鼻腔鼻窦少见恶性肿瘤的影像诊断

Imaging diagnosis of rare malignant tumors in nasal cavity and paranasal sinuses

目的:探讨鼻腔鼻窦少见恶性肿瘤的CT和MR成像特征,提高对少见恶性肿瘤病变的影像认识。方法:回顾性收集2016—2020年我院经术后病理或活检病理证实的18例鼻腔鼻窦少见恶性肿瘤的影像资料,其中炎性肌纤维母细胞瘤3例,横纹肌肉瘤3例,尤文肉瘤/原始神经外胚层肿瘤3例,髓外浆细胞瘤3例,软骨肉瘤2例,卵黄囊肿瘤2例,转移性肾透明细胞癌1例,腺泡细胞癌1例,结合文献回顾分析其影像特征。结果:18例病灶形态不规则,边界不清,均伴有不同程度骨质破坏及周围组织侵犯。2例卵黄囊肿瘤发生于鼻腔,骨质破坏轻微,T_(2)WI序列呈等信号,其内可见点状囊泡样高信号,增强扫描呈中度强化,1例延迟期扫描可见在T_(2)WI序列呈点状高信号区发生强化。2例软骨肉瘤沿鼻咽部生长局限1例、蔓延1例,1例骨质破坏内可见残留骨嵴及点状高密度影,增强扫描均呈边缘强化。3例髓外浆细胞瘤信号均匀,T_(2)WI序列呈均匀低信号,增强扫描实体部分呈明显均匀强化,2例病灶旁见流空血管。1例转移性肾透明细胞癌T_(2)WI序列呈等信号,增强扫描呈显著强化。尤文肉瘤/原始神经外胚层肿瘤和横纹肌肉瘤容易发生于儿童,T_(2)WI序列呈等/低信号,可伴有不同程度囊变、出血。炎性肌纤维母细胞瘤T_(2)WI序列呈高/低信号,可伴有出血、囊变,增强扫描呈不均匀强化,有渐进性强化趋势。结论:鼻腔鼻窦少见恶性肿瘤具有大部分恶性肿瘤的一般特征,部分肿瘤具有自身的一定特点,CT和MR成像可帮助判断病变良恶性、明确病变侵犯范围,为临床诊疗方案确定提供依据。

Objective:To explore the CT and MR imaging features of rare malignant tumors in nasal cavity and paranasal sinuses,and to improve the imaging understanding of rare malignant tumors.Methods:From 2016 to 2020,the imaging data of 18 cases of rare malignant tumors of nasal cavity and paranasal sinuses confirmed by postoperative pathology or biopsy pathology in our hospital were retrospectively collected,including 3 cases of inflammatory myofibroblastic tumor,3 cases of rhabdomyosarcoma,3 cases of Ewing’s sarcoma/primitive neuroectodermal tumor,3 cases of extramedullary plasmacytoma,2 cases of chondrosarcoma,2 cases of yolk sac tumor,1 case of metastatic renal clear cell carcinoma and 1 case of acinar cell carcinoma.Results:Eighteen cases were irregular in shape and unclear in boundary,all of which were accompanied by bone destruction and invasion of surrounding tissues.Two cases of yolk sac tumors occurred in nasal cavity,with slight bone de-struction.The T_(2)WI sequence showed isointense signal,in which punctate vesicle-like hyperintensity was observed,while enhanced scan showed moderate enhancement.One case of delayed scan showed enhancement in the punctate hyperintensity area of T_(2)WI sequence.In 2 cases,chondrosarcoma grew locally along nasopharynx in 1 case and spread in 1 case.Residual bone ridge and punctate high-density shadow were found in 1 case of bone destruction,and all of them showed edge en-hancement on enhanced scan.The signal intensity of extramedullary plasmacytoma was uniform in 3 cases,low signal intensity in T_(2)WI sequence was uniform,the solid part of enhanced scan showed obvious uniform enhancement,and empty blood ves-sels were seen beside the lesions in 2 cases.One case of metastatic renal clear cell carcinoma showed isointense on T_(2)WI and significant enhancement on enhanced scanning.Ewing’s sarcoma/primitive neuroectodermal tumor and rhabdomyosarcoma are easy to occur in children,with isointense/hypointense on T_(2)WI,which may be accompanied by cystic degeneration and hemorrhage in different degrees.The inflammatory myofibroblastic tumor T_(2)WI sequence showed high/low signal intensity,which could be accompanied by hemorrhage and cystic change.The enhanced scan showed uneven enhancement,with a progressive enhancement trend.Conclusion:The rare malignant tumors in nasal cavity and paranasal sinuses have the general characteristics of most malignant tumors,and some tumors have their own characteristics.CT and MRI can help judge the benign and malignant lesions,define the invasion scope of lesions,and provide basis for clinical diagnosis and treatment.