成人咽旁间隙淋巴管瘤

Adult parapharyngeal space great lymphoceles:a case report and literature review

目的报道罕见成人咽旁间隙巨大淋巴管瘤1例。方法总结分析成人咽旁间隙巨大淋巴管瘤1例的临床及组织病理学特征。详细采集患者体格检查、CT和MRI、手术及组织病理学检查等资料,并进行文献复习。结果患者,女性,37岁,因左侧咽痛3年,夜里打鼾,左耳听力下降,左侧鼻塞4个月入院。入院前3年患者无诱因出现左侧咽部隐痛,持续非放射性。近4个月来逐渐出现夜里打鼾,左耳听力下降与左侧鼻塞,伴低调左耳鸣。鼻内镜检查见左侧鼻咽部为一巨大肿物全部堵塞鼻后孔,无法看清鼻咽部正常结构,但粘膜正常。左侧口咽部明显突出接近右侧咽壁,软腭水肿、移位。口咽部包块穿刺出暗红血液,病理涂片示退变坏死物。CT见左侧咽旁间隙8cm×6cm×3.5cm低密度包块,密度均匀,边界清楚,邻近组织受压变形,强化不明显。MRI见左侧咽旁间隙不规则肿块约3cm×6.5cm×6.8cm,长T1、长T2信号,上达颅底,下接近喉部,鼻咽部几乎全被占位,不均匀强化,紧贴颈内动静脉,周围组织推压变形,无骨质破坏。在气管切开插管全麻下行手术切除。术后病理检查:海绵状淋巴管瘤。复习文献,淋巴管瘤90%以上发生于12岁以下小儿,特别是2岁以前,发生于成人者非常少见。而发生于咽旁间隙的淋巴管瘤更是罕见,容易误诊。结论影像学检查有助于咽旁间隙肿瘤诊断及鉴别诊断,一旦确诊应采取手术切除。

Objective By learing the clinicl features of adult rare great lymphangioma of parapharyngeal space to enhance the ability of diagsnosis and treatment.Methods One case of adult with great parapharyngeal space lymphoceles was reported clinical and histopathological features,detailed acquisition patients medical examination,CT and MRI,surgery,and histopathological examination data.Then the case was followed up and the literatures were reviewed.Results The case was a 37 years old female.She came to hospital because of sore throat for 3 years,the night of snore,hearing loss of left ear,left snivel fore 4 months.The patient has left incentive angina for 3 years and the pain is last and without radioactivity.In resent four months she appeared nighttime snoring greadually,ear hearing loss in left and left snivel,low-key left tinnitus.We can see a huge mass in the left nasopharynx and blocking back nostril after all through nasal endoscopic examination.The nasopharynx structures is not normal,but it has the normal mucosa.The left oropharyngeal wall of the pharynx is prominent obvious and close to the right side.The soft palate edema,shift.Oropharyngeal mass puncture the dark blood,pathological smears showed necrosis and degeneration.CT see on the left parapharyngeal space 8×6×3.5cm low-density mass,density,uniform,clear boundary,adjacent tissue deformation pressure,strengthen the obvious.MRI see irregular mass in the left parapharyngeal space about 3×6.5×6.8cm,long T1,long T2 signals on up to the skull base,close under the throat,was occupying almost the entire nasopharynx,heterogeneous enhancement,close to neck artery and vein,push the deformation of the surrounding tissue,no bone damage.Surgical resection is performed In the tracheostormy under general anesthesia.Postoperative histopathologic examination：cavernous lymphoceles.Literature review,over 90% of lymphangiomas occur in children under the age of 12,especially two years ago,occurs in adults are rare.The gap occurs in the parapharyngeal lymphangioma is a rare and easily misdiagnosed.Conclusion Imaging studies is avail to diagnosis and differential diagnosis of parapharyngeal space cancer.Once parapharyngeal space cancer was confirmed it should be exscinded surgically.