Osteosarcoma of the ethmoid sinus

A rare case of chondroblastic osteosarcoma arising from the ethmoid sinus is reported. The patient, a 34-year-old woman, presented with diminished visual acuity of the left eye. CT and MR imaging showed a heterogeneous left-sided nasoethmoidal mass destroying the medial orbital wall. Biopsy revealed a chondroblastic osteosarcoma containing malignant chondroid elements and calcified malignant osteoid. Treatment consisted of craniofacial resection followed by radiotherapy and chemotherapy with symptomatic improvement. We briefly discuss ethmoidal osteosarcomas.Presented at the 30th Annual Meeting of the International Skeletal Society in San Francisco, USA, September, 2003     

Osteoblastoma of the ethmoid sinus

An osteoblastoma is a benign bone tumor that most often occurs in the vertebral column and the long bones of the extremities. Paranasal sinus involvement is very rare. We report an osteoblastoma of the ethmoid sinus in a 13-year-old boy who presented with exophthalmos. CT demonstrated an expansile, lesion of the right ethmoid sinus, which caused the orbital contents to be compressed and deviated to the right. A mixture of ground glass opacity and dense bone was present. The less dense portions of the lesion showed intense enhancement on MRI; a signal void was present on all sequences in the densely sclerotic areas. Curettage was performed. Histologically, the lesion was composed of proliferating osteoblasts along with small trabeculae of woven bone and rich vascular fibrous stroma. The literature concerning occurrence of osteoblastoma in this unusual location is reviewed and discussed.     

Low-grade osteosarcoma of metacarpal bone

A radiograph of the second left metacarpal bone in a 34-year-old man showed irregular lytic areas in the diaphysis that was expanded with perpendicular periosteal reactions. Examination of the first biopsy specimen indicated a fibrous dysplasia. Examination of the second biopsy specimen revealed an unequivocal grade I intramedullary osteosarcoma, desmoid to fibrous dysplasia-like in histological pattern. Three years after an adequate en bloc resection of the metacarpal bone, the man was healthy. The long-term course is usually favorable.     

Low-grade osteosarcoma of the maxillary sinus

Low-grade osteosarcomas of the paranasal sinus are extremely rare. Most reported cases of maxillary sinus osteosarcoma are high-grade. We present a 51-year-old man with a low-grade osteosarcoma which was histologically difficult to diagnose in isolation since it had bland features. The presence of an aggressive destructive lesion on imaging influenced the final pathological diagnosis as often appears to be the case with this rare tumor. We briefly discuss paranasal sinus osteosarcomas.     

鼻窦骨肉瘤的CT和MRI诊断

目的探讨鼻窦骨肉瘤的CT和MRI表现并评价2种影像检查方法的临床应用价值。方法回顾性分析9例经组织学证实的鼻窦骨肉瘤患者的影像资料。结果9例中发生于上颌窦5例，筛窦3例，蝶窦1例；原发7例，继发于骨纤维异常增殖症及骨化性纤维瘤各1例。CT表现：受累部位骨质破坏，伴有形态不规则软组织肿块，边界不清，密度不均匀，内散在数量及形态不一的肿瘤骨，呈棉絮状3例，象牙质状2例，放射状2例，棉絮状和放射状1例，放射状和象牙质状1例。3例增强后呈不均匀低至中度强化。MRI表现：病变与脑实质比较，在T1WI上表现为低信号5例，等信号2例；T2WI表现为高信号4例、等信号3例，内部信号不均匀，散在数量不等、形态不一的极低信号影，对应CT所见的肿瘤骨，增强后可见中度到显著不均匀强化。MRI清楚显示病灶大小及伴发的改变。病变侵犯眼眶5例，翼腭窝、颞下窝4例，颅底3例，广泛侵犯颅面部结构1例。结论CT是显示肿瘤骨较好的影像检查方法，MRI能够更清楚、准确显示病变侵犯的范围，两者结合可为该病诊断和治疗提供更全面的影像信息。     

Low-grade central osteosarcoma of the rib

We report a case of low-grade central osteosarcoma of the rib, mimicking fibrous dysplasia protuberans or parosteal osteosarcoma. A 13-year-old boy presented with a densely ossified exophytic tumor in the left sixth rib. The surgically resected rib revealed an ossified tumor that had developed within bone and had formed an exophytic mass. Microscopic examination revealed parosteal osteosarcoma-like low-grade central osteosarcoma. Low-grade central osteosarcomas rarely affect the rib, and exophytic tumor formation is also rare. This tumor required differentiation from fibrous dysplasia protuberans and parosteal osteosarcoma because of its clinical presentation.Presented at the 31st Closed Meeting of the International Skeletal Society in Malta, October 2004     

筛窦骨瘤鼻内镜微创手术切除（一例报告并文献复习）

目的分析筛窦骨瘤的临床特征,探讨其诊治方法及鼻内镜下微创手术切除的优点。方法报告1例筛窦骨瘤的临床诊治及手术过程,并就筛窦骨瘤的特点与诊治方法进行文献回顾复习分析。结果高分辨率CT及三维重建技术有助于分辨骨瘤的大小、毗邻结构关系及术式选择,术中需防止脑脊液鼻漏、眶壁损伤等并发症的发生。结论筛窦为鼻窦骨瘤的好发部位,局限于筛窦及鼻腔的骨瘤适于鼻内镜下手术切除,具有手术创伤小、术后无面部瘢痕等优点。     

Low-grade parosteal osteosaracoma of the ulna with dedifferentiation into high-grade osteosarcoma

 This report describes a low-grade parosteal osteosarcoma of the ulna with dedifferentiation into high-grade osteosarcoma. The clinical, pathological, and imaging findings are described and discussed.     

筛窦畸胎癌肉瘤1例报道并文献复习

目的提高对鼻腔鼻窦畸胎癌肉瘤(SNTCS)的影像学认识。方法报道1例经病理证实的筛窦畸胎癌肉瘤,复习相关文献并探讨其临床特征、影像学表现及鉴别诊断。结果肿瘤CT平扫表现为软组织密度肿块,有小囊变,无明显钙化,侵犯鼻咽及前颅底;MRI表现为T1WI不均匀等、稍低信号,T2WI不均匀等、稍高信号,增强扫描肿块明显不均匀持续强化,小囊变区未见强化。结论鼻腔鼻窦畸胎癌肉瘤非常罕见,肿瘤具有一定的影像学特征,确诊需依赖病理学诊断。     

Imaging features of low-grade central osteosarcoma of the long bones and pelvis

Purpose To determine the age and gender distribution and imaging features of low-grade central osteosarcoma (LGCOS) of the long bones and pelvis and to discuss our findings in the context of lesions for which LGCOS has been mistaken.Materials and methods We reviewed 99 cases of LGCOS collected between 1919 and 2002 from our institution and pathology consultation files. Adequate imaging was available in 70 cases (36 radiographs only, 17 radiographs/CT, 12 radiographs/MRI, 2 radiographs/CT/MRI, 2 CT only, 1 MRI only, 5 bone scans).Results Patient average age was 30.1±14.2 years, with a slight female predominance. The femur and tibia were the most common long bones involved (29 and 20 each) with the majority of these tumors arising around the knee, followed by the fibula, radius, humerus and ulna (four, three, two and one case each). Flat bones were involved in six cases (three pelvis, one rib, two scapulae). Short tubular bones were involved in five cases (two metatarsal, two phalanges, one clavicle). The lesion extended to the end of the affected long bone in 22 of 59 cases. Lesions were large at presentation (mean 7.9±4.6 cm, range 2–24). Four radiographic patterns were identified: lytic with varying amounts of thick and coarse trabeculation (n=22), predominantly lytic with few thin, incomplete trabecula (n=21), densely sclerotic (n=17) and mixed lytic and sclerotic (n=10). Lesions were benign-appearing overall with focally aggressive features. CT or MRI demonstrated cortical breech or extension into the soft tissues in all cases.Conclusions LGCOS has a variable appearance on radiographs. A frequent pattern is a slow-growing large intracompartmental fibro-osseous lesion with varying amounts of septal ossification associated with focal areas of aggression. A homogeneously sclerotic pattern was also noted. Imaging with CT or MRI was helpful in every instance in our series in identifying areas of soft tissue extension or cortical disruption suggestive of a low-grade malignancy.     

内窥镜鼻窦外科手术治疗后组筛窦及眼球后病变38例临床探讨

 目的 探讨内窥镜鼻窦外科手术治疗后组筛窦及眼球后病变的疗效.方法 使用国产内窥镜对38例(42侧)病人施行手术治疗,其中鼻窦炎鼻息肉30例(34侧)、外伤5例(5侧)、肿瘤3例(3侧).肿瘤病人术后结合放疗/化疗.结果 按照海口会议(1997)临床分型分期标准,鼻窦炎鼻息肉治愈率83.33%、好转10.0%、无效6.6%,外伤病人术后眼部症状消失、视力提高4.2～5.0,肿瘤病人术后随访24～48个月无复发.结论 内窥镜鼻窦外科手术是治疗后组筛窦及眼球后病变的理想方法.强调术前CT扫描检查、术中掌握技术操作及术后局部换药处理.     

多层螺旋CT重组技术对眶下筛房的影像解剖研究

目的 研究眶下筛房的影像解剖学特点,分析其与鼻窦黏膜增厚的相关性,探讨其在慢性鼻窦炎发病中的作用.方法 根据纳入及排除标准,从头面部多层螺旋CT(MSCT)扫描的连续病例中采用随机数字表法抽取260例(520侧)进行回顾性研究,图像数据行多层面重组(MPR)及仿真内镜重组(VR),观察眶下筛房的显示率、起源、分型等情况;分析眶下筛房的存在与鼻窦黏膜增厚的关系;测量上颌窦口区眶下筛房的最大横径、上颌窦口横径,观察眶下筛房炎性征象及上颌窦1:I黏膜碰触情况,应用X2检验和Logistic回归方法与鼻窦黏膜增厚进行相关性研究.结果 (1)260例眶下筛房的显示率:单侧26.1%(68例),双侧对称31.2%(81例),单双侧显示率差异无统计学意义(x2=1.59,P>0.05).左右分侧观察,两侧显示眶下筛房合计230侧,左侧占52.2%(120侧),右侧占47.8%(110侧),左、右侧显示率差异无统计学意义(x2=0.78,P>0.05).(2)眶下筛房的起源:单纯起源于前组筛房124侧(53.9%),单纯起源于后组筛房62侧(27.O%),既有起源于前组筛房、又有起源于后组筛房的眶下筛房44侧(19.1%).(3)眶下筛房的分型:共分3型,起源于前组筛房的以I型为主(160侧),Ⅱ、Ⅲ型少见;起源于后组筛房的Ⅱ(48侧)、Ⅲ型(45侧)更为多见,不同起源的眶下筛房分型差异有统计学意义(x2=193.433,P<0.01).(4)眶下筛房与鼻窦黏膜增厚的关系:眶下筛房鼻窦黏膜增厚165侧,无鼻窦黏膜增厚192侧,差异无统计学意义(X2=1.824,P>0.05).鼻窦黏膜增厚时上颌窦13区眶下筛房的最大横径为(4.48±1.28)mm,未增厚时为(4.54±1.18)mm.二者差异无统计学意义(t=0.273,P>0.05);鼻窦黏膜增厚时上颌窦口径线为(2.63±1.64)mill.未增厚时为(2.28±0.75)mm,上颌窦13径线与鼻窦黏膜增厚无明显相关关系(Wald=2.534.P>0.05);眶下筛房炎性征象与鼻窦黏膜增厚有明显相关关系(Wahl=10.817,P<0.Ol,OR:4.125),上颌窦口黏膜碰触与鼻窦黏膜增厚具有明显相关关系(Wald=6.64,P<0.0l,OR=3.728).结论 MSCT三维重组技术可以满意显示眶下筛房的解剖学特征;在影像分析中,不能简单地把眶下筛房的存在作为慢性鼻窦炎患病的危险因素,应根据不同个体的具体情况分析眶下筛房解剖特征及对窦口鼻道复合体的影响,为临床选择不同的处理方法提供依据.     

Multiplanar reconstructions in the study of ethmoid anatomy

Summary Multiplanar and surface reconstructions are useful tools in anatomical studies. Details of ethmoid architecture which are hard to image in axial and coronal scans are well displayed by means of oblique sections. This paper addresses reformatted images of a) the nasal lateral wall; b) the middle meatus lateral wall; c) the lamina basilaris of the middle turbinate and d) the frontonasal duct.     

Chondromyxoid fibroma of the ethmoid sinus

Only a smal proportion of cases of this rare neoplasm occur in the skull. We present an unusually extensive tumour in a young man. Received: 1 June 1997 Accepted: 17 January 1998     

视神经管与蝶筛窦毗邻关系的多层螺旋CT研究

(242侧)、筛旁型26.7%(139侧)、筛蝶型22.3%(116侧);蝶上筛房形成者中,3、4级视神经管及筛旁型、筛蝶型视神经管发生率较蝶前筛房者均明显提高(X2值分别为117.4、201.2,P值均<0.01).前床突气化者89.1%(57/64)为4级视神经管,10.9%(7/64)为3级.结论 鼻窦MSCT容积扫描、结合MPR技术多方位连续、动态观察可准确显示视神经管与周围结构立体关系,为鼻内镜手术安全实施提供可靠依据.     

脑静脉窦血栓形成的MRI诊断(附15例分析)

目的 :探讨MRI对脑静脉窦血栓 (VST)的诊断价值。方法 :回顾性分析 15例VST患者的完整临床和影像学资料。全部行MR检查 ,其中 9例行增强扫描 ,8例行脑静脉MRA检查 ;12例曾行CT检查 ,其中 4例行增强扫描。结果 :上矢状窦受累 12例合并横窦血栓 11例 ,窦汇 7例、乙状窦 6例、下矢状窦、直窦受累 6例 ,海绵窦受累 1例。血栓在T1WI上均呈等、高不均匀信号 ,并出现脑组织肿胀 ,脑沟变浅 ,脑回模糊 ,在T2 WI上信号因发病时间不同而有所不同 ,8例T2 WI脑实质无异常信号 ,7例T2 WI脑实质出现异常信号。增强扫描 9例全部出现静脉异常强化。MRA表现为受累静脉窦信号较淡、边缘模糊且不规则的血流信号或血流信号完全消失。 12例CT检查中 2例见“空delta征” ,4例表现为梗塞、出血等不典型改变。结论 :MRI是诊断VST的首选检查方法 ,并对VST的预后评价有重要意义     

骨肉瘤的影像病理对照表现

目的 总结原发骨肉瘤的影像学表现,探讨有关的临床特点和鉴别诊断。材料与方法 搜集1980－1999年14例原发骨肉瘤,经手术与病理证实。男6例,女8例,平均23．5岁。其中股骨9例,腓骨2例,肱骨2例,胫骨1例。回顾性分析14例原发骨肉瘤的X线平片、CT和MRI的表现并对照相关的病理学检查。结果 原发骨肉瘤影像学表现包括广泛骨质破坏、骨膜反应、软组织肿块,部分病例可见肿瘤骨和肿瘤钙化。病理证实影像学确定病变范围不准确。X线平片诊断最佳,CT检查和MRI有助于鉴别诊断。结论 原发骨肉瘤骨破坏范围大,成骨型诊断较易,溶骨型应用与Ewing’s瘤、恶性巨细胞瘤等鉴别。     

Small-cell osteosarcoma

Small-cell osteosarcoma, a subtype of osteogenic sarcoma, consists of sheets of round cells that produce an osteoid matrix. It may be confused with Ewing sarcoma if the osteoid matrix is not included in the biopsy. The distinctive radiographic features of an osteoblastic tumor and a pattern of permeative destruction will confirm the histologic diagnosis or indicate the true nature if tumor osteoid is not included in the histological sections. We add 13 patients to the 32 previously reported in the literature. Fourteen (31%) of the 45 are living and well, though three have been followed for only 2 months (Tables 1 and 2). The treatments have been so varied that a statistically significant evaluation cannot be developed. The radiographic features are not distinctive, but the diagnosis may be suggested when a tumor has osteoblastic features in the metaphysis and extends well down into the shaft with a pattern of permeative destruction. The radiographic features are especially important when limited biopsies reveal only sheets of round cells, thus suggesting Ewing sarcoma. The presence of an osteoid-producing tumor as evidenced by osteoblastic new bone formation will lead to the correct diagnosis.     

螺旋CT三维重建评价筛窦解剖变异及临床意义

目的：探讨应用螺旋CT对筛窦进行三维图像重建，认证筛窦解剖变异及临床意义。材料和方法：应用GE Lightspeed Plus多排螺旋机扫描仪，对75例病例进行筛窦横断面扫描，通过GE W4．0工作站，在三维重建软件支持下作冠状位图像重建。结果：筛窦常见的解剖变异有5种：筛大泡占52％，Onodi气房21％，眶五气房5％，筛凹低位4％，纸样板过度内移7％。结论：经横断面CT扫描，通过三维重建，能够很好地显示筛窦冠状面图像及其解剖变异，为手术提供详细的影像学资料，对鼻内镜外科有重要临床指导意义。     

肢体骨肉瘤以介入为主的综合治疗

目的 探讨介入性综合治疗方法治疗肢体骨肉瘤的效果。方法 １１例经病理证实的肢体骨肉瘤（临床分期ⅡＢ１０期,Ⅲ期１例）,给予介入为主的综合治疗。１、经股动脉顺行插管埋置药合导管系统后,行动脉内局部灌注及全身化疗两个疗程。２、动脉内局部小剂量灌注及同时放疗。３、再予全身化疗,每月１次,共６个疗程。所有病例均随访１２～４６个月。结果 所有患肢均得以保留,疼痛症状消失,功能改善,肿瘤局部控制率为９０．９％