上颌窦炎性肌纤维母细胞瘤病例报告及文献回顾

Inflammatory myofibroblastoma of maxillary sinus:a case report and literature review

目的探讨上颌窦炎性肌纤维母细胞瘤的临床表现,病理学特征、诊断、治疗及预后,旨在提高耳鼻咽喉科医生对该病的认识和治疗水平,并减少漏诊误诊。方法报告1例上颌窦炎性肌纤维母细胞瘤,并复习相关的国内外文献。结果 CT扫描示窦腔可见低密度肿块影且突入眼眶,邻近窦壁明显受压、变薄,增强明显不均匀强化。MRI示类圆形稍高/等T2、T1信号肿块影,边界不清。病理示瘤组织主要由梭形肌纤维母细胞及大量炎性细胞组成。免疫组化中SMA、VIM等呈阳性,CK呈阴性。术后随访9个月,复查CT示左上颌窦窦腔未见明显新生物,呈术后改变。结论上颌窦炎性肌纤维母细胞瘤是非常罕见的,其诊断主要依靠病理及免疫组化检测。根治性手术切除仍为目前首选治疗方法,对于体积过大的血供占位病变,术前可辅助介入栓塞治疗。

Objective To investigate the clinical features, diagnosis, treatment and prognosis of maxillary sinus inflammatory myofibroblastoma so as to improve the awareness and treatment level of the doctors for avoidance of misdiagnose and missed diagnosis. Methods Clinical data of one patient suffering from maxillary sinus inflammatory myofibroblastoma were analyzed retrospectively with literature review. Results The CT scan showed a low density mass in maxillary sinus with orbital invasion, compression and thinning of adjacent sinus walls. Enhanced CT scan revealed markedly heterogeneous reinforcement. MRI scan showed a round mass shadow of slightly high or equal T2 and T1 signals with obscure boundary. The pathology confirmed that the tumor was mainly composed of spindle-shaped myofibroblasts and inflammatory cells. Immunohistochemistry indicated positive expressions of SMA and VIM, and negative expression of CK. The patient was followed up for 9 months. Postoperative CT scan showed no obvious neoplasm in the maxillary sinus cavity. Conclusion Inflammatory myofibroblastoma of maxillary sinus is very rare and the diagnosis mainly depends on pathology and immunohistochemistry. Radical resection is the preferred treatment method. Preoperative embolization can be used for the treatment of tumor with large size and abundant blood supply.