嗅神经母细胞瘤误诊原因分析

Analysis on the Misdiagnosis of Esthesioneuroblastoma

目的 探讨嗅神经母细胞瘸的误诊原因。方法 回顾性地分析我科1993年1月～2004年12月收治的24例嗅神经母细胞瘤病人的临床资料，主要包括临床诊断、影像学术前诊断、术前术后病理学诊断。从临床、影像、病理三方面分析。结果 临床误诊13／24（54．16％），术前影像／实际不符16／24（66．67％），病理误诊6／24（25％），病理诊断不明确1／24（4％）。结论 对于鼻塞或鼻出血伴有鼻腔顶部可疑新生物者要警惕本病；CT及MRI显示中心位于鼻腔顶部和筛窦，密度较均匀的大片状组织肿块，侵犯邻近结构（眼眶／颅内），筛板及眼眶内侧壁被侵蚀性破坏。应首先考虑嗅神经母细胞瘤；对于临床可疑而初次病理诊断非本病的病例，应反复取检并结合形态学特点及免疫组化结果尽早确诊。

Objective To analyse the cause of misdiagnosis of csthesioncuroblastoma. Methods A retrospective analysis was given to the clinical data of the 24 patients with esthesioncuroblastoma treated surgically in our department from Jan. 1993 to Dee. 2004, including clinical diagnosis, pre-operation imaging diagnosis, and pathological diagnosis pre- and after operation. Results Clinical misdiagnosis was found in 13 cases （54.16%）, pro-operation imaging inconsistent with the final diagnosis in 16 cases （66.67 % ）, pathological misdiagnosis in 6 cases and undetermined pathological diagnosis in 1 ease. Conclusions Patients with nasal bleeding 0 nasal occlusion and superior endonasal masses should be alerted｜ Esthesioneuroblastoma should be considered in the patients whose CT or MRI indicate the epicenter of tumor is close to the superior nasal cavity and ethoid sinus, and the cribfiform plate and orbital medial wall were infiltrated;Immunohistochemical analysis could aid in the diagnosis and the differential diagnosis of esthesiaoneuroblastoma.