头颈部肿瘤沿翼腭窝神经周围扩散的CT研究(附12例报道)

CT study of perineural extension of tumor in the head and neck through the pterygopalatine fossa (with report of 12 cases)

目的 :探讨CT诊断头颈部肿瘤沿翼腭窝神经周围扩散的价值 ,旨在提高对此种转移方式的认识。方法 :回顾性分析经临床和病理证实 1 2例资料完整的通过翼腭窝神经周围蔓延的头颈部肿瘤的表现 ,均行CT扫描。结果 :原发病变病理类型包括腺样囊性癌 7例、鳞癌 3例、横纹肌肉瘤 1例及淋巴瘤 1例 ,早期CT主要表现包括翼腭窝脂肪消失、相连的孔道出现强化软组织影 ;随病程进展 ,翼腭窝和相连孔道先后出现向心性、轮廓光滑扩大以至破坏 ,海绵窦、Meckel′s腔出现强化软组织肿块。结论 :尽管神经周围扩散为头颈部肿瘤最少见、最隐蔽的转移方式 ,但CT能较好显示沿翼腭窝神经周围转移的病变 ,准确及时发现对选择合适的治疗方案和评估病人预后有重要意义。

Objective:To evaluate CT in diagnosing perineural spread of head and neck tumors through the pterygopalatine fossa,and to improve the understanding of this mode of metastasis.Methods:12 cases of tumors of head and neck proved by clinical data and pathology were performed CT scanning,which had perineural tumor extension into pterygopalatine fossa.Results:From 12 cases,7 cases were adenoid cystic carcinoma,3 squamous cell carcinoma,1 rhabdomyoscarcoma and 1 lymphoma.Their early CT signs showed obliteration of fatty tissue in pterygopalatine fossa and soft tissue shadows in foramina or canals contiguous with pterygopalatine fossa. As the lesion invaded the pterygopalatine fossa,the corresponding foramina or canals may enlarge in a smooth concentric fashion and be eventually destroyed, and enhancing soft tissue mass appeared in the region of cavernous sinus or Meckel′s cave.Conclusion:Perineural extension is possibly the rarest and most insidious mode of metastasis in which head and neck tumors spread through pterygopalatine fossa. However, this mode can be depicted well by CT.