Adenosquamous carcinoma of the facial bones,skull base,and calvaria: CT and MR manifestations.

A 62-year-old woman had proptosis of the right eye, decreased visual acuity of the left eye, and no other focal neurologic deficits. She had a grand mal seizure 1 month before admission. The CT and MR studies showed extensive bone destruction of the margins of the right orbit, the floor of the middle cranial fossa, the right cavernous sinus, and much of the calvaria. There was considerable dural disease and tumor in the right orbit, paranasal sinuses, and scalp, as well as mucoceles of the left ethmoidal sinus with desiccated secretions. The diagnosis was adenosquamous carcinoma, an aggressive tumor related to both squamous cell carcinoma and adenocarcinoma.     

复杂型颅盖底联合骨折处理新技巧

对29例复杂型颅盖底联合骨折外科治疗病例资料进行回顾性分析。23例同期行颅骨还纳,6例行Ⅱ期颅骨修补。27例Ⅰ期愈合,2例术区发生感染,经局部换药痊愈。在传统的方法上辅以特殊器械和新材料的应用可以取得比较好的治疗效果。     

Imaging of giant tumours involving the anterior skull base

Tumours involving the anterior skull base are a challenge in diagnosis and treatment. They may arise from the bony skull base itself, intracranially or from the sinonasal tract and orbit. It is often difficult to determine the site of origin of giant tumours as anatomical boundaries are frequently breached. Accurate imaging evaluation is useful in planning treatment and may help in the differential diagnosis. We review those CT and MRI features of giant anterior cranial fossa tumours which may be helpful in identifying a pre-operative diagnosis.     

CT and MRI diagnosis of skull base chondrosarcoma extensively involving parapharyngeal space

目的:探讨CT、MRI对累及咽旁间隙的颅底软骨肉瘤的诊断价值.方法:回顾性分析6例经病理证实的累及咽旁间隙的颅底软骨肉瘤患者的CT、MRI资料,其中3例为黏液样软骨肉瘤.结果:6例均广泛累及咽旁间隙,侵犯颈静脉孔5例、岩尖3例、寰椎旁3例.主要CT表现为软组织肿块伴不规则骨质破坏,肿块呈分叶状4例,类圆形2例,伴不同程度点状、斑片状及周边弧形钙化;4例CT增强扫描呈轻度不均匀强化.MRI T1 WI示肿块呈低或稍低信号,T2 WI上呈多房分叶状明显高信号,内有低信号分隔,其中3例黏液样软骨肉瘤信号较均匀,其余信号不均匀,有片状等或稍高信号灶.增强扫描呈轻度不均匀强化,伴周边及间隔强化.结论:颅底软骨肉瘤可广泛累及咽旁间隙,易造成误诊;CT可显示钙化及骨质破坏,MRI上肿块信号特点及强化方式有一定特点,两种检查方法联合应用可减少误诊.     

累及咽旁间隙的颅底软骨肉瘤的CT和MRI诊断

目的:探讨CT、MRI对累及咽旁间隙的颅底软骨肉瘤的诊断价值。方法:回顾性分析6例经病理证实的累及咽旁间隙的颅底软骨肉瘤患者的CT、MRI资料,其中3例为黏液样软骨肉瘤。结果:6例均广泛累及咽旁间隙,侵犯颈静脉孔5例、岩尖3例、寰椎旁3例。主要CT表现为软组织肿块伴不规则骨质破坏,肿块呈分叶状4例,类圆形2例,伴不同程度点状、斑片状及周边弧形钙化;4例CT增强扫描呈轻度不均匀强化。MRI T1WI示肿块呈低或稍低信号,T2WI上呈多房分叶状明显高信号,内有低信号分隔,其中3例黏液样软骨肉瘤信号较均匀,其余信号不均匀,有片状等或稍高信号灶。增强扫描呈轻度不均匀强化,伴周边及间隔强化。结论:颅底软骨肉瘤可广泛累及咽旁间隙,易造成误诊;CT可显示钙化及骨质破坏,MRI上肿块信号特点及强化方式有一定特点,两种检查方法联合应用可减少误诊。     

Squamous cell carcinoma of the thyroid

A patient with squamous cell carcinoma of the thyroid is presented. The I-123 images failed to show any cold areas but demonstrated the posterior extension of the gland.     

Squamous cell carcinoma of the base of the tongue: results of treatment in 115 cases

Between 1976 and 1986, we treated 115 patients (mean age 53.8 years) with base of tongue carcinomas. The staging system used was the UICC TNM classification of 1979. Seventy per cent of the tumours were T3 or T4 and 42% had N2 or N3 lymph node. Locoregional treatment was irradiation alone (98/115) or surgery and post-operative radiotherapy (17/115). Sixty-seven patients received induction chemotherapy. Actuarial survival of the entire group at 3 and 5 years was 25 and 23%, respectively, and 3-year actuarial survival rates for T1, T2, T3 and T4 lesions were 42, 48, 20 and 17%, respectively. The local control rate at the primary site was 55% and 78% in the neck. Distant metastases occurred in 10% of patients and 8% had a second primary. Nodal status was the only other prognostic factor. The local control rate obtained with irradiation alone was not good. For limited T1 and T2 tumours, interstitial therapy or surgery should improve the local control rate.     

Amyloidoma of the skull base

We report a case of a primary amyloidoma of the skull base. Plain radiography and CT showed a lytic, highly destructive lesion with multiple scattered calcifications within. MR imaging revealed that the tumor was isoto hypointense to muscle on T1-weighted images and extremely hypointense on T2-weighted images. In contrast to two previous reports, marked enhancement after the administration of contrast material was absent. Bone amyloidomas are very rare and are frequently misinterpreted as chondrosarcomas.     

Fibrosing inflammatory pseudotumors involving the skull base: MR and CT manifestations with histopathologic comparison.

PURPOSETo describe the MR and CT features of fibrosing inflammatory pseudotumors of the skull base region, and to document the MR signal intensity of the lesions with histopathologic comparison.METHODSWe reviewed the MR and CT studies of five patients with pathologically proved fibrosing inflammatory pseudotumor involving the skull base. Unenhanced spin-echo T1- and T2-weighted and contrast-enhanced T1-weighted MR images were obtained at 0.5 T in three patients and at 1.5 T in two patients. MR findings were correlated with histopathologic findings in all five cases, and the enhancement pattern was compared with CT findings in three cases.RESULTSIn three cases, the cavernous sinus was involved unilaterally, with adjacent extracranial infiltrative masses. In one case, both orbits, the cavernous sinuses, and the tentorium were involved with diffuse infiltrative lesions. One patient had an infiltrative nasopharyngeal mass; and in all five patients, MR images showed localized involvement of the skull base, with bone marrow replaced by tumor. The soft-tissue lesions were hypointense on T2-weighted images in all five cases and showed homogeneous contrast enhancement. Histopathologic studies revealed scanty inflammatory cell infiltration with densely fibrotic background in all cases. The hypointensity of the lesions on T2-weighted images seemed to be related to the degree of fibrosis.CONCLUSIONFibrosing inflammatory pseudotumor shows characteristic MR findings of infiltrative lesion with bone destruction and hypointensity on T2-weighted images. The lack of mobile protons due to the fibrotic background and/or high cellularity of the lesions may be the reason for their hypointensity and weaker enhancement on MR images.     

Skull base tumours Part II. Central skull base tumours and intrinsic tumours of the bony skull base

With the advances of cross-sectional imaging radiologists gained an increasing responsibility in the management of patients with skull base pathology. As this anatomic area is hidden to clinical exam, surgeons and radiation oncologists have to rely on imaging studies to plan the most adequate treatment. To fulfil these endeavour radiologists need to be knowledgeable about skull base anatomy, about the main treatment options available, their indications and contra-indications and needs to be aware of the wide gamut of pathologies seen in this anatomic region. This article will provide a radiologists' friendly approach to the central skull base and will review the most common central skull base tumours and tumours intrinsic to the bony skull base.     

Apparent reformation of the base of the skull following radiotherapy for nasopharyngeal carcinoma

Skull radiographs of 11 selected patients with carcinoma of the nasopharynx were reviewed before and after radiotherapy. Apparent bone reformation was seen at the initial sites of osteolytic destruction within four to six months after delivery of cancericidal radiation dosages.     

Squamous cell carcinoma of the uroepithelium: CT evaluation

Fourteen cases of primary squamous cell carcinoma (SCC) originating in the uroepithelium were studied with computed tomography (CT). Nine cases were of vesical origin, three were of renal pelvic origin, and two were of ureteral origin. CT scans of eight of the 14 cases, including four cases of vesical origin and four cases of renal pelvic or ureteral origin, demonstrated predominantly extraluminal extension with invasion into adjacent organs or the renal parenchyma. CT scans of the remaining six cases showed almost equal extra- and intraluminal tumor growth and no predominantly intraluminal extension. An associated urinary stone was demonstrated in four of the five cases of SCC of renal pelvic or ureteral origin. Two of these cases were diagnosed as urinary stones before CT was performed. Eight of the nine cases of SCC of vesical origin and four of the five cases of SCC of renal pelvic or ureteral origin were correctly staged with the aid of CT.     

Giant-cell tumor of the skull base

Giant cell tumors are uncommon primary bone tumors. They primarily occur in the long bones. Giant cell tumors are extremely rare in the skull and head and neck. When it does occur, the maxilla and mandible are the common sites to be involved. We described two cases of giant cell tumor in the temporal bone. In the non-contrast enhanced CT, the lesion presents as a soft tissue density mass with expansion of the bone. The bony cortex is usually intact. The adjacent soft tissues and cerebral parenchyma show no infiltration or edema. The post contrast scan reveals homogenous enhancement of the mass. Received: 20 April 1998 Accepted: 11 August 1998     

Primary lymphoma of the skull base

This case demonstrates the rare finding of a primary malignant lymphoma of the frontobasis and ethmoidal cells in a patient presenting with progressive loss of vision. Computed tomography and MRI demonstrated a homogenously enhancing tumour with extensive bony destructions of the skull base. After transsphenoidal biopsy, histology revealed a highly malignant primary B-cell lymphoma. The patient was further treated with immunochemotherapy. Tissue diagnosis is, therefore, crucial before a definitive therapy is instituted.     

Invasive aspergilloma of the skull base

Summary Aspergillus infection originating in the nasal cavity or paranasal sinuses is a rare cause of benign, locally invasive disease affecting the skull base. We describe a case in which extensive disease led to bilateral proptosis and invasion of the anterior cranial fossa.