鼻腔鼻窦嗜酸细胞性乳头状瘤的临床和影像学特征分析

Clinical and imaging features of sinonasal oncocytic papilloma

目的:初步探讨鼻腔鼻窦嗜酸细胞性乳头状瘤(SNOP)的临床和影像学特点。方法:回顾性分析2006年5月—2020年9月于北京同仁医院诊治的31例鼻腔鼻窦SNOP患者的临床资料,分析其常见发病部位、临床症状、影像学特点及随访结果等。结果:31例患者主要临床表现为鼻塞和流涕;病变均位于单侧;肿瘤源于上颌窦17例,筛窦7例,额窦4例,蝶窦3例。鼻窦CT:12例(38.7%)有骨质增生或破坏,其中3例(9.7%)表现为灶状增生。MRI表现:25例(92.6%)病变在T2WI或增强T1WI上瘤体有"脑回征"表现;19例(70.4%)在T1WI上表现为等或者高信号;17例(63.0%)伴有多发性囊肿样改变。所有患者术后病理均证实为SNOP,1例灶状中重度异型增生,1例原位癌变。随访5~177个月,1例复发,复发率为3.2%。结论:鼻腔鼻窦SNOP临床症状缺乏特异性,可与息肉伴发。鼻内镜和影像学检查有一定特点。上颌窦最常受累,其他鼻窦也可发病。需选择合理的手术方式,以彻底切除病变减少复发。

Objective: To analysze the clinical and imaging features of sinonasal oncocytic papilloma(SNOP). Methods: The clinical data of 31 cases of SNOP confirmed by pathology from May 2006 to September 2020 were retrospectively analyzed. The common sites of the tumor, clinical symptoms, imaging features and follow-up results were analyzed. Results: Among the 31 patients, the common clinical symptoms were nasalobstructionand running nose. All the lesions were unilateral. The origin of the tumors was maxillary sinus in 17 cases, ethmoid sinus in 7 cases, frontal sinus in 4 cases, and sphenoid sinus in 3 cases. CT findings: 12 cases(38.7%) had hyperosteogeny or destruction, of which 3 cases(9.7%) showed focal osteitis. MRI findings: 25 cases(92.6%) showed "cerebriform" sign on T2 WI or enhanced T1 WI;19 patients(70.4%) showed high or isointense signal on T1 WI;17 cases(63.0%) were associated with multiple cystoid changes. All patients were pathologically confirmed as SNOP, including 1 case with focal moderate to severe dysplasia and 1 case with carcinogenesis in situ. With follow-up 5 to 177 months, 1 case recurred, and the recurrence rate was 3.2%. Conclusion: The clinical symptoms of SNOP lack specificity and could be accompanied by polyps. The maxillary sinuses are most often involved, but other sinuses may also be affected. Nasal endoscopy and imaging examination have certain characteristics. The root pedicle of the tumor was mostly broad-based, with certain recurrence rate and malignant degeneration. Therefore, a reasonable surgical method should be selected to completely resect the lesion and reduce the recurrence.