鼻咽纖維血管瘤的影像表現(xiàn)及臨床

讀書報(bào)告會(huì)鼻咽纖維血管瘤的影像表現(xiàn)及臨床患者：男，26歲主訴：右鼻出血2天圖1CT平掃圖2CT增強(qiáng)2021/10/102影像圖像圖3增強(qiáng)矢狀位圖4骨窗2021/10/103影像圖像圖5MRIT1WI圖6MRIT2WI2021/10/104影像圖像圖7MRIT1WI增強(qiáng)圖8MRIT1WI增強(qiáng)圖9MRIT1WI增強(qiáng)2021/10/105影像圖像圖10DSA冠狀位圖11DSA矢狀位2021/10/106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。2021/10/107AbstractNasopharyngealangiofibroma(NA)isarare,vasculartumoraffectingdolescentmales.Duetoaggressivelocalgrowth,skullbaselocationandriskofprofoundhemorrhage,NAisachallengeforsurgeons.AngiofibromastumorshowedintensivecontrastenhancementonCTandmagneticresonanceimaging(MRI)scans,andabundantvascularityonangiography.2021/10/108

Background

(NA)isararevasculartumor,whichrepresents0.05%ofallheadandnecktumors.Atthesametime,itisthemostcommonbenignneoplasmofthenasopharynx.NAoccurspredominantlyinadolescentmales.Althoughhistologicallybenignitshowslocallyaggressivegrowthwithbonedestructionandspreadthroughnaturalforaminaandfissures.2021/10/109Itoriginatesfromtheposterolateralwallofthenasopharynxandfromthissiteusuallyextendstothenasopharynx,nasalcavity,paranasalsinuses,sphenoid-palatineforamenandinfratemporalfossa.In10–20%ofthecasestumorinvadesthecranialcavity。2021/10/1010NasaltumorunderwentCT,whichdemonstratedhomogenousmass,withcontrastenhancementrangingfromstrongtointermediate(Fig.1).Inonecase,signsofbonydestructionwithtumorinvasiontotheethmoidsinuswerevisible.ThepatientwiththetumoroftheinfratemporalfossaunderwentCT,(MRI)andcarotidarteriographywithpreoperativeembolization.Thelesionshowedintensivecontrast。2021/10/1011Fig.1Computedtomography,coronalplane,showshomogenoustumormassintherightnasalcavityFig.2Magneticresonance,saggitalT1-weightedimageaftercontrastadministration.2021/10/1012Histologicsectionofthetumor(H&Estain)showsfibrousstromawithectatic,thin-walledvascularchannelsEnhancementonCTandMRIaswellassignal-voidareasonMRimages,typicalforhighflowvessels(Fig.2).Arteriographyrevealedabundantvascularitywithmainbloodsupplyfromtheinternalmaxillaryartery.2021/10/1013EnhancementonCTandMRIaswellassignal-voidareasonMRimages,typicalforhighflowvessels(Fig.2).Arteriographyrevealedabundantvascularitywithmainbloodsupplyfromtheinternalmaxillaryartery.2021/10/1014HistopathologicalappearancetypicalforNAconsistsofnumerouswide,irregularvesselswithasinglelayerofendothelialcells,embeddedinfibrousstroma.Theabundantvascularcomponentisresponsibleforexcessivebleedingduringsurgeryorfollowingbiopsies.ItalsocontributestocertaincharacteristicradiologicalfeaturesofNAs,includingstrongcontrastenhancementonCTandMRimages,signal-voidareasrepresentingtumorvesselsvisibleonMRimages,aswellasintensivevascularblushdemonstratedonangiography.Discussion2021/10/1015Selectiveangiographyisausefuldiagnosticmethodtodemonstratetumorvascularcompositionandconfirmsthediagnosis.Italsoallowstumorembolization,whichreducesintraoperativebleeding.Duetoariskofprofoundhemorrhage,inapresenceofcharacteristicclinicalsymptomsandclassicradiologicalfindings,preoperativebiopsyisnotrecommendedinthemanagementofNAs.2021/10/1016鑒別診斷要點(diǎn)1.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