鼻腔及鼻窦成釉细胞瘤4例并文献复习

Ameloblastoma of nasal cavity and paranasal sinus:A report of 4 cases and literature review

目的探讨鼻腔及鼻窦成釉细胞瘤(ameloblastoma,AB)的临床影像特点、诊治方法及预后。方法回顾性分析2012年7月~2022年2月4例鼻腔及鼻窦AB临床资料。患者均为男性,年龄14~80岁,中位年龄56.5岁。2例因面颊部无痛性肿胀,2例因右侧/双侧鼻腔间断性鼻塞、流涕就诊。病程3个月~1年,中位确诊时间8个月。查体见粉红色新生物,鼻窦、硬腭等骨质不同程度破坏。患者均行副鼻窦CT检查,4例为平扫,1例术后复查时行CT增强检查,病变呈软组织密度,1例病变内见结节样骨性密度影;增强扫描无强化效应。3例行内镜下鼻腔、鼻窦肿物切除术,1例行上颌骨次全切除术。结果无明显并发症发生。术后病理确诊为AB。随访2~19个月,1例术后9个月原位复发,1例术后随访19个月原位复发3次。2例随访2个月尚无复发迹象。结论鼻腔、鼻窦AB临床症状无特征性,CT检查有助于发现病变、明确骨质膨胀性破坏或缺损情况,但基于影像学定性及确诊肿瘤类型存在困难,确诊仍靠病理。AB呈侵袭性生长且易复发,根治性手术效果较好,术后可长期生存。

Objective To investigate the clinical imaging features,diagnosis,treatment and prognosis of ameloblastoma(AB)of nasal cavity and paranasal sinus.Methods The clinical data of 4 cases of nasal cavity and paranasal sinus AB from July 2012 to February 2022 were analyzed retrospectively.All patients were male,aged from 14 to 80 years,with a median age of 56.5 years.Two cases were treated for painless swelling of the cheek,and two cases were treated for intermittent nasal congestion and runny nose in the right/bilateral nasal cavity.The course of disease ranged from 3 months to 1 year,and the median diagnosis time was 8 months.On physical examination,pink new organisms were found,and bone such as paranasal sinuses and hard palate were damaged to varying degrees.All patients underwent CT examination of paranasal sinus,4 cases were plain scan,1 case underwent CT enhancement examination during postoperative reexamination,the lesion showed soft tissue density,and 1 case showed nodular bone density shadow;Enhanced scanning has no enhancement effect.Endoscopic resection of nasal cavity and sinuses was performed in 3 cases and subtotal maxillary resection was performed in 1 case.Results No obvious complications occurred.The pathological diagnosis was ab.Followed up for 2~19 months,1 case recurred in situ 9 months after operation,and 1 case recurred in situ 3 times after 19 months.Two cases were followed up for 2 months and there was no sign of recurrence.Conclusion The clinical symptoms of nasal cavity and paranasal sinus AB are not characteristic.CT examination is helpful to find the lesions and clarify the destruction or defect of bone swelling.However,it is difficult to determine the nature of imaging and the type of tumor,and the diagnosis still depends on pathology.AB is invasive and easy to relapse.The effect of radical surgery is good and can survive for a long time.