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摘要: 目的 探讨鼻腔鼻窦少见肿瘤的影像学特点，提高对该类疾病的认识，为临床诊断和治疗提供帮助。方法 回顾性分析经病理证实的79例鼻腔鼻窦少见肿瘤的CT和MRI表现，总结其影像学特征。结果 79例中，神经内分泌癌16例，骨质破坏多表现为膨胀性骨质破坏与浸润性骨质破坏并存，而不伴骨质增生硬化，位于蝶窦者双侧对称呈“鸽”形；恶性黑色素瘤28例，MRI信号表现多样，典型者少见，而以混杂信号多见；横纹肌肉瘤12例，MRI增强多呈“葡萄状”强化、部分环状强化；嗅神经母细胞瘤10例，病灶与嗅黏膜分布区一致，多呈分叶状，边缘结节状，“花环状”强化，2例跨颅内外生长，颅内病灶见多发囊变及周围片状水肿带；孤立性纤维性肿瘤5例，良性者形态规则，密度均匀，恶性者形态不规则，密度不均，增强明显不均匀强化，呈“地图样”改变；肉瘤样癌2例，形态似分叶，密度不均，内见片状低密度影，均有溶骨性骨质破坏；神经鞘瘤4例，增强呈明显欠均匀强化，1例见囊变坏死，1例见钙化，周围结构受压而无破坏；神经纤维瘤1例，囊变成分多，内见低信号分隔，增强呈分隔样强化；副神经节瘤1例，增强动脉期中度强化，静脉期进行性明显强化，伴有明显膨胀性骨质破坏。结论 鼻腔鼻窦少见肿瘤具有一定的影像学特征，CT和MRI能更好地显示病灶范围及对邻近组织器官的浸润程度，有助于临床早期诊断和分期，确诊仍需依靠病理和免疫组织化学。Abstract: Objective To explore the imaging features of rare tumors of nasal cavity and sinuses, and to improve the understanding of these diseases, thereby aiding clinical diagnosis and treatment.Methods The CT and MRI findings of 79 cases of rare neoplasm of nasal cavity and sinuses confirmed by pathology were retrospectively analyzed, and the imaging features were summarized.Results Among the 79 cases, there were 16 cases of neuroendocrine carcinoma, most showing expansive and infiltrative bone destruction without hyperosteogeny and sclerosis. The sphenoid sinus exhibited a "pigeon" shape. In 28 cases of malignant melanoma, MRI signals were diverse, typical signals were rare, but mixed signals were more common. In 12 cases of rhabdomyosarcoma, MRI enhancement mostly showed "grape-like" enhancement and partial ring enhancement; There were 10 cases of olfactory neuroblastoma, the lesions were consistent with the distribution area of olfactory mucosa, most of them were lobulated, marginal nodules, and "flower ring" enhancement, and 2 cases grew across intracranial and external, with multiple cystic lesions and surrounding flaky edema bands. In 5 cases of solitary fibrous tumor, Benign tumors had regular shape and uniform density, while malignant tumors had irregular shape and uneven density, The enhancement was obviously uneven and showed a "pattern" change. There were 2 cases of sarcomatoid carcinoma, both with lobed appearance, uneven density, lamellar low-density shadow, and osteolytic bone destruction. In 4 cases of schwannoma, the enhancement showed obvious inhomogeneous enhancement. One case showed cystic necrosis, one case showed calcification, and the surrounding structure was compressed without damage. There was 1 case of neurofibroma, with many cystic components, low signal separation and compartmentalized enhancement. One case of paraganglioma showed moderate enhancement in the arterial phase and progressive enhancement in the venous phase, accompanied by significant swelling bone destruction.Conclusion Rare tumors of nasal cavity and paranasal sinuses have distinctive imaging features. CT and MRI can effectively show the extent of the lesions and the degree of infiltration into adjacent tissues and organs, which is helpful for early clinical diagnosis and staging. However, definitive diagnosis still depends on pathology and immunohistochemistry.
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表 1 79例鼻腔鼻窦少见肿瘤基本影像表现
肿瘤类型 例数 中心部位 大小/mm 囊变坏死 骨质破坏 密度/信号 形态 边界 生长方式 鼻窦 鼻腔 鼻腔-鼻窦 侵蚀性 压迫吸收性 NEC 16 8 6 2 17×20×12~
63×20×6015 12 2 不均14
欠均2不规则10
铸形5
“鸽”形1边界不清13
边界尚清3侵袭性6
蔓延7
局限3MM 28 4 16 8 30×10×24~
65×22×414 20 4 不均22
欠均6不规则15
铸形13边界不清22
边界欠清5
边界清楚1侵袭性16
蔓延7
局限5RMS 12 8 1 3 26×12×31~
46×49×525 10 1 不均8
欠均1
均匀3不规则12 边界不清6
边界欠清2
边界清楚4侵袭性9
蔓延3ONB 10 3 2 5 36×27×31~
65×59×619 3 2 不均7
欠均3分叶状6
蘑菇状1
不规则2
铸形1边界不清6
边界尚清4侵袭性3
蔓延7SFT 5 3 2 19×25×19~
49×23×341 1 0 均匀4
不均1椭圆形2
铸形2
不规则1边界清3
边界欠清2蔓延2
局限3SC 2 2 37×25×40~
44×43×402 2 0 不均2 分叶状2 边界不清2 蔓延2 神经鞘瘤 4 1 2 1 35×25×26~
52×60×561 0 1 均匀3
不均1不规则2
椭圆形2边界清楚4 局限3
蔓延1NF 1 1 43×39×35 1 0 0 均匀1 不规则1 边界清1 局限1 PGL 1 1 35×25×29 0 1 0 欠均1 不规则1 边界欠清1 蔓延1 
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[1] Lin NE, Qi M, Wang ZY, et al. Small cell neuroendocrine carcinoma of paranasal sinuses: radiologic features in 14 cases[J]. J Comput Assist Tomogr, 2021, 45(1): 135-141. doi: 10.1097/RCT.0000000000001065
[2] 彭金林, 李笑秋, 刘柱, 等. 31例鼻腔鼻窦神经内分泌癌临床分析[J]. 临床耳鼻咽喉头颈外科杂志, 2022, 36(1): 32-35. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.2096-7993.2022.01.007
[3] 瞿姣, 袁欣, 赵卫, 等. 少见部位神经内分泌癌的CT及MRI表现[J]. 放射学实践, 2019, 34(10): 1137-1141. https://www.cnki.com.cn/Article/CJFDTOTAL-FSXS201910023.htm
[4] Zhu QQ, Zhu WR, Wu JT, et al. The CT and MRI observations of small cell neuroendocrine carcinoma in paranasal sinuses[J]. World J Surg Oncol, 2015, 13: 54. doi: 10.1186/s12957-015-0475-z
[5] Jayme EM, Morimoto TP, Lozano TM, et al. Sphenoid sinus neuroendocrine carcinoma[J]. BJR Case Rep, 2017, 3(1): 20150334.
[6] 常雯, 吴莉, 韩丹. 鼻腔鼻窦恶性黑色素瘤的影像学研究进展[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(12): 960-962. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.1001-1781.2018.12.020
[7] 方三高. WHO(2017)头颈部肿瘤分类[J]. 诊断病理学杂志, 2017, 24(8): 638-641. doi: 10.3969/j.issn.1007-8096.2017.08.024
[8] Saboo SS, Krajewski KM, Zukotynski K, et al. Imaging features of primary and secondary adult rhabdomyosarcoma[J]. AJR Am J Roentgenol, 2012, 199(6): W694-W703. doi: 10.2214/AJR.11.8213
[9] Hagiwara A, Inoue Y, Nakayama T, et al. The"botryoid sign": a characteristic feature of rhabdomyosarcomas in the head and neck[J]. Neuroradiology, 2001, 43(4): 331-335. doi: 10.1007/s002340000464
[10] 张玉莲, 李辉, 程伟, 等. 胚胎性横纹肌肉瘤的CT和MRI特征[J]. 放射学实践, 2021, 36(10): 1283-1287. https://www.cnki.com.cn/Article/CJFDTOTAL-FSXS202110025.htm
[11] 李晶, 谢传淼, 李卉, 等. 儿童头颈部横纹肌肉瘤的影像表现[J]. 放射学实践, 2014, 29(3): 326-329. https://www.cnki.com.cn/Article/CJFDTOTAL-FSXS201403042.htm
[12] Zhang SG, Li QT, Zhang F, et al. Computed tomography image analysis and clinical diagnosis value of nasal olfactory neuroblastoma[J]. World Neurosurg, 2021, 149: 333-340. doi: 10.1016/j.wneu.2020.09.124
[13] 蒋黎, 周永, 刘焱, 等. 嗅神经母细胞瘤CT和MRI特征及病理表现[J]. 中国医学影像学杂志, 2016, 24(6): 433-436. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYZ201606011.htm
[14] Dublin AB, Bobinski M. Imaging characteristics of olfactory neuroblastoma(esthesioneuroblastoma)[J]. J Neurol Surg B Skull Base, 2016, 77(1): 1-5.
[15] 曲方园, 刘颖, 黄金超, 等. 胸膜外孤立性纤维性肿瘤的影像学表现及病理对照分析[J]. 实用放射学杂志, 2020, 36(1): 38-41, 86. https://www.cnki.com.cn/Article/CJFDTOTAL-XYXZ202109012.htm
[16] 冯莉娟, 张涛, 杨菲菲, 等. 少见部位孤立性纤维性肿瘤的影像学表现[J]. 临床放射学杂志, 2021, 40(6): 1055-1059. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFS202106005.htm
[17] 刘柱, 李笑秋, 李克鹏, 等. 鼻部肉瘤样癌9例临床分析[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(18): 1429-1431. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.1001-1781.2018.18.016
[18] Liu TW, Hung SH, Chen PY. Sinonasal spindle cell carcinoma presenting with bilateral visual loss: a case report and review of the literature[J]. Oncol Lett, 2016, 12(1): 401-404.
[19] 朱庆强, 朱文荣, 吴晶涛, 等. 鼻窦肉瘤样癌的CT和MRI表现[J]. 中华放射学杂志, 2014, 48(2): 155-157.
[20] Sharma DK, Sohal BS, Parmar TL, et al. Schwannomas of head and neck and review of literature[J]. Indian J Otolaryngol Head Neck Surg, 2012, 64(2): 177-180.
[21] 朱丽, 刘川, 周雪梅, 等. 周围神经鞘瘤的影像学表现与病理对照分析[J]. 实用放射学杂志, 2019, 35(11): 1779-1782, 1812. https://www.cnki.com.cn/Article/CJFDTOTAL-XYXZ202209004.htm
[22] 刁向宇, 刘文胜, 张彬, 等. 46例头颈部神经纤维瘤的临床分析[J]. 中华肿瘤杂志, 2015, 37(7): 526-529. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA201622039.htm
[23] 张帆, 张隐笛, 杨亚英. 前颅凹底神经纤维瘤1例[J]. 实用放射学杂志, 2017, 33(10): 1643-1644.
[24] Parmar K, Chandna A, Kumar S. Retroperitoneal paraganglioma: a chameleon masquerading as an adrenal pheochromocytoma[J]. Annals, 2019, 101(2): e62-e65.
[25] Raja A, Leung K, Stamm M, et al. Multimodality imaging findings of pheochromocytoma with associated clinical and biochemical features in 53 patients with histologically confirmed tumors[J]. Am J Roentgenol, 2013, 201(4): 825-833.
[26] van Leeuwen J, van der Putten HW, Demeyere TB, et al. Paraganglioma of the uterus. A case report and review of literature[J]. Gynecol Oncol, 2011, 121(2): 418-419.
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