鼻腔鼻窦内的恶性肿瘤ppt课件

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 nasalrouteitwon tberemovedentirely 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 Asitdoesn tenhance weknowwearen tdealingwithtumor 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 Themostcharacteristicimagingfeatureofthesilentsinussyndromeistheinwardretractionofthesinu