16 林蒙 头颈病例分析-全国肿瘤影像诊断学习班

头颈病例中国医学科学院肿瘤医院影像诊断科林蒙病例一CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences问题CancerInstitute&Hospital,ChineseAcademyofMedicalSciences解答CancerInstitute&Hospital,ChineseAcademyofMedicalSciences解答•病变与桥小脑角区没有关系，可能侵犯颞骨岩部及舌下神经管，同时把左侧的颈内动脉向前•XII伸舌偏左，左侧舌肌萎缩，提示舌下神经有受侵，而舌下神经从舌下神经管出颅，故肯定CancerInstitute&Hospital,ChineseAcademyofMedicalSciences•颈静脉孔区最常见的肿瘤分别是颈静脉球瘤、神经鞘瘤和脑膜瘤，少见的肿瘤十分多，有软骨肉瘤、脊索瘤、软骨母细胞瘤、颞骨鳞癌、转移瘤等T2WI/FLAIR上呈高低混杂信号，说明其内部有囊变的区域。这些表现与脑膜瘤T1WI等信号、T2WI等信号的特点不符，脑膜瘤应为均匀强化伴或不伴有脑膜尾征典型的颈静脉球瘤在T2WI上可以看见多发流空的小血管,即“盐-胡椒”征，颈静脉球瘤应为均匀明显强化，与此病例表现不符CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences•本病例的磁共振特点–T2WI/FLAIR上呈高低混杂信号，提示其内部CancerInstitute&Hospital,ChineseAcademyofMedicalSciences•好发于脊柱两端即骶尾部（50%）和颅底(•分为普通型（80%）、软骨瘤样型（10%）及CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences&Hospital,Academy&Hospital,AcademyofSciencesCancerInstituteChineseMedical问题CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences–均有可能–两个病变，不能除外转移瘤可能–病变较大，边界欠清楚CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciencesT2WIT2WI脂肪抑制CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences），CancerInstitute&Hospital,ChineseAcademyofMedicalSciences•喉部肿物超声引导下活检P63（-CD56（3+Syno（3+•病理：神经内分泌肿瘤，考虑恶性副节瘤CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,ChineseAcademyofMedicalSciences•喉上部：假声带，沿着喉上动脉和神经•喉下部：环状软骨侧缘的环状软骨粘膜CancerInstitute&Hospital,ChineseAcademyofMedicalSciencesCancerInstitute&Hospital,