鼻腔鼻窦恶性纤维组织细胞瘤的CT诊断

CT Diagnosis of Malignant Fibrous Histocytoma

目的分析鼻腔鼻窦恶性纤维组织细胞瘤(MFH)的CT表现,评价其临床诊断价值。资料与方法回顾分析经病理证实的鼻腔鼻窦MFH 13例,3例单行平扫,4例行平扫加增强扫描,6例直接行增强扫描。结果肿瘤主要位于鼻腔2例,上颌窦8例,鼻腔筛窦2例,颞部及上颌窦1例。肿瘤易侵犯周围组织,包括面颊部、上齿槽骨、硬腭、眼眶、翼腭窝、颞颌窝、颞下窝及颅底。CT平扫示多数肿块密度不均匀,边界欠清,注射对比剂后实质部分轻度或明显强化。5例有低密度坏死囊变区,2例有钙化灶,1例有放射状骨膜反应,均有不同程度骨质吸收破坏。6例局部复发,2例发生颈部淋巴结转移,1例晚期发生骨转移。结论鼻腔鼻窦MFH进展快、早期侵犯邻近器官组织、易复发,可有颈淋巴结转移。CT显示肿块呈浸润性生长,密度不均匀,边界不清,可有钙化或液化坏死,骨质广泛吸收破坏,影像学对诊断和制定治疗方案有一定帮助。

Objective To analyze CT findings of malignant fibrous histiocytoma （MFH） of nasal and paranasal sinus, to evaluate the value of CT in the diagnosis of MFH. Materials and Methods CT findings of 13 cases with pathologically proved MFH were retrospectively analyzed, including plain （ n = 3） and enhanced （ n = 10） CT. Results The lesions were mainly located in nasal cavity in 2 cases, maxillary sinus in 8 cases, nasal cavity and ethmoid sinus in 2 cases, temporal and maxillary in 1 cases. Adjacent structures were widely invaded. On CT scan, most lesions were heterogeneous, ill defined with slight or obviously enhancement. Calcification （ n = 2）, cystic necrosis（ n = 5 ）, periosteal reaction （ n = 1 ） and metastasis to the cervical lymph nodes （ n = 2） were found. 6 cases were adjacent recurred, metastasis to cervical lymph node（ n = 2） and metastasis to bone （ n = 1 ） in advanced stage were found in MFH. Conclusion MFH is invasive and heterogeneous with bone destruction, sometimes with calcification, necrosis and metastasis, CT is helpful in diagnosis and treatment.