheintegrityoftheadjacentbone.Noticethebonydestructionofthefoveaethmoidalis.Thisindicatesthatthisisamalignantlesionandbiopsydemonstratedanadenocarcinoma.CT可以判断病变邻近骨的完整性。这个患者的CT上可见筛凹处的骨质破坏（蓝色箭头），提示这是一个恶性病变，活检证实为腺癌。,6,RoleofCTandMRISignalcharacteristicsofsecretionsPseudo-pneumatizedsinusEnhancementComplicationsofSinusitisBrainabscessMucoceleOrbitalCellulitisandAbscessComplicationofFESS(Functionalendoscopicsinussurgery)Tumorandtumorlikelesions肿瘤及肿瘤样病变Encephalocele脑膨出Mucocele黏液囊肿Invertedpapilloma内翻乳头状瘤Malignanttumorsofthesinonasaltract鼻腔鼻窦恶性肿瘤Meningioma脑膜瘤Keratocyst角化囊肿Silentsinus静窦综合症Fibro-osseousLesionsFibrousdysplasiaOsteitisOsteomaMonitoringresponsetotherapy,7,Meningioma,Ameningiomacanspreadtranscranially.Ontheleftisapatientwithameningioma,whichspreadsalongtheanteriorclinoid(arrow).脑膜瘤可以向颅内播散。这个患者的脑膜瘤沿着前床突播散。,8,MRInicelydemonstrateshowthemeningiomaspreadsdownintothesino-nasalcavity.这是更向前的一张。MRI可以很好的显示脑膜瘤向鼻腔、鼻窦内播散。,9,RoleofCTandMRISignalcharacteristicsofsecretionsPseudo-pneumatizedsinusEnhancementComplicationsofSinusitisBrainabscessMucoceleOrbitalCellulitisandAbscessComplicationofFESS(Functionalendoscopicsinussurgery)Tumorandtumorlikelesions肿瘤及肿瘤样病变Encephalocele脑膨出Mucocele黏液囊肿Invertedpapilloma内翻乳头状瘤Malignanttumorsofthesinonasaltract鼻腔鼻窦恶性肿瘤Meningioma脑膜瘤Keratocyst角化囊肿Silentsinus静窦综合症Fibro-osseousLesionsFibrousdysplasiaOsteitisOsteomaMonitoringresponsetotherapy,10,Keratocyst,Firstlookattheimagesontheleft.Fromwhereisthislesionarising?Thelesionisexpansilewithboneremodellingandthereisanobviousrelationtoatooth.观察一下这个病变的起源。病变呈膨胀性改变，周围骨质吸收、变薄，而且病变很显然与牙齿相关。,11,Itisveryimportanttodeterminewhetherornotsinuspathologyhasanodontogenticorigin（牙源）,simplybecausethesurgicalapproachisdifferent.Ifodontogentic,thesurgerywillbedonepreferablybyamaxillofacialsurgeon.Ifapproachedbyasino-nasalrouteitwontberemovedentirely.Thisisakeratocyst.判断鼻窦内的病变是否是牙源性的非常重要，因为手术范围不一样。如果是牙源性的，颌面部手术效果更好，因为经鼻腔鼻窦切除可能会切除不彻底。这个病变是角化囊肿。,12,Keratocyst,Ontheleftanothercase.Thispatientpresentedwithfacialpain.Onthiscontrast-enhancedMRIweseeanon-enhancingexpansilelesionintherightmaxillarysinus.Asitdoesntenhance,weknowwearentdealingwithtumor.Itistemptingtocallthisaretentioncystandmoveontothenextcase,butaCTiscalledfortomakethecorrectdiagnosis.这是另外一个患者，主诉面部疼痛。冠状位MRI增强图像上可见右侧上颌窦内膨胀性非增强的病变。因为病变的不强化，所以可以认为其不是一个肿瘤。根据磁共振上的表现可以认为这是一个储留囊肿，但是后来进行的CT证实这是一个错误的判断。,13,ThecorrespondingCTshowselevationofthemaxillarybone(bluearrow).Theredarrowintherightimageindicatesthecystdissectingaroundtherootofatooth.Thisisalsoakeratocyst.相应的CT上显示右侧上颌骨的升高（蓝色箭头）。红色箭头提示囊肿起源于牙根部周围。这个病变同样是一个角化囊肿。,14,RoleofCTandMRISignalcharacteristicsofsecretionsPseudo-pneumatizedsinusEnhancementComplicationsofSinusitisBrainabscessMucoceleOrbitalCellulitisandAbscessComplicationofFESS(Functionalendoscopicsinussurgery)Tumorandtumorlikelesions肿瘤及肿瘤样病变Encephalocele脑膨出Mucocele黏液囊肿Invertedpapilloma内翻乳头状瘤Malignanttumorsofthesinonasaltract鼻腔鼻窦恶性肿瘤Meningioma脑膜瘤Keratocyst角化囊肿Silentsinus静窦综合症Fibro-osseousLesionsFibrousdysplasiaOsteitisOsteomaMonitoringresponsetotherapy,15,Silentsinus,Ontheleftapatientwhopresentedwithasymmetriceyes.Thisfilmwasoriginallyreadasethmoidsinusitisandpost-surgery.However,thispatienthadneverundergonesino-nasalsurgery.Whatyouinfactsee,isadhesionofthemiddlerightturbinate(redarrow)andtheuncinateprocesstotheflooroftheorbit.Thereisalsovolumelossoftherightmaxillarysinus.这个患者双眼不对称。根据CT得出的最初诊断是筛窦炎和术后改变。然而，这个患者从来没有接受过鼻腔、鼻窦的手术。仔细观察可以发现，这个患者的中鼻甲和钩突附着于眼眶底壁。同时可见右侧上颌窦窦腔缩小。,16,Thisiscalledthesilentsinussyndrome,whichconsistsofpainlessfacialasymmetryandenophthalmoscausedbychronicmaxillarysinusatelectasis.Themostcharacteristicimagingfeatureofthesilentsinussyndromeistheinwardretractionofthesinusw