Sinonasal teratocarcinosarcoma involving the nasal cavity,unilateral paranasal sinuses,and intracranial invasion:A case report

BACKGROUND Sinonasal teratocarcinosarcoma(SNTCS)is a rare and highly invasive neoplasm originating from the nasal cavity and sinuses.Typically,it exhibits an invasive behavior towards adjacent structures;however,in exceptional instances,it may infiltrate the intracranial compartment.Due to the tumor's rarity and lack of distinctive features on computed tomography(CT)and magnetic resonance imaging(MRI)images,SNTCS is often misdiagnosed.CASE SUMMARY In this study,we present a case of SNTCS in a 56-year-old patient who exhibited unexplained cognitive impairment before admission.CT and MRI scans revealed the presence of a mass in the right nasal cavity,with lesions extending to the right ethmoid sinus and right frontal region.Subsequently,the patient underwent pathological examination for confirmation and received surgical intervention to excise the tumor.The future advancement in our understanding of this disease will significantly contribute to the precise diagnosis and treatment of SNTCS.CONCLUSION SNTCS is an exceptionally rare malignant tumor that originates from the nasal cavity and paranasal sinuses,presenting a diagnostic challenge due to its nonspecific imaging findings.MRI accurately delineates the location,morphological characteristics,size,internal structure,extent of surrounding involvement,and metabolic information of the lesion.These aspects play a pivotal role in the precise localization and qualitative assessment of SNTCS.Nevertheless,a definitive diagnosis still requires a pathological biopsy.

Value of magnetic resonance imaging including dynamic contrast-enhanced magnetic resonance imaging in differentiation between inverted papilloma and malignant tumors in the nasal cavity

Background Distinguishing inverted papilloma （IP） from malignant tumors in the nasal cavity is difficult in a substantial number of cases,thus hindering the administration of appropriate therapeutic strategies.This study aimed to evaluate whether magnetic resonance imaging （MRI）,including dynamic contrast enhanced MRI （DCE-MRI）,could improve differentiation between IP and malignant tumors,and to identify which MRI features were the best in discriminating IP from malignant tumors in the nasal cavity.Methods Non-enhanced,static,and dynamic contrast enhanced MRI was performed in 88 patients with an IP or a malignant tumor in the nasal cavity that had been confirmed by histological results.MRI features of IP and malignant tumors including side,margin,T1 signal intensity,T1 homogeneity,T2 signal intensity,T2 homogeneity,lobulation signs,convoluted cerebriform pattern,extra-sinonasal involvement,pattern of enhancement,Tpeak,Tmax,Clmax,and TIC type were evaluated and correlated with histological findings.Results There were significant differences between IP and malignant tumors in T2 homogeneity,Iobulation signs,convoluted cerebriform pattern,extra-sinonasal involvement,Tpeak,Tmax and TIC types.A convoluted cerebriform pattern had a higher sensitivity and specificity in diagnosis of IP while washout-type TIC had a higher sensitivity and specificity in diagnosis of malignant tumors in the nasal cavity.Non-enhanced combined with static and dynamic enhancement MRI was significantly superior to non-enhanced combined with static enhancement MRI in the differentiation of IP and malignant tumors in the nasal cavity.Multivariate logistic regression analysis identified that the best MRI features were a convoluted cerebriform pattern,extra-sinonasal involvement,and washout-type TIC for both observers （Wang XY and Zhang ZY）.Conclusion Non-enhanced and static combined with dynamic contrast-enhanced MRI improves differentiation of IP and malignant tumors in the nasal cavity.

Histopathologic Observation and Three Dimeninal CT Reconstruction of the Nasal Cavity and Paranasal Sinuses in Children with Cleft Palates

The morphologic characteristics of nasal cavity and paranasal sinuses in childred with cleft plaate were studied by

Feasibility and value of quantitative dynamic contrast enhancement MR imaging in the evaluation of sinonasal tumors

Background Quantitative dynamic contrast enhancement MR imaging （DCE-MRI）,used to measure properties of tissue microvasculature and tumor angiogenesis,is a promising method for distinguishing benign and malignant tumors and characterizing tumor response to antiangiogenic treatment.The aim of this study was to assess the feasibility of quantitative parameters derived from clinically used DCE-MRI for distinguishing benign from malignant tumors in the sinonasal area,which may be potentially useful for prediction and monitoring of treatment response to chemoradiotherapy of sinonasal tumors.Methods One hundred and forty-three patients with sinonasal tumors,including 78 malignant tumors and 65 benign tumors and tumor-like lesions,underwent clinically used DCE-MRI.Parametric maps were obtained for quantitative parameters including Ktrans,kep and ve.Two radiologists reviewed these maps and measured Ktrans,kep and ve in the tumor tissue.Data were analyzed using independent T-test or Mann-Whitney U test analysis and receiver operating characteristic curves.Results Ktrans,kep and ve showed significant differences between benign and malignant tumors in the sinonasal area （P=-0.000 1）.The accuracy of Ktrans,kep and ve in differentiation between benign and malignant sinonasal tumors were 72.0％,76.2％ and 67.1％,respectively.There were significant differences in kep and ve between malignant epithelial sinonasal tumors and lymphomas （P ＜0.05）.Using a ve value of 0.213 as the threshold value differentiated malignant epithelial tumors from lymphomas with an accuracy of 78.3％,sensitivity of 88.2％,specificity of 68.0％,positive predictive value of 66.7％,and negative predictive value of 90.9％.However,no significant difference in Ktrans and kep was found between malignant epithelial and non-epithelial tumors in the sinonasal area （P ＞0.05）.Conclusions It is feasible that quantitative parameters of tumors can be derived from clinically used DCE-MRI in the sinonasal region.Preliminary findings suggest an increased value for quantitative DCE-MRI in the evaluation of sinonasal tumors in clinical practice.

鼻窦冠状位与轴位CT平扫对鼻腔鼻窦恶性肿瘤诊断价值分析

目的:分析和对比鼻窦冠状位与轴位CT平扫对鼻腔鼻窦恶性肿瘤诊断价值。方法:选取2023年1—12月贵州省人民医院收治的50例鼻腔鼻窦恶性肿瘤患者作为研究对象,患者分别行鼻窦冠状位与轴位CT平扫检查诊断。以病理检查结果作为金标准,比较鼻窦冠状位与轴位CT平扫对鼻腔鼻窦恶性肿瘤类型、肿瘤分期的诊断准确率。结果:病理检查出上皮性肿瘤32例、间叶性肿瘤11例、神经内分泌肿瘤7例,鼻窦冠状位平扫检查出上皮性肿瘤32例、间叶性肿瘤10例、神经内分泌肿瘤6例,轴位CT平扫检查出上皮性肿瘤26例、间叶性肿瘤11例、神经内分泌肿瘤7例。鼻窦冠状位CT平扫对鼻腔鼻窦恶性肿瘤类型的诊断准确率高于轴位CT平扫,差异有统计学意义(P<0.05)。鼻窦冠状位CT平扫对鼻腔鼻窦恶性肿瘤T1期、T2期、T3期、T4a期、T4b期等分期的诊断准确率高于轴位CT平扫,差异有统计学意义(P<0.05)。结论:与鼻窦轴位CT平扫比较,鼻窦冠状位CT平扫在鼻腔鼻窦恶性肿瘤诊断中具有较高的价值,能更好地显示肿瘤的位置、大小、侵犯范围及骨质破坏情况。

CT、MRI在鼻腔鼻窦恶性肿瘤鉴别诊断中的准确性及影像学分析

目的分析CT和磁共振(MRI)在鼻腔鼻窦恶性肿瘤鉴别诊断中的准确性表现以及影像学特征。方法从本院选取90例鼻腔鼻窦恶性肿瘤患者作为研究对象,所选患者均接受CT检查和MRI检查。对患者CT检查以及MRI检查在鉴别诊断中的准确性表现展开对比,并分析患者的影像学特征。结果CT与MRI在鼻腔鼻窦恶性肿瘤鉴别诊断准确性上的差异无统计学意义(P>0.05);CT联合MRI对于鼻腔鼻窦恶性肿瘤鉴别诊断的准确性明显高于CT或MRI单独应用,差异有统计学意义(P<0.05);鼻腔鼻窦恶性肿瘤患者在CT影像中多表现为密度不均匀的软组织肿块影,且肿瘤边界不清,多呈不规则形态,部分患者病灶周边存在骨质破坏情况;鼻腔鼻窦恶性肿瘤患者在MRI影像中的T1加权像表现为低或稍低信号,T2加权像表现为稍高信号,且信号表现不均。结论CT、MRI在鼻腔鼻窦恶性肿瘤鉴别诊断中单独应用的准确性表现,联合运用可有效提高鉴别诊断的准确性,对于明确患者鼻腔鼻窦恶性肿瘤病情发展情况具有积极影响。

副鼻窦肉瘤样癌影像学表现一例

本研究为回顾性研究,遵守《赫尔辛基宣言》,并经兰州大学第二医院伦理委员会审核批准,免除受试者知情同意,批准文号:2023A-362。患者女,73岁,“鼻塞、流涕伴头痛2年”就诊。患者于入院前2年无明显诱因出现双侧鼻腔间断性鼻塞、流涕,右侧为著,伴间断性头痛,于外院给予对症治疗后症状无缓解,遂于2023年2月来我院就诊。此次我院专科查体:鼻黏膜充血,右侧中鼻道及下鼻道可见淡粉色肿物,表面光滑,无渗血。

中西医结合治疗鼻腔鼻窦非角化型未分化癌1例

鼻腔鼻窦未分化癌临床罕见,本文介绍1例中西医结合治疗鼻腔鼻窦非角化型未分化癌。此病例采取中西医治疗手段,早期以六君子汤为主方调理脏腑功能、顾护正气,中期酌情使用攻伐之药以祛邪扶正,后期使用健脾生髓方以助气血之生化,填补西医治疗空窗期,巩固手术治疗效果,缓解放化疗所带来的副作用,有效地改善了肿瘤的预后及促进了机体的康复。

Improved Performance in Differentiating Benign from Malignant Sinonasal Tumors Using Diffusion-weighted Combined with Dynamic Contrast-enhanced Magnetic Resonance Imaging

Background：Differentiating benign from malignant sinonsal lesions is essential for treatment planning as well as determining the patient＇s prognosis,but the differentiation is often difficult in clinical practice.The study aimed to determine whether the combination of diffusion-weighted （DW） and dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI） can improve the performance in differentiating benign from malignant sinonasal tumors.Methods：This retrospective study included 197 consecutive patients with sinonasal tumors （116 malignant tumors and 81 benign tumors）.All patients underwent both DW and DCE-MRI in a 3-T magnetic resonance scanner.Two different settings ofb values （0,700 and 0,1000 s/mm^2） and two different strategies of region of interest （ROI） including whole slice （WS） and partial slice （PS） were used to calculate apparent diffusion coefficients （ADCs）.A DW parameter with WS ADCsb0.1000 and two DCE-MRI parameters （time intensity curve [TIC] and time to peak enhancement [Tpeak]） were finally combined to use in differentiating the benign from the malignant tumors in this study.Results：The mean ADCs of malignant sinonasal tumors （WS ADCsb0,1000=1.084 × 10^-3 mm^2/s） were significantly lower than those of benign tumors （WS ADCsb0,1000=1.617 × 10^-3 mm^2/s,P 〈 0.001）.The accuracy using WS ADCsb0,1000 alone was 83.7% in differentiating the benign from the malignant tumors （85.3% sensitivity,81.2% specificity,86.4% positive predictive value [PPV],and 79.5% negative predictive value [NPV]）.The accuracy using DCE with Tpeak and TIC alone was 72.1% （69.1% sensitivity,74.1% specificity,77.5% PPV,and 65.1% NPV）.Using DW-MRI parameter was superior than using DCE parameters in differentiation between benign and malignant sinonasal tumors （P 〈 0.001）.The accuracy was 87.3% （90.5% sensitivity,82.7% specificity,88.2% PPV,and 85.9% NPV） using DW-MRI combined with DCE-MRI,which was superior than that using DCE-MRI alone or using DW-MRI alone （both P 〈 0.001） in differentiating the benign from the malignant tumors.Conclusions：Diffusion-weighted combined with DCE-MRI can improve imaging performance in differentiating benign from malignant sinonasal tumors,which has the potential to improve diagnostic accuracy and to provide added value in the management for these tumors.

经鼻内镜下手术治疗侵及眼眶的鼻腔鼻窦恶性肿瘤的临床分析

目的探讨经鼻内镜下手术对侵及眼眶的鼻腔鼻窦恶性肿瘤的临床疗效及其预后效果。方法选取2013年5月至2015年5月本院收治的64例侵及眼眶的鼻腔鼻窦恶性肿瘤患者作为研究对象,追踪随访5年,统计患者的预后生存率和复发率,分析影响患者预后效果的因素。结果64例患者中,59例临床症状明显改善,总缓解率为92.19%;3例失访,随访完成率为95.31%(61/64)。随访5年,复发率为22.95%(14/61),6例转移,2例颅内转移,2例淋巴结转移,2例骨转移。5年总生存率为59.02%(36/61);Ⅰ、Ⅱ、Ⅲ期患者的中位生存期分别为61、22、15个月。不同临床分期的生存曲线比较差异有统计学意义(P<0.05);鳞状细胞癌、腺样囊性癌、肉瘤及其他恶性肿瘤整体中位生存期分别为20、35、10和50个月,各生存曲线比较差异无统计学意义;将临床分期纳入多因素进行回归方程分析,结果显示,临床分期Ⅲ期是影响患者预后的独立危险因素(P<0.05)。结论经鼻内镜下手术治疗侵及眼眶的鼻腔鼻窦恶性肿瘤疗效显著,对患者创伤小,有利于预后恢复,患者的预后效果与肿瘤的临床分期密切相关。

兔适合构建鼻窦炎动物模型(英文)

背景:以实验动物模拟人类相关疾病是研究疾病发生发生及治疗的基础,鼻腔、鼻窦疾病也需要恰当实验动物作为其模型。目的:观察兔鼻腔、鼻窦的CT和局部解剖表现,探讨兔应用于鼻窦炎动物模型的可行性。方法:利用CT使用常规鼻窦冠状位与水平位扫描新西兰兔,随后进行常规鼻腔、鼻窦解剖学观察。结果与结论:兔鼻中隔将鼻腔分为左右两个腔,鼻腔外侧壁由上颌鼻甲、中间鼻甲、内侧鼻甲、下鼻甲组成,上颌窦窦腔最大,筛窦、蝶窦、额窦相对较小,以上结构均对称分布。兔鼻腔、鼻窦在CT扫描下显示清晰。兔鼻腔、鼻窦的解剖与人类鼻腔、鼻窦解剖结构既有相似也有不同,其上颌窦解剖部位与人相似且窦腔较大便于操作,具有动物实验模型建立的可行性,适用于鼻窦炎动物模型建立,可应用于模拟人类鼻窦炎的研究。

鼻腔及鼻窦内翻性乳头状瘤临床分期中CT的作用

目的探讨鼻腔及鼻窦内翻性乳头状瘤临床分期中CT的应用价值。方法回顾性分析33例鼻腔及鼻窦内翻性乳头状瘤的CT影像资料及手术资料。结果按照Krouse分期标准,将本组病例分为四期(四组)。在每组中将CT分期与手术所见分期比较,结果如下(相符/不相符):T1期1/0,T2期22/2,T3期3/3,T4期2/0,总共28/5。结论鼻腔及鼻窦内翻性乳头状瘤虽无特异CT表现,但CT影像与手术所见对比显示,它能较准确判断肿瘤的侵及范围,是鼻腔及鼻窦内翻性乳头状瘤分期中不可缺少的资料之一。

104例鼻腔鼻窦腺样囊性癌临床分析

背景与目的：腺样囊性癌是一种来自于涎腺组织的少见肿瘤,占所有头颈部恶性肿瘤的1%~2%。鼻腔鼻窦腺样囊性癌的发病率较低,且生长缓慢,较少淋巴转移,但是容易侵犯临近组织和沿着神经浸润生长,后期有较高的复发率和远处转移率,往往预后不佳。该研究总结鼻腔鼻窦腺样囊性癌的临床及病理特点,并对其预后和影响因素进行分析。方法：该研究为一项单中心、回顾性的研究,分析了104例2000年9月—2012年11月间在复旦大学附属眼耳鼻喉科医院接受过放疗的鼻腔鼻窦腺样囊性癌患者,中位随访时间5.1年。使用Kaplan-Meier、log-rank检验和COX比例风险模型进行生存相关的数据分析。结果：患者平均年龄（54.5±11.5）岁,男女各占50%。鼻腔为最常见的原发部位（63.5%）,其次为上颌窦（29.8%）,临床分期以Ⅲ~Ⅳ期为主（76.0%）,手术切缘阳性者为56.7%,出现神经浸润者为34.6%。术后放疗的患者占67.3%,术前放疗占27.9%,仅4.8%的患者采用了单纯放疗,其中29.8%的患者在手术和放疗基础上联合了化疗。采用CRT放疗者为81.7%,采用IMRT放疗者为18.3%。最终18例出现复发,28例出现远处转移,肺部为最常见的转移部位,神经浸润是影响复发或转移的独立危险因素（P=0.0002）。患者的5年和10年总生存率（overall survival,OS）分别为77.0%（95%CI：68.7%~85.3%）和67.8%（95%CI：57.8%~77.9%）;5年和10年的无瘤生存率（disease-free survival,DFS）分别为57.8%（95%CI：48.0%~67.7%）和56.4%（95%CI：46.3%~66.4%）。复发或远处转移是显著影响OS的危险因素（未校正HR=60.1,95%CI：8.15~443.1,P〈0.0001）,神经浸润阳性是显著影响DFS的危险因素（未校正HR=2.99,95%CI：1.642~5.445,P=0.0002）。原发部位、临床分期、手术切缘是否阳性及放疗方式对预后无明显影响。结论：神经浸润、复发或远处转移可能是影响鼻腔鼻窦腺样囊性癌预后的重要因素。

鼻腔鼻窦恶性肿瘤的CT表现

目的探讨鼻腔鼻窦恶性肿瘤的CT特点。方法回顾分析45例经病理证实鼻腔鼻窦恶性肿瘤的CT表现。结果鼻腔鼻窦癌20例,多为密度不均匀肿块(14/20),直接侵犯腔内(34/20)及腔外结构(20/20)并形成软组织肿块;18例骨质破坏明显,可见骨壁碎裂、缺失,鼻面部软组织肿胀不常见(2/20)。T细胞性淋巴瘤16例,多起源于鼻前庭(11/16),以混合表现为主(11/16),多数密度均匀(12/16),主要累及腔内结构(36/18),但鼻面部肿胀常见(8/16);骨质破坏不明显或轻微,5例可见骨质吸收。1例恶性神经鞘瘤和2例B细胞性淋巴瘤表现与癌肿相似。1例骨肉瘤病灶内可见骨样组织影。4例恶性黑色素瘤表现无特异性。结论CT能有效观察鼻腔鼻窦肿瘤的病变范围并对良、恶性进行鉴别,对NHL等具有一定特征性的肿瘤能进行提示性诊断。

鼻腔鼻窦鳞癌、癌前期病变与癌基因c-myc扩增的相关性研究

目的：为明确鼻腔鼻窦鳞癌、癌前期病变与癌基因ｃ－ｍｙｃ的关系，为鼻腔鼻窦鳞癌和癌前期病变的早期诊断和诊疗提供依据和方法。方法：利用分子生物学技术对４４例标本进行分子病因学研究，包括２４例鼻腔鼻窦鳞癌，１５例良性肿瘤和５例鼻腔正常组织。结果：２４例鼻腔鼻窦鳞癌ｃ－ｍｙｃ的扩增倍数为１０～４０倍，癌前期病变组ｃ－ｍｙｃ的扩增倍数为５～１０倍，良性肿瘤及鼻腔正常组织中ｃ－ｍｙｃ的扩增倍数为５倍以下。结论：ｃ－ｍｙｃ的扩增水平与鼻腔鼻窦鳞癌的发生有关，与癌前期病变转化为恶性肿瘤有关。因而，ｃ－ｍｙｃ的水平可能作为临床鼻腔鼻窦鳞癌的分子水平诊断和检测鼻腔内翻性乳头状瘤是否有恶变倾向的一种参考指标。

晚期鼻腔鼻窦腺样囊性癌21例临床特征分析

目的探讨发生于鼻腔鼻窦晚期腺样囊性癌的临床特征、治疗方法、预后及影响因素。方法分析2007年2月~2016年5月入住我院的21例晚期鼻腔鼻窦腺样囊性癌患者的临床资料,包括临床表现、临床分期、病理、治疗方法、局部复发、远处转移及预后等,并结合文献进行诊疗特征分析。采用Kaplan-Meier法和Log-rank检验进行单因素生存分析,COX模型对影响预后的临床因素进行多因素分析。结果 21例患者中,实体型占比小于30%的有10例(47.6%),1、3、5年总生存率分别为100%、100%、71%,实体型占比大于等于30%的有11例(52.4%),1、3、5年总生存率分别为70%、40%、10%,两者差异有统计学意义(P=0.02),且实体型占比大于等于30%的患者预后较差。Log-rank检验及全变量模型下协变量的生存曲线表明病理分型对预后具有显著影响,T3期预后略优于T4期,源发于上颌窦略优于蝶窦,手术及放化疗综合治疗优于单纯手术及单纯放化疗。多因素Cox回归模型分析结果显示,病理分型、病程与预后关系密切(P=0.045、0.028)。结论鼻腔鼻窦腺样囊性癌发病率较低,症状表现无特异性,部分患者病程较长,多发鼻窦内,尤其是上颌窦,早期诊断较困难,等到就诊时多为晚期。晚期患者以手术结合术后放化疗的综合治疗方式为主。病理分型、病程、发病部位、分期、治疗方式、周围神经侵袭,手术切缘阳性,术后放疗剂量不足60 Gy可能是影响晚期腺样囊性癌患者预后的因素。

原发性鼻腔鼻窦恶性淋巴瘤临床特点分析

原发性鼻腔鼻窦恶性淋巴瘤是结外淋巴瘤的一种,病理类型以NK/T细胞淋巴瘤常见,恶性度较高,并且近些年来有发病率逐渐上升的趋势,但因其临床表现的特异性不高,早期症状不典型,临床上出现延误诊治的现象较多。为提高对该病的诊疗水平,现对28例原发性鼻腔鼻窦恶性淋巴瘤患者的临床资料进行回顾性分析,总结其临床特点,以不断提高对该病的诊疗水平,减少误诊误治。

鼻腔及鼻窦骨化性纤维瘤的MRI诊断

目的探讨鼻腔、鼻窦骨化性纤维瘤的MRI表现及其诊断价值。资料与方法回顾性分析经手术病理证实的8例鼻腔及鼻窦骨化性纤维瘤患者的MRI资料。结果8例中病变中心位于筛窦3例,蝶窦3例,额窦2例;5例原发病例中4例病变呈膨胀性生长,1例形态不规则呈分叶状;3例术后复发病变的形态均不规则并呈分叶状;所有病变边界均清晰,伴周围结构不同程度受压。骨化性纤维瘤T1WI呈等信号7例(与脑灰质相比),呈低信号1例;T2WI呈低信号7例,其中4例夹杂片状高信号,呈高信号1例;继发囊变者4例,T2WI均呈高信号,T1WI呈等、低信号各2例;增强后病变呈中度强化,囊变部分不强化,而囊壁及间隔明显强化。结论鼻腔及鼻窦骨化性纤维瘤的MRI表现有一定特征性,MRI对观察病变与周围组织结构的关系及手术方案制定有重要临床意义。

鼻腔-鼻窦内翻性乳头状瘤复发与恶变的治疗

目的 探讨鼻腔 鼻窦内翻性乳头状瘤复发与恶变的临床特点与治疗方法。方法 回顾性分析 1990～ 2 0 0 0年我院收治的鼻腔 鼻窦内翻性乳头状瘤复发和恶变患者的临床资料。结果2 2例肿瘤复发患者既往均有鼻腔 鼻窦手术史 ,其中复发 1次者 13例 ,复发 2次者 7例 ,复发 3次者 1例 ,复发 4次者 1例 ,复发时间从 3个月～ 11年。 2 2例中 ,经鼻腔入路 ,经上颌窦根治径路 ,经鼻侧切开径路的复发率分别为 73 3% ,4 2 9%和 33 3% ,10例采用了内镜或内镜辅助手术 ,经随访 1～ 5年 ,未见肿瘤再次复发。 8例肿瘤恶变患者 ,4例接受了鼻侧切开肿瘤切除术 ,1例柯 陆手术 ,手术后均给予放射治疗 (40～ 70Gy) ,这 5例经随访 2～ 6年未见肿瘤复发 ,另外 3例 ,1例失随访 ,2例死亡。结论 积极、彻底的内镜下手术 (包括内镜 +外部切口的联合入路 )是治疗内翻性乳头状瘤 (包括复发肿瘤 )的首选方法 ,对于肿瘤恶变患者应采取广泛手术切除加手术后放射治疗 。

鼻腔副鼻窦恶性肿瘤的CT诊断

目的 :探讨鼻腔副鼻窦CT检查方法和肿瘤的形态、密度、窦壁骨质破坏、周围脂肪层侵犯、窦腔外软组织肿块等征象在鼻腔副鼻窦恶性肿瘤中的诊断作用。材料与方法 :逐项对比观察分析经病理证实的鼻腔副鼻窦恶性肿瘤 3 2例和良性肿物 13 9例的CT表现。结果 :CT冠状位扫描显示 15例恶性肿瘤破坏 2 5个窦腔骨壁 ,2 0例腔外软组织肿块累及 2 3个相邻部位。轴位扫描发现骨壁受累 12例 ,有 2 0个侧壁骨质显示破坏 ,15个腔外肿块累及 18个相邻结构。恶性组和良性组突出于窦腔外的软组织肿块分别为 71 9%和 5 0 %、窦壁骨质侵蚀性破坏 5 9 4%和 14 4%、窦腔周围脂肪层的侵犯消失 5 6 3 %和 13 7% ,而软组织肿块形态不规则和密度不均匀 ,两组间无显著差异。结论 :鼻腔副鼻窦腔外软组织肿块、侵蚀性骨质破坏和窦壁周围脂肪层的侵犯消失 ,是诊断鼻腔副鼻窦恶性肿瘤的可靠征象。冠状扫描观察解剖内容和病变侵犯范围优于轴位扫描。