咽旁间隙神经鞘瘤与多形性腺瘤的鉴别诊断
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摘要
目的探讨咽旁间隙神经鞘瘤和多形性腺瘤的影像学表现,旨在提高对两者的鉴别诊断能力。方法回顾性分析经手术病理证实的12例神经鞘瘤和8例多形性腺瘤的CT和/或MRI表现,分析内容包括病灶部位、最长径、形态与边界、密度或信号特点、强化方式、邻近解剖结构改变情况等。结果咽旁间隙神经鞘瘤及多形性腺瘤发生于左、右侧分别为6/6例和3/5例;两者均表现为类圆形肿块,境界多较清楚。CT表现为软组织密度肿块,可伴有囊变。MRI多表现为长T1长T2信号,伴有囊变者信号不均匀,增强后呈不均匀强化。神经鞘瘤多见于茎突后间隙(10/12,83. 3%),推压二腹肌后腹(10/12,83. 3%)、颈动脉鞘区血管(8/12,66. 7%)及茎突(4/12,33. 3%)向前和/或外侧移位,与腮腺深叶间境界均较清楚。多形性腺瘤多见于茎突前间隙(6/8,75%),推压二腹肌后腹(5/8,62. 5%)、颈动脉鞘区血管(5/8,62. 5%)及茎突(6/8,75%)向内和/或后侧移位。有2例(25%)与腮腺深叶分界不清。结论咽旁间隙神经鞘瘤和多形性腺瘤的影像学表现各具特征性,临床工作中通过仔细分析其起源部位、与周围结构的关系等有助于鉴别诊断。
Objective To investigate the imaging features of neurilemmomas and pleomorphic adenomas in the parapharyngealspace,and to improve the differential diagnosis ability. Methods The CT/MRI performance of neurilemmomas( n = 12) andpleomorphic adenomas( n = 8) confirmed by pathology were retrospectively analyzed,including location,size,shape,boundary,density or signal characteristics,enhancement pattern,and adjacent anatomical structure changes. Results The numbers ofneurilemmomas located in the left/right side were 6/6 respectively,while those of pleomorphic adenomas were 3/5 respectively.Both of them showed as round mass with well-defined border,which demonstrated as tissue density mass with or without cystic de-generation. The mass showed hypo-intensity on T1 WI and hyper-intensity on T2 WI,with heterogenous enhancement on enhancedscans. 10 cases of neurilemmomas were occured in the posterior styloid space( 83. 3%),with clear boundaries between the lesionand the deep lobe of the parotid gland. The posterior belly of digastric muscle( 10/12,83. 3%),vagina carotica( 8/12,66. 7%) and styloid processes( 4/12,33. 3%) were pushed forward and/or outward. 6 cases of pleomorphic adenomas were lo-cated in the anterior styloid space( 75%). The posterior belly of digastric muscle( 5/8,62. 5%),vagina carotica( 5/8,62. 5%) and styloid processes( 6/8,75%) were pushed backward and/or inward. There were 2 cases( 25%) of pleomorphicadenomas which displayed ill-defined margin with the deep lobes of parotid gland. Conclusion The imaging findings of neurilem-momas and pleomorphic adenomas in the parapharyngeal space have varied characteristics. This is helpful to differential diagnosisby carefully observation in clinical practice.
Objective To investigate the imaging features of neurilemmomas and pleomorphic adenomas in the parapharyngealspace,and to improve the differential diagnosis ability. Methods The CT/MRI performance of neurilemmomas( n = 12) andpleomorphic adenomas( n = 8) confirmed by pathology were retrospectively analyzed,including location,size,shape,boundary,density or signal characteristics,enhancement pattern,and adjacent anatomical structure changes. Results The numbers ofneurilemmomas located in the left/right side were 6/6 respectively,while those of pleomorphic adenomas were 3/5 respectively.Both of them showed as round mass with well-defined border,which demonstrated as tissue density mass with or without cystic de-generation. The mass showed hypo-intensity on T1 WI and hyper-intensity on T2 WI,with heterogenous enhancement on enhancedscans. 10 cases of neurilemmomas were occured in the posterior styloid space( 83. 3%),with clear boundaries between the lesionand the deep lobe of the parotid gland. The posterior belly of digastric muscle( 10/12,83. 3%),vagina carotica( 8/12,66. 7%) and styloid processes( 4/12,33. 3%) were pushed forward and/or outward. 6 cases of pleomorphic adenomas were lo-cated in the anterior styloid space( 75%). The posterior belly of digastric muscle( 5/8,62. 5%),vagina carotica( 5/8,62. 5%) and styloid processes( 6/8,75%) were pushed backward and/or inward. There were 2 cases( 25%) of pleomorphicadenomas which displayed ill-defined margin with the deep lobes of parotid gland. Conclusion The imaging findings of neurilem-momas and pleomorphic adenomas in the parapharyngeal space have varied characteristics. This is helpful to differential diagnosisby carefully observation in clinical practice.
引文
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[9]Pilolli F,Giordano L,Galli A,et al.Parapharyngeal space tumours:video-assisted minimally invasive transcervical approach[J].Acta Otorhinolaryngol Ital,2016,36(4):259-264.
[10]田文栋,李湘平,李丹凤,等.咽旁间隙良性肿瘤的影像学特征及经口手术进路分析[J].临床耳鼻咽喉头颈外科杂志,2010,24(21):983-986.
[11]黄洋,刘业海,杨清,等.涉及颅底咽旁间隙肿瘤的CT及MRI影像学特征[J].临床耳鼻咽喉头颈外科杂志,2013,27(8):400-403.
[2]Laturiya R,Kasim JS,Jankar AS,et al.Pleomorphic adenoma of minor salivary gland arising de novo in the parapharyngeal space-A rare case report[J].J Clin Diagn Res,2016,10(3):1-3.
[3]吴芹,陈燕萍,徐嬿,等.咽旁间隙多形性腺瘤与神经鞘瘤的影像鉴别诊断[J].临床放射学杂志,2011,30(8):1116-1119.
[4]Metgudmath RB,Metgudmath AR,Malur PR,et al.Surgical management of parapharyngeal space tumors:our experience[J].Indian J Otolaryngol Head Neck Surg,2013,65(1):64-68.
[5]庄奇新,杨世埙,尚克中,等.累及咽旁间隙的肿物的影像学特征[J].中华放射学杂志,1997,31(4):226-230.
[6]Akn I,Karagz T,Mutlu M,et al.Pleomorphic adenomas of the parapharyngeal space[J].Case Rep Otolaryngol,2014,20(10):16840-16845.
[7]Hakeem AH,Hazarika B,Pradhan SA,et al.Primary pleomorphic adenoma of minor salivary gland in the parapharyngeal space[J].World J Surg Oncol,2009,36(7):819-885.
[8]夏建东,江新青,彭国晖.腮腺肿瘤的CT及MRI诊断及鉴别诊断[J].医学影像学杂志,2009,19(9):1116-1119.
[9]Pilolli F,Giordano L,Galli A,et al.Parapharyngeal space tumours:video-assisted minimally invasive transcervical approach[J].Acta Otorhinolaryngol Ital,2016,36(4):259-264.
[10]田文栋,李湘平,李丹凤,等.咽旁间隙良性肿瘤的影像学特征及经口手术进路分析[J].临床耳鼻咽喉头颈外科杂志,2010,24(21):983-986.
[11]黄洋,刘业海,杨清,等.涉及颅底咽旁间隙肿瘤的CT及MRI影像学特征[J].临床耳鼻咽喉头颈外科杂志,2013,27(8):400-403.