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摘要: 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。
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关键词:
- 乳头状瘤 /
- 疾病特征 /
- 体层摄影术，X线计算机 /
- 磁共振成像
Abstract: 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 T2WI or enhanced T1WI; 19 patients(70.4%) showed high or isointense signal on T1WI; 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.-
Key words:
- papilloma /
- disease attributes /
- tomography, X-ray computed /
- magnetic resonance imaging
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图 1 图1 鼻内镜下表现 1a:59 岁男性SNOP 患者,0°内镜下见左侧鼻腔总鼻道新生物, 呈细小的乳头状改变, 表面可见脓 性分泌物;1b:61岁女性SNOP患者,70°内镜自口腔向后鼻孔方向观察可见肿瘤表面呈粟粒样改变(*所示) MT: 中 鼻甲;IT: 下鼻甲;NS: 鼻中隔;ET: 咽鼓管圆枕; 图2 68岁女性SNOP患者的鼻窦 CT矢状位和水平位图像 2a、2b: 骨窗, 窗宽2000, 窗位200, 示左侧上颌窦病变呈膨胀性生长, 边缘清晰, 上颌窦口受压扩大;2c、2d: 软窗, 窗宽350, 窗位50, 示左上颌窦软组织影, 病变密度不均匀; 图3 68岁女性SNOP患者的鼻窦MRI的T1WI增强相 可见瘤体部分 表现出“脑回征” 3a: 冠状位;3b: 水平位;3c: 矢状位; 图4 68岁女性SNOP患者的鼻窦MRI的T1WI 和T2WI相 4a: 瘤体在T1WI相上表现为稍高信号, 呈斑块状;4b: 在 T2WI 上表现为高、 等信号相间的“脑回征”, 较细小; 图5 组织病理学检查 5a: 低倍镜下见SNOP 瘤体组织为乳头状, 瘤体细胞可向黏膜下方深部间质内呈内翻性生长(苏木精-伊红染色×40) ;5b: 瘤体上皮细胞常呈高柱状, 卵圆形或多边形, 胞质内含多量嗜酸颗粒, 可形成黏液腔(苏木精-伊红染色×100) ;5c: 瘤上皮细胞内可见较多充满黏液的细胞, 形成特征性的微囊(苏木精-伊红染色×100) ;5d: 微囊内可 见红染的嗜酸性物质, 如箭头所示(苏木精-伊红染色×200) 。
表 1 SNOP的内镜及影像特点
SNOP SNIP 内镜特点 红色或淡黄色新生物，呈粟粒样或者细乳头状改变 粉红色新生物，呈乳头状改变 多与息肉伴发，对侧可合并息肉 常与息肉伴发 常有囊肿样改变 鼻窦CT 瘤体为软组织密度影，密度均匀或不均匀，病变呈膨胀性生长，边缘清晰CT值50~80 HU 多为单侧鼻腔、鼻窦形态多不规则的软组织影，密度均匀或不均，呈膨胀性生长 最常累及上颌窦、鼻腔外侧壁及筛窦 最常累及上颌窦、鼻腔外侧壁及筛窦 弥漫性骨质硬化多见，锥状骨质增生较少 锥状骨质增生、弥漫性骨质硬化及骨质破坏 鼻窦MRI T1加权像 等或者高信号，呈葡萄状或斑块状 等或低信号 T2加权像 伴有多发性囊肿样改变 信号不均匀，高信号为主 T1增强像 中度不均匀强化，“脑回征”常见，但较细小 中度不均匀强化，“脑回征”常见 
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