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1、读书报告会鼻咽纤维血管瘤的影像表现及临床Page 2u患者：男，26岁u主诉：右鼻出血2天图1 CT平扫图2 CT增强影像图像Page 3图3 增强矢状位图4 骨窗影像图像Page 4图5 MRI T1WI图6 MRI T2WI影像图像Page 5图7 MRI T1WI增强图8 MRI T1WI增强图9 MRI T1WI增强影像图像Page 6图10 DSA冠状位图11 DSA矢状位Page 7u患者：男，26岁u主诉：右鼻出血2天u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
2、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”。u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。Abstract Nasopharyngeal angiofibroma (NA) is a rare,vascular tumor affecting dolescent males. Due to aggressive local growth, skull bas
3、e location and risk of profound hemorrhage, NA is a challenge for surgeons.Angiofibromas tumor showed intensive contrast enhancement on CT and magnetic resonance imaging (MRI) scans, and abundant vascularity on angiography.Page 8Background(NA) is a rare vascular tumor, which represents 0.05 % of all
4、 head and neck tumors. At the same time, it is the most common benign neoplasm of the nasopharynx . NA occurs predominantly in adolescent males. Although histologically benign it shows locally aggressive growth with bone destruction and spread through natural foramina and fissures. Page 9It originat
5、es from the posterolateral wall of the nasopharynx and from this site usually extends to the nasopharynx, nasal cavity, paranasal sinuses, sphenoid-palatine foramen and infratemporal fossa. In 1020 % of the cases tumor invades the cranial cavity 。Page 10Nasal tumor underwent CT, which demonstrated h
6、omogenous mass, with contrast enhancement ranging from strong to intermediate (Fig. 1).In one case, signs of bony destruction with tumor invasion to the ethmoid sinus were visible. The patient with the tumor of the infratemporal fossa underwent CT, (MRI) and carotid arteriography with preoperative e
7、mbolization. The lesion showed intensive contrast。Page 11Page 12Fig. 1 Computed tomography, coronal plane, shows homogenoustumor mass in the right nasal cavityFig. 2 Magnetic resonance, saggital T1-weighted image after contrastadministration. Page 13Histologic section of the tumor (H&E stain) shows
8、fibrous stroma with ectatic, thin-walled vascular channelsEnhancement on CT and MRI as well as signal-void areas on MR images, typical for high flow vessels (Fig. 2). Arteriography revealed abundant vascularity with main blood supply from the internal maxillary artery. Enhancement on CT and MRI as w
9、ell as signal-void areas on MR images, typical for high flow vessels (Fig. 2). Arteriography revealed abundant vascularity with main blood supply from the internal maxillary artery. Page 14Histopathological appearance typical for NA consists of numerous wide, irregular vessels with a single layer of
10、 endothelial cells, embedded in fibrous stroma. The abundant vascular component is responsible for excessive bleeding during surgery or following biopsies. It also contributes to certain characteristic radiological features of NAs, including strong contrast enhancement on CT and MR images, signal-vo
11、id areas representing tumor vessels visible on MR images, as well as intensive vascular blush demonstrated on angiography . Page 15 Discussion DiscussionSelective angiography is a useful diagnostic method to demonstrate tumor vascular composition and confirms the diagnosis. It also allows tumor embo
12、lization, which reduces intraoperative bleeding. Due to a risk of profound hemorrhage, in a presence of characteristic clinical symptoms and classic radiological findings, preoperative biopsy is not recommended in the management of NAs.Page 16鉴别诊断要点Page 171.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.鼻咽癌：最常发生于中年人，回缩性血涕是其典型早期临床表现之一，影像检查见鼻咽部浸润性肿块，边界不清，侵蚀性骨质破坏明显，增强扫描呈轻中度强化，颈部淋巴结肿大往往为初诊的首发症状。3.鼻咽非霍奇金淋巴瘤：以青壮年多见，病变侵犯范围较广，增强扫描呈轻度强化，骨质破坏少见，转移常见，如转移到皮肤、胃肠道、肝、淋巴结等。
