原发性鼻腔鼻窦黏膜恶性黑色素瘤CT、MR诊断  

CT and MR imaging diagnosis of primary nasal cavity and paranasal sinuses mucosal malignant melanoma

作　　者：侯刚强 张小静 高德宏[3] 曾志斌[3] 熊伟[4] HOU Gang-qiang;ZHANG Xiao-jing;GAO De-hong;ZENG Zhi-bin;XIONG Wei(Kimgning Hospital, Mental Health Center, Shenzhen Guangdong 518020, China;Medical College of Shenzhen University, Shenzhen Guangdong 518062, China;Department of Imaging Diagnose, Nans han Hospital of Shenzhen,Shenzhen Guangdong 518052, China;Diagnostic Imaging Center, Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]深圳市康宁医院深圳市精神卫生中心,广东深圳518020 [2]深圳大学医学部,广东深圳518062 [3]深圳市南山区人民医院放射科,广东深圳518052 [4]南方医科大学南方医院影像中心,广东广州510515

出　　处：《中国临床医学影像杂志》2019年第3期162-165,共4页Journal of China Clinic Medical Imaging

基　　金：广东省医学科研基金立项项目(编号:A2017620);深圳市医疗卫生三名工程(项目编号:SZSM 201512038);深圳市南山区卫生科技计划项目(编号:A2015014)

摘　　要：目的:探讨CT、MR对原发性鼻腔鼻窦黏膜恶性黑色素瘤的诊断价值。材料与方法:回顾分析经活检或手术病理证实的11例原发性鼻腔鼻窦黏膜恶性黑色素瘤影像、病理及临床资料。CT检查11例,增强5例。其中3例行MR平扫、增强扫描。观察病灶位置、范围、密度或信号特点、周围淋巴结以及病变同周围组织结构的关系等特征。结果:肿瘤位于鼻腔3例,鼻窦6例,同时累及鼻腔、鼻窦者2例。CT平扫病灶形态欠规则,软组织密度,未见坏死囊变或钙化灶;增强扫描2例明显强化,3例中度强化。3例MR检查中,1例T_1WI呈高信号,T_2WI呈低信号;余2例T_1WI、T_2WI均呈等信号;增强扫描中度强化。11例均对周围组织有不同程度的侵犯。11例均行免疫组化染色,肿瘤细胞HMB-45(+)、S-100(+)、Vimentin(+)。结论:原发性鼻腔鼻窦黏膜恶性黑色素瘤CT缺乏特异表现;典型的黑色素瘤MRI表现典型的信号特征。CT、MR能准确显示病灶部位、肿瘤与周围组织关系及相邻重要结构侵犯情况。Objective: To evaluate the diagnostic value of CT and MR in the diagnosis of primary nasal sinus mucosal malignant melanoma. Materials and Methods: The images, pathology and clinical data of 11 cases of primary nasal sinus mucosal malignant melanoma confirmed by biopsy or pathology were retrospectively analyzed. Eleven patients underwent CT plain scan, and 5 underwent CT contrast enhancement. Three of them underwent through both MR scan and enhanced scan.The study examined the CT and MRI findings in the following aspects: the lesion location, size, border, the relationship with the surrounding tissue, and the lymph nodes. Results: In 3 cases, the tumor was located in the nasal cavity, 6 cases in both the sinus and the nasal cavity, and 2 cases in the sinus. The CT findings showed that all the tumors were irregularly shaped,with soft tissue density, but without calcification or cystic degeneration. Severe enhancement was observed in 2 cases, moder-ate enhancement in 3 cases. Among the 3 cases that underwent MR examination, 1 case was hyperintense on T1 WI, and hypointense on T2 WI. The other 2 cases were isointense on T1 WI, T2 WI. The mass showed mild enhancement. All the tumors invaded the surrounding bone tissue. Immunohistochemistry showed that the tumor cells were positive for HMB-45, S-100 and Vimentin. Conclusion: Primary nasal sinus mucosal malignant melanoma is not specifically manifested on CT imaging. But typical malignant melanoma has typical manifestation on MR. CT combined with MR can accurately show the location of the tumor, and the invasive relationship between the lesion and the surrounding tissues.

关 键 词：黑色素瘤 鼻窦肿瘤 体层摄影术 X线计算机 磁共振成像 

分 类 号：R739.61[医药卫生—肿瘤] R445.2[医药卫生—临床医学]