鼻咽纤维血管瘤的影像表现及临床ppt课件.ppt

读书报告会,鼻咽纤维血管瘤的影像表现及临床,1,患者：男，26岁主诉：右鼻出血2天,图1CT平扫,图2CT增强,2,影像图像,图3增强矢状位,图4骨窗,3,影像图像,图5MRIT1WI,图6MRIT2WI,4,影像图像,图7MRIT1WI增强,图8MRIT1WI增强,图9MRIT1WI增强,5,影像图像,图10DSA冠状位,图11DSA矢状位,6,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。,7,Abstract,Nasopharyngealangiofibroma(NA)isarare,vasculartumoraffectingdolescentmales.Duetoaggressivelocalgrowth,skullbaselocationandriskofprofoundhemorrhage,NAisachallengeforsurgeons.AngiofibromastumorshowedintensivecontrastenhancementonCTandmagneticresonanceimaging(MRI)scans,andabundantvascularityonangiography.,8,Background,(NA)isararevasculartumor,whichrepresents0.05%ofallheadandnecktumors.Atthesametime,itisthemostcommonbenignneoplasmofthenasopharynx.NAoccurspredominantlyinadolescentmales.Althoughhistologicallybenignitshowslocallyaggressivegrowthwithbonedestructionandspreadthroughnaturalforaminaandfissures.,9,Itoriginatesfromtheposterolateralwallofthenasopharynxandfromthissiteusuallyextendstothenasopharynx,nasalcavity,paranasalsinuses,sphenoid-palatineforamenandinfratemporalfossa.In1020%ofthecasestumorinvadesthecranialcavity。,10,NasaltumorunderwentCT,whichdemonstratedhomogenousmass,withcontrastenhancementrangingfromstrongtointermediate(Fig.1).Inonecase,signsofbonydestructionwithtumorinvasiontotheethmoidsinuswerevisible.ThepatientwiththetumoroftheinfratemporalfossaunderwentCT,(MRI)andcarotidarteriographywithpreoperativeembolization.Thelesionshowedintensivecontrast。,11,Fig.1Computedtomography,coronalplane,showshomogenoustumormassintherightnasalcavity,Fig.2Magneticresonance,saggitalT1-weightedimageaftercontrastadministration.,12,Histologicsectionofthetumor(H&Estain)showsfibrousstromawithectatic,thin-walledvascularchannels,EnhancementonCTandMRIaswellassignal-voidareasonMRimages,typicalforhighflowvessels(Fig.2).Arteriographyrevealedabundantvascularitywithmainbloodsupplyfromtheinternalmaxillaryartery.,13,EnhancementonCTandMRIaswellassignal-voidareasonMRimages,typicalforhighflowvessels(Fig.2).Arteriographyrevealedabundantvascularitywithmainbloodsupplyfromtheinternalmaxillaryartery.,14,HistopathologicalappearancetypicalforNAconsistsofnumerouswide,irregularvesselswithasinglelayerofendothelialcells,embeddedinfibrousstroma.Theabundantvascularcomponentisresponsibleforexcessivebleedingduringsurgeryorfollowingbiopsies.ItalsocontributestocertaincharacteristicradiologicalfeaturesofNAs,includingstrongcontrastenhancementonCTandMRimages,signal-voidareasrepresentingtumorvesselsvisibleonMRimages,aswellasintensivevascularblushdemonstratedonangiography.,Discussion,15,Selectiveangiographyisausefuldiagnosticmethodtodemonstratetumorvascularcompositionandconfirmsthediagnosis.Italsoallowstumorembolization,whichreducesintraoperativebleeding.Duetoariskofprofoundhemorrhage,inapresenceofcharacteristicclinicalsymptomsandclassicradiologicalfindings,preoperativebiopsyisnotrecommendedinthemanagementofNAs.,16,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