头颈部畸胎瘤2例

目的探讨头颈部畸胎瘤的临床诊断和治疗方法。方法回顾总结我科诊治的2例头颈部畸胎瘤的临床表现、诊断思路、治疗策略、组织学所见、治疗效果和预后。结果头颈部畸胎瘤表现为囊性或实性包块,可固定或活动,表面光滑,边界清晰。诊断时可结合B超、CT、细针吸取细胞学、核医学显像等检查。2例患者均采取手术治疗,术后随访无复发。结论颈部B超与CT联合应用可提高诊断的准确性。手术治疗可彻底清除病灶,预后良好。     

头颈部血管平滑肌瘤临床特点分析

目的 分析总结头颈部血管平滑肌瘤(ALM)的临床特点，为其临床诊疗提供参考。方法 回顾性分析2009年11月—2021年7月收治的17例头颈部ALM患者的临床病历及随访资料。结果 17例头颈部ALM患者，其中男7例，女10例，平均年龄49.5岁。发病部位位于耳廓、面颊部各6例，鼻前庭1例，鼻腔2例，鼻咽部1例，左上唇侧前庭沟1例。位于鼻前庭者诉鼻塞，位于鼻咽部者诉鼻塞伴涕中带血，其余患者均表现为无痛性肿块。17例患者，6例行CT检查，其中4例行增强CT扫描后可见肿物血管丰富，呈明显强化或不均匀强化；6例行鼻内镜检查；5例行细针穿刺细胞学检查均查见血细胞。15例由HE染色确诊，2例由HE染色和免疫组化确诊。根据Morimoto分类方法，实体型8例，静脉型4例，海绵型4例，实体型-海绵型1例。所有患者均采用手术治疗，其中1例位于鼻咽部的肿物术中大量出血，约2 000 mL，予以电凝、压迫止血，其余病例术中均无明显出血。术后平均随访5年，均无复发、恶变。结论 头颈部ALM临床表现各异，组织学和免疫组化检测可明确诊断。对位于头颈部腔隙内、瘤体较大、完整切除困难且术前影像学检查提示瘤体血供丰富的病例，术前可考虑行瘤体血管栓塞以减少术中出血。手术切除预后良好。     

头颈部低度恶性肌纤维母细胞肉瘤二例分析

目的 探讨头颈部低度恶性肌纤维母细胞肉瘤(LGMS)的临床表现、影像学表现、病理表现、治疗方法及预后。 方法 回顾性分析2例头颈部LGMS患者的临床资料并复习相关文献,总结其临床表现、影像学表现、病理表现及治疗方法、预后情况。 结果 头颈部LGMS的临床表现取决于肿瘤的部位,声门区的LGMS以声音嘶哑为首发症状,随着肿瘤增大可出现呼吸困难,颈部的LGMS表现为无痛性肿块。肿瘤表面光滑,似有被膜,界不清,基底广泛,表面可有坏死。CT表现为均匀或不均匀的中等密度肿瘤,肿瘤内可见钙化,偶可破坏骨质,增强后呈现轻度均匀强化或环形强化。MRI扫描T₁W2呈低信号或等限号,T₂W1呈均匀或不均匀高信号,肿瘤内有条索信号影,增强后肿瘤实质呈周边明显强化表现。光镜下见肿瘤细胞由梭形细胞和小多角形细胞组成,呈束状、疏松状、编织状排列,弥漫性浸润性生长,可侵犯黏膜鳞状上皮、肌肉,肿瘤细胞界限不清,纺锤形,核为细长型,核增大、深染、不规则。免疫组化见Vimentin、SMA、desmin、actin等阳性表达,S-100等阴性表达。治疗方法以广泛手术切除为主,术后随访12~23个月,均无复发及转移。 结论 头颈部LGMS临床及影像学表现无特异性,病理诊断必须结合免疫组织化学检查,广泛手术切除是最有效的治疗方法,肿瘤对放化疗不敏感,肿瘤的复发与是否切除彻底有关。     

鼻窦骨化纤维瘤CT诊断

目的探讨鼻窦骨化纤维瘤的CT诊断。方法回顾性分析8例鼻窦骨化纤维瘤患者的临床资料及CT表现,对比CT表现及术后病理诊断。结果鼻窦骨化纤维瘤的CT表现为鼻窦内单发类圆形或不规则性高密度肿块,部分区域可见低密度影,其周边出现完整骨性包壳,呈膨胀性生长,周边组织受压变形但分界清楚。8例均诊断为鼻窦骨化纤维瘤,与术后病理相符。结论鼻窦内圆形或类圆形高密度影,密度均匀或不均匀,部分区域内见低密度影,表面为厚薄不均的骨壳,界限清楚,为骨化纤维瘤的CT表现特点。     

原发性颅底软骨肉瘤CT和MRI诊断

目的分析原发性颅底软骨肉瘤的CT和MRI表现,探讨CT和MRI在颅底软骨肉瘤中的诊断价值。方法搜集经病理组织学证实的9例颅底软骨肉瘤,全部病例均行CT和MRI平扫及增强。结果 9例CT平扫表现为等或略低密度的分叶状或类圆形软组织肿块,伴有不同程度的钙化,且形态不规则,呈散在沙粒样或弧形及粗糙团块状,同时合并骨质破坏;增强后病灶呈非均匀强化。MRI检查T1WI呈等低信号混杂影,T2WI呈高低信号混杂影,肿瘤内钙化在T1WI、T2WI均为无信号区,增强扫描明显不均匀性强化。结论颅底软骨肉瘤有较特有的CT和MRI影像学表现,是诊断颅底软骨肉瘤的有效方法 。     

26例变应性真菌性鼻-鼻窦炎临床分析

目的:分析变应性真菌性鼻-鼻窦炎(AFRS)的临床特点及以鼻内镜手术为主的综合治疗的作用.方法:对26例AFRS患者术前常规进行鼻窦CT扫描,血清总IgE及特异性IgE检测,术中取窦内分泌物及受累鼻窦黏膜行真菌学及组织病理学检查.26例患者均行鼻内镜手术,术前及术后配合抗生素、皮质类固醇激素和局部抗真菌药鼻腔冲洗治疗.术后随访至少1年.结果:26例患者中有21例伴变应性疾病史,临床表现无特异性,鼻窦CT多表现为受累鼻窦腔内中间呈斑片状或条索状高密度影,在软组织窗表现更为典型,部分患者窦腔扩大、窦壁变薄甚至骨质吸收;血清总IgE阳性22例,真菌SIgE阳性20例.窦内分泌物涂片均可见真菌菌丝,真菌培养阳性14例,以曲霉菌多见.分泌物及黏膜苏木精-伊红染色可见大量嗜酸细胞浸润,8例分泌物内可见Charcot-leyden结晶.术后1年有19例术腔黏膜完全上皮化,其余7例有不同程度的黏膜肿胀、息肉样变或黏脓性分泌物.结论:AFRS诊断主要依据病史、鼻窦CT扫描、组织病理学、真菌学和免疫学检测.鼻内镜手术结合全身和(或)局部激素以及局部抗真菌药鼻腔冲洗是治疗AFRS的有效手段.     

头颈部非霍奇金淋巴瘤的临床特点

目的探讨头颈部非霍奇金淋巴瘤临床特点.方法结合相关文献的复习,回顾18例头颈部非霍奇金淋巴瘤的临床表现、诊断过程及部分CT影像.结果位于咽淋巴环多见,其次为鼻腔鼻窦;发病年龄在16～71岁之间;男女比为2∶1;18例中有11例曾被诊断为慢性炎症;CT检查均未明确提示恶性病变;从发病至确诊时间在12～500天不等.结论头颈部NHL的临床表现缺乏特异性,容易误诊;短期内进行性单侧扁桃体肿大、外观可疑者应考虑本病可能;准确的活检取材有助于最终明确诊断.     

颈部多间隙感染12例临床分析CSCD

目的总结颈部多间隙感染患者的临床特点和治疗经验。方法回顾性分析吉林市人民医院耳鼻咽喉头颈外科收治的12例颈部多间隙感染患者的详细临床资料,对其感染来源、实验室结果、影像学检查、治疗方式、疗效等进行总结和分析。结果男10例,女2例,2例牙源性感染,白细胞及C反应蛋白均不同程度升高,颈部增强CT可见局部软组织肿胀、密度不均,部分患者可见气体影或边缘及分隔样强化。6例保守治疗,6例手术治疗,所有患者均治愈出院,无死亡病例。结论颈部多间隙感染患者根据病情轻重选择保守或手术治疗,手术治疗的关键在于彻底清创引流,合理应用抗生素和规律控制血糖,必要时多科联合治疗以提高治愈率。     

CT检查在真菌球型鼻窦炎术前诊断中的临床意义

目的 探讨CT检查在真菌球型鼻窦炎术前诊断中的临床意义。 方法 回顾性分析2019年1月~2020年12月术前CT检查判断为真菌球型鼻窦炎32例患者的病例资料,包括术前CT检查、术中所见和术后病理结果。所有患者入院后均行鼻窦CT平扫并重建,均行内镜鼻窦手术,术中观察鼻窦内黏膜肿胀、分泌物等情况,并与术前鼻窦CT影像学检查进行对比。 结果 30例患者术中检查和术后病理明确诊断为真菌性鼻窦炎,诊断准确率为93.7%。鼻窦CT检查可见鼻窦内钙化影27例;鼻窦内完全浑浊高密度影21例;部分浑浊且表面不规则的“土坷垃征”13例;鼻窦局部骨质增厚16例。另外2例患者术后病理诊断为上颌窦嗜酸细胞乳头状瘤1例、出血坏死性息肉1例。 结论 真菌球型鼻窦炎患者CT主要特征是鼻窦内软组织不均匀密度影,其内可见高密度钙化点;其次鼻窦内部分浑浊影,表面高低不平;骨质局部增生肥厚也是其体征性表现。单纯依靠CT检查结果诊断真菌球型鼻窦炎有误诊的可能。     

颅内三叉神经鞘瘤的CT及MRI诊断

目的分析颅内三叉神经鞘瘤的CT和MRI表现。方法搜集36例经手术和病理证实的颅内三叉神经鞘瘤的CT和MRI资料,探讨颅内三叉神经鞘瘤分型、诊断要点及有关鉴别诊断。结果颅内三叉神经鞘瘤分三型：颅后窝型（8例）、颅中窝型（4例）及骑跨型（24例）。病灶信号混杂,易囊变（12例）,增强后可见不均匀强化;CT能看到岩尖骨质吸收或破坏（17例）。结论CT和MRI的联合应用对三叉神经鞘瘤的定位、定性诊断具有较高的准确性,对临床治疗及手术方式的选择具有指导作用。     

Predictive ability of the CT to evaluate cervical lymph nodes in head and neck tumours

ObjectiveThe aim of this study was to determine the predictive value of computed tomography (CT) i.e., its sensitivity and specificity in detecting metastatic lymph nodes of head and neck tumours. We also studied the capacity of CT in correct nodal staging.Patients and methodsA CT was performed on 95 patients diagnosed with neoplastic disease of the pharynx and/or larynx. All patients subsequently underwent cervical lymph node dissections. In the imaging study, the following parameters were considered for suspected radiological nodal involvement: lymph node diameter greater than 10 mm, lesion margins poorly defined, capsule enhancement after contrast administration and lymph nodes that, despite their size, had signs of central necrosis.ResultsIn the dissections, 70.53% resulted N+ in the histological study. The sensitivity of CT was 82.09% and the specificity, 85.71%. The CT detected positivity in 55 of the 67 histologically pathological dissections, while the CT detected negativity in 24 of the 28 dissections histologically negative. The weighted kappa index value was 0.6408, indicating limited capacity for appropriate staging of the lymph nodes.ConclusionsWhile the ability of CT to detect metastatic lymph nodes in head and neck tumours is quite acceptable, it is less so for correctly staging them. It is therefore necessary to look for other imaging tests that provide greater accuracy to avoid unnecessary elective neck dissections and to reduce morbidity and mortality from them. We must now pay attention to new imaging techniques such as PET and PET/CT.     

The role of tonsillectomy in the initial diagnostic work-up of head and neck squamous cell carcinoma of unknown primary

ObjectiveThe aim of the present study was to determine the value of tonsillectomy in the initial diagnostic work-up of head and neck squamous cell carcinoma of unknown primary (HNSCCUP).Material and methodsA single-center retrospective study (1999–2012) included 45 patients. All cases underwent physical examination, panendoscopy and contrast-enhanced neck and chest CT scan; 27 (60%) also underwent 18-FDG PET scan. Imaging was systematically performed before panendoscopy. In 34 cases (75%), histologic tonsil samples ipsilateral to the HNSCCUP were collected (28 tonsillectomies and 6 biopsies) during panendoscopy. Categoric variables were compared on Chi-square test.ResultsClinical examination and CT did not identify any primary tumor. In 13 cases (38%), invasive squamous cell carcinoma (SCC) was diagnosed on histological samples (12 tonsillectomies, 1 biopsy). For these 13 cases, lymph nodes were located in the upper or middle jugular group, and in 3 cases lymph nodes were cystic on CT scan. In 7 cases (26%), there was an abnormal tonsillar 18-FDG uptake ipsilateral to the cervical lymphadenopathy; tonsillectomy was performed, and SCC was found in 5 of these cases: i.e., 18-FDG PET showed sensitivity and specificity of respectively 55.5 and 88.8%.ConclusionTonsillectomy has a role in the initial diagnostic work-up of HNSCCUP. It is especially useful when lymph nodes are located in the upper and/or middle jugular group with a cystic aspect on CT.     

Patients with cutaneous head and neck melanoma,particularly elderly with more advanced primary tumors,seem to benefit from initial CT staging before considering a sentinel lymph node biopsy

Abstract

Background: The role of CT scanning at the time of diagnosis for patients with primary cutaneous head and neck melanoma (cHNM) clinically asymptomatic for metastatic disease remains unclear.

Aim: To determine the positive yield of initial CT scanning before considering sentinel lymph node biopsy (SLNB) staging.

Materials and methods: A retrospective review was performed on 170 consecutive patients with cHNM referred to a tertiary head and neck academic center for SLNBs from 2014 through 2018.

Results: Initial CTs identified occult melanoma metastases in 7.1% and other advanced malignancies in 4.7%. The overall CT yield for patients >65 years (n?=?115) was 13.9%, and 5.5% for patients <65 (only occult melanoma metastases). The SLNB yield did not differ between older (11.5%) and younger patients (10.2%). Patients with more advanced primary tumors were upstaged more often by both staging procedures. Multivariate analysis indicated a true-positive CT finding as the strongest prognostic factor for OS (p<.001).

Conclusions and significance: The CT yield was >11% and higher for older than for younger patients. The findings suggest that CT imaging may be considered before SLNB staging, potentially identifying metastatic melanoma disease as well as other occult malignancies, enabling especially older patients to bypass the SLNB procedure.     

18F-FDG-PET/CT interpretation pitfalls in patients with head and neck cancer

AimThe aim of the present study is to raise awareness of ENT Surgeons on the limitations of ¹⁸F-FDG PET/CT in head and neck cancer by presenting illustrative cases from our department archives.Materials and methodsA retrospective chart review was conducted for all patients with head and neck cancer treated in our ENT department from 2015 to 2020. Cases with various interpretation pitfalls due to false-positive and false-negative PET/CT results that lead to diagnostic dilemmas and treatment delays either in their pre-therapeutic work-up or in their post-therapeutic monitoring were included.ResultsFive cases of various image interpretation pitfalls (3 false negative and 2 false positive cases) were identified and are presented in detail.ConclusionsAlthough ¹⁸F-FDG PET/CT has gained in popularity and improved head and neck cancer management, clinicians should be aware of its limitations. The combination of ¹⁸F-FDG PET/CT with other imaging modalities can reduce the number of interpretation pitfalls but by no means will substitute sound clinical judgement.     

Clinical features of sarcoidosis patients presenting with head and neck manifestations – a two-center retrospective study and proposal of a diagnostic algorithm for the otorhinolaryngologist

Abstract

Background and Aims: We aimed to investigate the clinical characteristics of patients presenting with sarcoidosis of the head and neck as the initial manifestation and to provide recommendations for the diagnostic work-up for the practicing otorhinolaryngologist.

Material and Methods: We performed a retrospective cohort study at two university medical centers in Germany. Patients with a histopathologically confirmed diagnosis of sarcoidosis treated in the otorhinolaryngology departments were analyzed.

Results: We identified 62 patients (2003–2016). In total, 85.4% (n?=?53) of patients received the initial diagnosis of sarcoidosis during their ENT treatment. Sarcoidosis was detected in the lymph nodes in 42.3% (n?=?30) of the patients; 57.7% had extra-lymphatic manifestations. Fifteen patients (24.2%) showed pulmonary involvement. 30.6% (n?=?19) were treated with oral glucocorticoids (GC) alone, three patients with GC and methotrexate, one patient initially received a combination of GC and azathioprine, one patient rejected the recommended treatment.

Conclusions: Sarcoidosis should be considered as a differential diagnosis in patients presenting with head and neck symptoms. The most frequent presenting symptoms were cervical lymphadenopathy and affection of the paranasal sinuses. Therefore, otorhinolaryngologists should be aware of sarcoidosis and help guide referral strategies as they may be the first physicians treating these patients.     

Incidental radiographic findings of thyroglossal duct cysts: Prevalence and management

Objectives/HypothesisTo determine the epidemiology of incidental thyroglossal duct cysts (TGDC) discovered on imaging studies obtained in the head and neck area in children and to discuss subsequent management.MethodsA retrospective chart review was performed at Texas Children's Hospital of all computed tomography (CT) and magnetic resonance (MR) imaging studies obtained in the head and neck region between July 2011 and July 2014. Images obtained for the purpose of evaluating a neck or lingual mass were excluded from the study, as were patients with previously known TGDCs. Data including age, sex, location of TGDC, size, presence of symptoms, referral to Otolaryngology, and intervention were recorded.ResultsA total of 60,663 CT and MR studies of the head, brain, sinus, neck, and C-spine during this time period were reviewed; of these 69 (0.1%) cases contained incidental discovery of probable TGDCs with more males (40) than females (29). Ages ranged from 3 days to 17 years old, with the mean age at 5 years. Locations varied, with majority at base of tongue (83%) followed by hyoid (13%) then infrahyoid straps (4%). Sizes ranged from 2 to 28 mm with average size at 8 mm. 11 of these patients were referred to an Otolaryngologist; 9 were asymptomatic and decision was made to observe, the other two subsequently underwent surgical excision secondary to mass effect and dysphagia with histologic confirmation of diagnosis.ConclusionTGDCs commonly present as an anterior neck mass, however the majority of incidentally discovered TGDCs on imaging are located at the base of tongue. Management of these findings should include referral to an Otolaryngologist for further evaluation with the decision to intervene surgically based on development of clinical symptoms.     

CT staging and surveillance of the thorax in patients with newly diagnosed and recurrent squamous cell carcinoma of the head and neck: is it necessary?

The detection of distant metastases or synchronous primary tumours at initial presentation, or at recurrence in patients with head and neck squamous cell carcinoma (HNSCC), frequently alters the selection of therapy in these patients. A number of series report appreciably high rates for these lesions. This study evaluated 108 computed tomography (CT) scans and chest radiographs (CXR) of the thorax, in 80 patients presenting with HNSCC over a 4 year period. There were three clinical settings; (a) at original diagnosis n = 61, (b) clinical evidence of local/regional recurrence n = 19 (c) suspicion of recurrence due to neck symptomatology n = 28. CT thorax detected two out of 61 (3%) distant metastases at the initial diagnosis stage (both were either stage III or IV) and one out of 19 (5%) patients evaluated at the time of loco/regional recurrence. CXR failed to reveal evidence of pulmonary metastases in the two patients at initial diagnosis stage, but correctly identified pulmonary metastases in the loco-regional recurrence patient. There was no thoracic malignancy detected in the surveillance CT scans, and no synchronous second primary tumour detected during the study. CT is known to be more sensitive than conventional CXR in detecting thoracic pathology in HNSCC patients, however, we feel CT is of limited value in stage I or II disease. We no longer carry out routine staging CT scans of the thorax in patients presenting with stage I or II HNSCC, or with neck symptomatology with no clinical evidence of recurrence.Presented at the Royal Academy of Medicine in Ireland, Otolaryngology Head and Neck Surgery Section 2005.     

Comparison between 18F-FDG PET and conventional imaging techniques (CT SCAN and MRI) in the diagnosis of head and neck tumor suspicion of recurrence

BackgroundThis study aimed to assess the results obtained with the positron emission tomography (PET) and conventional anatomic imaging methods (CT scan and MRI) in the diagnosis of suspicion of tumor recurrence in head and neck cancers.MethodsThirty patients with suspicion of tumor recurrence due to head and neck cancers were reviewed retrospectively. Consequently, 34 PET studies were performed. The images were obtained in the PET Institute of Madrid. They were interpreted by visual and semiquantitative analysis. The results were confirmed with clinical followup, response to treatment or with histological studies in some cases.ResultsSensitivity and specificity of the PET were 95.6% and 81.8% respectively, while it was 65% and 80% for the CT scan/MRI.ConclusionsWe can conclude that PET provides better results than conventional imaging techniques in the detection of head and neck cancer recurrence.     

Value of extranodal extension detected by computed tomography for predicting clinical response after chemoradiotherapy in head and neck squamous cell cancer

Objectives: Radiological extranodal extension (rENE) upon CT is obtained before concurrent chemoradiation therapy (CCRT) for head and neck squamous cell carcinoma (HNSCC). We evaluated the prognostic value of rENE, rather than pathologically proven ENE, in patients who received CCRT for HNSCC.

Materials and methods: We reviewed 117 patients. We divided the patients into rENE(+) and rENE(?) groups and evaluated overall survival (OS) and disease-specific survival (DSS), and factors affecting these outcomes.

Results: Median follow-up was 37.4 months; 31 patients (26.2%) died and 26 (22.2%) had recurrence. Thirty patients were rENE(+) and these had worse 5-year OS (74% vs. 94%, p?p?n?=?87). rENE (hazard ratio [HR] 3.57, p?p?p?p?p?p?Conclusions: CT findings suggesting ENE predicts treatment response to CCRT and prognosis, and could be used to determine the treatment modality for HNSCC.     

Effect of treatments for head and neck cancer on sinus shadow on computed tomography

ObjectiveHead and neck surgeries may cause changes in the nasal airflow, and radiotherapy irreversibly damages paranasal sinus epithelial cells. Some chemotherapeutic drugs have been reported to negatively affect airway ciliary activity in mice, and chronic rhinosinusitis could be an adverse effect of head and neck cancer (HNC) treatment. To evaluate whether HNC treatment is a risk factor for developing sinonasal mucosal thickening that may reflect paranasal sinus inflammation, we compared pre- and post-treatment paranasal sinus computed tomography (CT) images of patients treated for HNC at a single university hospital.MethodsThe patients who received curative treatment for HNC (oral, pharyngeal, and laryngeal cancers) and started receiving first-line therapy between January 2015 and December 2019 were included. Data on age, sex, primary lesion, clinical stage, treatment, smoking history, drinking history, comorbidities (diabetes and chronic lung disease), and pre- and post-treatment (three months and one year after the final treatment) paranasal sinus CT images were analyzed from medical records. Pre- and post-treatment paranasal sinus CT images were scored using the Lund–Mackay (LM) staging system.ResultsIn total, 245 patients participated in this study. Three months after the final treatment, 80.4% of patients had no change in their total LM scores (p=0.621). Almost 80% of patients who underwent total laryngectomy also had no change in their total LM scores (p=0.833). One-third of patients with nasopharyngeal cancer (NPC) had worse LM scores after treatment (5/15), although no significant difference was observed (p=0.171). None of the various factors collected were significantly related to changes in LM scores three months after the completion of treatment. One year after the final treatment, 211 patients were included and no significant changes in the pre-and post-LM scores were observed in the same analyses, while changes in LM scores were significantly different between T categories (T1-2 vs. T3-4) (p=0.020).ConclusionWe found no significant changes in the LM scores after HNC treatment in all the patients, which implies that HNC treatment may not be an apparent risk factor for sinonasal mucosal inflammation.