摘要
目的通过术前CT影像与术后组织病理检查对比分析,探索和评价CT诊断上颌窦恶性肿瘤的窦内外侵犯的应用价值和受累骨壁的准确性。方法无淋巴结及远处转移的上颌窦鳞状细胞癌患者11例,术前给予组织病理学检查、增强CT扫描,根据CT影像特征和范围实施上颌骨部分切除或全切除,标记切下的骨组织标本的部位和方位,给予常规固定、脱钙、包埋、切片和HE染色,光镜下观察各壁上颌骨的骨组织病理学改变。结果 11例患者鼻腔鼻窦增强CT扫描显示上颌窦内侧壁均有破坏吸收(4例内壁缺失),其中侵犯前壁6例,上壁7例,底壁3例,后外壁9例;组织病理学检查见除外内壁缺失患者外,上颌窦内壁均有肿瘤细胞侵犯,且前壁和底壁均有肿瘤细胞侵及,其中上壁4例,后外壁4例;术前CT表现为骨质内壁虫蚀样改变但骨壁连续无中断且伴有增厚硬化的骨壁,术后病理验证无肿瘤侵及。结论术前CT骨壁的破坏并不意味着骨质被肿瘤侵犯,而且上颌骨各壁侵犯的机率是不同的;综合分析发现术前CT表现为骨质内壁呈虫蚀样改变但骨壁连续无中断且伴有增厚硬化的"改建性骨破坏"者,术后病理验证无肿瘤侵及骨壁;术后常规选取上颌骨骨组织病理分析,可以补充术前CT诊断上颌窦恶性肿瘤侵犯范围的不足,从而精确判断肿瘤的T分级,可能为选择微创的手术方式及术者术后评估手术效果、更科学的制定术后综合治疗提供更有力的依据。
OBJECTIVE To explore and evaluate the value of CT in diagnosis of malignant tumor of maxillary sinus and the accuracy of the involved bone wall by comparing the preoperative CT imaging with the pathologic examination. METHODS 11 patients without maxillary sinus squamous cell carcinoma and lymph node metastasis received pathological examination and enhanced CT scan before operation, partial or total maxillary resection were implemented according to the CT features and scope. The position and azimuth of the cut bone tissue samples were marked. The specimens were routinely fixed, decalcified, embedded, sliced and HE stained to observe the bone tissue pathological changes on the bone wall under light microscope. RESULTS Nasal sinus enhancement CT scan showed that the medial wall of maxillary sinus were all resorped and invaded（4 cases lack inner wall）. Anterior wall was invaded in 6 cases, superior wall in 7 cases and bottom wall in 3 cases, posterior and exterior wall in 9 cases; After ruling out the cases without internal wall of maxillary sinus, the inner wall of the maxillary sinus was invaded by cancer cells, so was the front wall and the bottom wall. Those showed bone wall erosion on preoperative CT with continuous change but without interruption and accompanied by bone wall thickening and hardening were found without tumor invasion by postoperative pathological verification. CONCLUSION Bone wall damage on preoperative CT does not mean tumor invasion, and the probability of each maxillary sinus wall invasion is different; the comprehensive analysis found that for wormhole like change of bone wallon preoperative CT with continuous bone wall thickening and hardening of the ＇reconstruction of bone destruction＇, there was no tumor invasion by postoperative pathological validation; Routine selection analysis of bone tissue pathology can supplement the extent diagnosis of malignant tumor of maxillary sinus on preoperative CT scan, so it can accurately estimate the T staging of tumor. It may provide a more eff
出处
《中国耳鼻咽喉头颈外科》
CAS
CSCD
2017年第2期90-94,共5页
Chinese Archives of Otolaryngology-Head and Neck Surgery
关键词
上颌窦肿瘤
癌
鳞状细胞
病理学
体层摄影术
X线计算机
Maxillary Sinus Neoplasms
Carcinoma, Squamous Cell
Pathology
Tomography, X-Ray Computed
