鼻腔鼻窦软骨肉瘤4例并文献复习

发布时间：2018-03-04 11:21

本文选题：软骨肉瘤　切入点：影像学　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的分析鼻腔鼻窦软骨肉瘤(Chondrosarcoma,CS)的临床特征、影像学及病理学特点、治疗及预后情况,以提高对该病的认识和治疗效果。材料与方法回顾性分析2014年5月至2016年12月吉林大学第二医院收治的经病理确诊的4例鼻腔鼻窦软骨肉瘤患者的临床资料,总结该病的临床特征、影像学检查及病理学检查的特点、治疗及预后情况。结果4例鼻腔鼻窦软骨肉瘤患者中,男性患者1例,女性患者3例。年龄范围为37-61岁,平均年龄49岁。病程从1个月到半年不等。1例肿瘤发生于额窦;1例肿瘤发生于上颌窦,累及颞下窝、硬腭、鼻腔;2例肿瘤发生于蝶窦,其中1例颅底受侵犯。1例以鼻塞伴头部胀痛为主诉就诊;1例以单纯头部胀痛为主诉就诊;1例以牙痛、面颊及硬腭肿胀为主诉就诊;1例以头痛伴视力下降为主诉就诊。电子鼻咽镜下见肿物呈淡红色或灰白色,表面膨隆。鼻腔鼻窦软骨肉瘤在CT上表现为软组织密度影,并可清晰显示骨质的破坏和肿瘤内的钙化灶。行MRI检查时鼻腔鼻窦软骨肉瘤在T1WI上常表现为低或等信号,在T2WI上常呈现出高信号,但信号不均匀,增强扫描呈现出轻度到中度不均匀强化,可显示周围组织受侵情况。3例根据组织形态学诊断及分级,1例依据免疫组化染色确诊。3例行鼻内镜下鼻腔鼻窦肿物切除术,1例行鼻侧切开上颌骨全截除术。1例术后1年余因肿瘤复发并侵犯颅内及眶内而死亡。2例术后随访7个月、1例术后随访3个月无复发。结论1.鼻腔鼻窦软骨肉瘤是一种缓慢生长的肿瘤,很少转移,但局部复发率较高。2.CT及MRI检查为鼻腔鼻窦软骨肉瘤术前评估提供可靠依据。3.确诊依赖于术后大块或完整肿瘤的病理学检查,Vimentin、S-100蛋白免疫组化染色阳性是该肿瘤区别于其他肿瘤的病理学特征。4.该病在治疗上首选根治性手术切除,放射治疗主要用于高级别的、不可切除的或行局部姑息切除的肿瘤。
[Abstract]:Objective to analyze the clinical, imaging and pathological features, treatment and prognosis of chondrosarcoma chondrosarcoma of nasal cavity and paranasal sinuses. Materials and methods Clinical data of 4 pathologically diagnosed patients with chondrosarcoma of nasal cavity and paranasal sinuses were analyzed retrospectively from May 2014 to December 2016 in the second Hospital of Jilin University. Results there were 1 male and 3 female patients with chondrosarcoma of nasal cavity and paranasal sinuses. The mean age was 49 years. The course of disease ranged from 1 month to 6 months. One case of tumors occurred in the maxillary sinus, involving the infratemporal fossa, the hard palate, and the nasal cavity. 2 cases of tumors occurred in the sphenoid sinus. One case with skull base invasion was treated with nasal obstruction with head distending pain as the main complaint, and one case with simple head distending pain as the main complaint and one case with toothache. The main complaint was swelling of cheek and hard palate in 1 case with headache and decreased visual acuity. Under electronic nasopharyngoscope, the tumor appeared to be reddish or grayish white, the surface was bulging, and the nasal sinus chondrosarcoma showed soft tissue density on CT. The lesions of bone and calcification in the tumor can be clearly displayed. The nasal cavity and sinusoidal chondrosarcoma often showed low or equal signal intensity on T _ 1WI and high signal intensity on T _ 2WI, but the signal intensity was not uniform when MRI was performed. The enhancement scan showed mild to moderate uneven enhancement. 3 cases were diagnosed according to histomorphology and 1 case was diagnosed by immunohistochemical staining. 3 cases were confirmed by endoscopic sinus tumor resection and 1 case was treated with total nasal incision and maxilla osteotomy. 1 case was treated with total maxillary osteotomy. More than 1 year after operation, 2 cases died of tumor recurrence and invasion of intracranial and intraorbital tumors. 1 case of chondrosarcoma of nasal cavity and paranasal sinuses was a slow growing tumor, and 1 case was followed up for 7 months and 1 case had no recurrence in 3 months after operation. Very rarely, However, the local recurrence rate was higher. 2. Ct and MRI examination provided reliable basis for preoperative evaluation of chondrosarcoma of nasal cavity and paranasal sinuses. 3.The diagnosis depended on the pathological examination of large or complete tumor after operation and the positive staining of Vimentininn S-100 protein was the difference between the tumor and the tumor. The pathological features of other tumors. 4. Radical surgical resection is the first choice in the treatment of the disease. Radiotherapy is mainly used in high-grade, non-resectable or locally palliative tumors.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.62

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