鼻窦癌和鼻窦淋巴瘤

CT diagnosis of the benign and malignant tumors of nasal cavityLIU Y uan ,LUO De -hong ,LI L in ,Y AO Xue -song ,SUN Wei ,WU Ning ,ZHOU Chun -w u(Department of Diagno stic Radiology ,Cancer hospital ,Chinese Academy of Medical Sciences ,Peking Union Medical College ,Beijing 100021,China )[Abstract ]　Objective To assess the CT manifestations of the tumors in nasal cavity and understand the key point of the diag no -sis and differential diagnosis between benig n and malignant tumo r o f nasal cavity .Metho ds CT finding s of the nasal cavity tumo r confirmed by patholog y in 43cases were review ed retrospectively ,including inv erted papilloma (12cases ,2cases had malignant transformation ),non -Hodgkin ly mphoma (12cases )and cancer (19cases ).Results T welve cases of the inver ted papilloma wereunilateral lesions ,all lo cated in the lateral nasal w all .O f the 10benig n inverted papillomas ,the tumors of 9cases (90%)located in middle -posterior po rtion of the nasal cavity ,10cases (100%)had clear rim ,8masses (80%)w ere homogeneous .Of 12cases of NHL ,10(83.3%)w ere unilateral lesions ,9(75%)located in the anterior por tion of the nasal cavity ,9(75%)involved the skin o f the ex ternal noses with disappearance of the subcutaneous fat in 6cases (50%),the adjacent bone was abso rbed in 3.O f the 19cancers of nasal cavity ,13cases (68.4%)were unilateral lesions ,the tumors were irregular in shape with adjacent structures inva -sion in 18(94.7%),the adjacent bone destruction in 18(94.7%).C onclusio n T here are different CT characteristics among the inver ted papilloma ,lymphoma and cancer in the nasal cavity ,CT scan is helpful to diagnose and differential diagnose in the tumo rs o f nasal cavity .[Key words ]　N asal cavity ;I nverted papilloma ;Cancer ;Lymphoma ;Tomog raphy ,X -ray computed鼻腔常见肿瘤的CT 诊断及鉴别诊断刘　媛,罗德红,李　琳,姚雪松,孙　伟,吴　宁,周纯武(中国医学科学院中国协和医科大学肿瘤医院放射诊断科,北京　100021)[摘　要]　目的　分析鼻腔常见肿瘤的CT 表现,了解其诊断及鉴别诊断要点。

鼻窦恶性肿瘤影像诊断1.概述：鼻窦恶性肿瘤较少见，约占头颈部肿瘤3％；好发部位：上颌窦>筛窦>额窦；老年人多见，男性>女性；鳞状细胞癌>腺样囊腺癌>未分化癌；早期症状与慢性鼻窦炎相似，发现一般较晚；治疗：手术+放疗。

2.鼻窦恶性肿瘤影像学特征：不规则软组织肿块；密度均匀或不均匀；伴邻近骨质破坏；增强强化均匀/不均匀；伴邻近结构及颅内侵犯；伴颈部淋巴结转移；神经周转移。

3.鳞状细胞癌（SCC）：最常见的上皮性恶性肿瘤，占鼻窦肿瘤50％-80％；好发于50-60岁男性；长期接触镍、木尘、煤烟和铬的人群发病危险性增加；上颌窦多见（60％-70％），其次鼻腔（12％-25％）；早期发现可提高生存率。

4.鳞状细胞癌临床表现：早期:临床症状隐匿，类似鼻窦炎（故预后差）晚期：侵犯牙槽骨和牙龈，产生牙痛及牙齿脱落、松动；侵犯眶下神经，产生顽固性面部疼痛；侵犯鼻腔，产生鼻塞、血涕及嗅觉减退；侵犯眼眶，造成眼球突出、复视等；侵犯翼腭窝，造成张口困难、麻木、疼痛。

5.鳞状细胞癌CT表现：鼻窦和（或）鼻腔不规则软组织肿块，边界不清；密度不均，内可见出血、坏死、囊变，钙化少见；增强扫描呈不均匀强化；窦壁骨质呈弥漫性、虫蚀样破坏；最常发生颈部II区淋巴结转移。

6.鳞状细胞癌MRI表现：T1WI等-低信号，T2WI不均匀中等稍高信号，坏死区呈长T1长T2信号；增强扫描中-明显不均匀强化，坏死区域不强化；周围侵犯时窦周脂肪间隙消失、模糊。

7.腺癌：好发于55-60岁老年男性；好发于筛窦；形态不规则，边界尚清晰，CT呈等、低密度；T1WI呈等信号，T2WI呈较高信号；增强扫描中-明显强化，程度高于鳞癌。

8.鼻窦未分化癌（SNUC）：发病年龄广泛，更具有侵袭性，淋巴结及远处转移较其它恶性肿瘤更常见；5年生存率低于20％；起源于鼻腔顶部和筛窦多见；不规则软组织肿块，边界不清，平扫密度尚均匀，增强后强化欠均匀；T1WI呈中等信号，T2WI为中等到高信号，增强后不均匀强化；常侵犯前颅窝、眼眶、翼腭窝、咽旁间隙、海绵窦等邻近结构。