30例鼻窦恶性肿瘤影像分析

The Diagnosis of Malignant Tumor of Nasal Cavity By X-ray Image

目的探讨鼻窦恶性肿瘤的影像学表现及其临床鉴别诊断,进一步提高鼻窦恶性肿瘤早期诊断水平。方法对我院30例经病理证实的鼻窦恶性肿瘤的X线平片及CT片进行回顾性分析,肿瘤原发于上颌窦15例(50.0%),筛窦10例(33.3%),额窦3例(10.0%),无法辨别起源2例(6.7%)。病理检查为低分化鳞癌18例,未分化癌5例,腺样囊性癌3例,恶性乳头状瘤和恶性黑色素瘤各2例。结果30例鼻窦恶性肿瘤中,25例术前确诊(占83.3%),误诊5例(16.7%)。其影像学表现为窦壁骨质呈溶骨性或筛孔样骨破坏,窦腔内均见软组织肿块,窦腔轮廓消失,软组织肿块超过窦壁边缘。结论为减少漏诊和误诊,须不同位置或体层摄片,上颌窦后壁破坏是诊断上颌窦恶性肿瘤的特征性影像学表现;高分辨率CT检查能清楚显示肿瘤范围和累及部位。

Objective The aim of this study was to explore the X-ray image manifestation and clinical differential diagnoses of the malignant tumors of nasal cavity, and further to improve the earlier diagnoses ability of the malignant tumors of nasal cavity. Methods 30 cases with nasal cavity malignant tumor confirmed by pathology investigation were enrolled in this clinical trial and their X-ray image and CT were retrospectively analyzed. Among these 30 cases, the tumor of 15 （50.0%）cases were arising from maxillary sinus, 10 （33.3%） cases were arising from ethodal sinus primarily,3 （10.0%）cases were arising from frontal sinus primarily and 2（6.7% ） cases couldn＇t be recognized the origin of the tumor. The pathology findings showed that 18 cases were poorly differentiated squamous-cell carcinoma,5 cases were undifferentiated carcinoma,3 cases were adenoid cystic carcinoma,2 cases were carcinoma villosum and 2 cases were malignant melanoma. Results Of 30 cases with malignant tumors of nasal cavity, 25 （83.3%） had been finally diagnosed and 5,5 examples（ 16.7% ） were misdiagnosed before operation. X-ray showed that the bone substance of sinus walls were osteolytic or cribriform damaged, the outline of sinus cavity was disappeared, soft lump could been seen in sinus cavity and it had exceeded the edge of the sinus. Conclusions In order to reduce the missed diagnoses and misdiagnoses, whether or not each wall of nasal cavity had been damaged, it should be obtained from different directions or body section by radiology and it should be clearly manifested. The damage of posterior wall of maxillary sinus is the distinctive imageological characteristics to diagnose the malignant tumor of nasal cavity. High definition of CT examinations can clearly show the tumor size and affect locations.