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鼻腔低分化鳞状细胞癌CT病例！

2018-07-23 佚名 影像园

鼻腔低分化鳞状细胞癌CT病例
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女，55岁，右侧反复鼻出血2年，加重伴鼻塞1月。

【病史临床】

女，55岁，右侧反复鼻出血2年，加重伴鼻塞1月。

【影像图片】





以上三幅图分别为CT平扫、平扫、骨窗及增强

【影像表现】 

CT扫描示右侧鼻腔软组织密度影，呈等密度，内可见片状稍低密度影，增强扫描病变呈明显强化。病变边界清楚，形态不规则，病变周围骨质可见明显破坏，累及同侧眶内侧壁、鼻中隔及蝶窦前壁，右侧眶内内直肌可见明显受压。 

【诊断】



病理诊断：（鼻腔）低分化鳞状细胞癌。 

【鉴别诊断】 

1．鼻腔内翻状乳头状瘤 2．鼻腔内淋巴瘤 

【讨论】

鼻腔恶性肿瘤是头颈部少见的肿瘤，大部分为上皮起源的鼻腔癌，由多到少依次为腺癌、淋巴瘤、肉瘤、恶性黑色素瘤。鼻腔鳞状细胞癌预后差，大多数患者属晚期，并且伴有眼眶和颅内浸润，症状与体征常与炎症、感染相混淆，误诊为慢性鼻窦炎者并不少见。对一侧鼻腔不通气、鼻出血的成年患者需行耳、鼻、喉全面检查和影像检查。

CT或MRI能够提供肿瘤的部位和范围，以帮助临床决定治疗的方法和术式的选择。CT虽然对显示骨质的侵蚀范围比较好，但MRI对显示软组织的受侵情况明显优越于CT，能够区分肿瘤和阻塞后改变。眶内和颅内侵犯需增强扫描。本病影像缺乏特异性，常表现为侵袭性和破坏性肿块，T1WI呈低至等信号，T2WI呈高信号。CT平扫呈等密度，内可见片状低密度影，增强扫描后明显强化。

与鼻腔内翻状乳头状瘤的鉴别：起源于中鼻甲附近的鼻腔外侧壁，易向上颌窦和筛窦蔓延，可侵犯邻近的骨质，但骨质破坏程度不如鼻腔癌明显。

与鼻腔淋巴瘤的鉴别：病变一般发生在鼻腔前部，骨质破坏不明显，病变范围较大时易累及鼻翼及周围皮肤组织，常有坏死。增强扫描呈轻中度强化。放射治疗有效。

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encodeId=2012334e2502, content=学习了，谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Sat Jul 28 14:28:41 CST 2018, time=2018-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334582, encodeId=239a33458267, content=学习了，谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Fri Jul 27 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    2018-10-23 qingting

    #细胞癌#

    0

  2. 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    2019-05-24 yinhl1978

    #CT病例#

    0

  3. 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encodeId=2012334e2502, content=学习了，谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Sat Jul 28 14:28:41 CST 2018, time=2018-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334582, encodeId=239a33458267, content=学习了，谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Fri Jul 27 23:41:04 CST 2018, time=2018-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334014, encodeId=acb8334014aa, content=学习了，谢谢谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1bb241978, createdName=phoebeyan520, createdTime=Wed Jul 25 07:49:36 CST 2018, time=2018-07-25, status=1, ipAttribution=)]
    2018-09-17 124987c6m36暂无昵称

    #低分化#

    0

  4. 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encodeId=2012334e2502, content=学习了，谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Sat Jul 28 14:28:41 CST 2018, time=2018-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334582, encodeId=239a33458267, content=学习了，谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Fri Jul 27 23:41:04 CST 2018, time=2018-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334014, encodeId=acb8334014aa, content=学习了，谢谢谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1bb241978, createdName=phoebeyan520, createdTime=Wed Jul 25 07:49:36 CST 2018, time=2018-07-25, status=1, ipAttribution=)]
    2018-08-10 1e145228m78(暂无匿称)

    学习了，谢谢作者分享!

    0

  5. 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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Thu Aug 09 23:40:11 CST 2018, time=2018-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=337143, encodeId=ac2e33e143c2, content=学习了，谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Tue Aug 07 17:57:01 CST 2018, time=2018-08-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334725, encodeId=2012334e2502, content=学习了，谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Sat Jul 28 14:28:41 CST 2018, time=2018-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334582, encodeId=239a33458267, content=学习了，谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Fri Jul 27 23:41:04 CST 2018, time=2018-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334014, encodeId=acb8334014aa, content=学习了，谢谢谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1bb241978, createdName=phoebeyan520, createdTime=Wed Jul 25 07:49:36 CST 2018, time=2018-07-25, status=1, ipAttribution=)]
    2018-08-09 1e145228m78(暂无匿称)

    一个上一件棉裤哦天，

    0

  6. 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createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Fri Aug 10 21:02:03 CST 2018, time=2018-08-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=337597, encodeId=669c33e597e9, content=一个上一件棉裤哦天，, beContent=null, objectType=article, channel=null, level=null, likeNumber=178, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Thu Aug 09 23:40:40 CST 2018, time=2018-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=337596, encodeId=367633e59630, content=烝, beContent=null, objectType=article, channel=null, level=null, likeNumber=194, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Thu Aug 09 23:40:11 CST 2018, time=2018-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=337143, encodeId=ac2e33e143c2, content=学习了，谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Tue Aug 07 17:57:01 CST 2018, time=2018-08-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334725, encodeId=2012334e2502, content=学习了，谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Sat Jul 28 14:28:41 CST 2018, time=2018-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334582, encodeId=239a33458267, content=学习了，谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Fri Jul 27 23:41:04 CST 2018, time=2018-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334014, encodeId=acb8334014aa, content=学习了，谢谢谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1bb241978, createdName=phoebeyan520, createdTime=Wed Jul 25 07:49:36 CST 2018, time=2018-07-25, status=1, ipAttribution=)]
    2018-08-09 1e145228m78(暂无匿称)

    烝

    0

  7. 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createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Fri Aug 10 21:02:03 CST 2018, time=2018-08-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=337597, encodeId=669c33e597e9, content=一个上一件棉裤哦天，, beContent=null, objectType=article, channel=null, level=null, likeNumber=178, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Thu Aug 09 23:40:40 CST 2018, time=2018-08-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=337596, encodeId=367633e59630, content=烝, beContent=null, objectType=article, channel=null, level=null, likeNumber=194, 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encodeId=2012334e2502, content=学习了，谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Sat Jul 28 14:28:41 CST 2018, time=2018-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334582, encodeId=239a33458267, content=学习了，谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Fri Jul 27 23:41:04 CST 2018, time=2018-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334014, encodeId=acb8334014aa, content=学习了，谢谢谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1bb241978, createdName=phoebeyan520, createdTime=Wed Jul 25 07:49:36 CST 2018, time=2018-07-25, status=1, ipAttribution=)]
    2018-08-07 1e145228m78(暂无匿称)

    学习了，谢谢作者分享!

    0

  8. 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23:41:04 CST 2018, time=2018-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334014, encodeId=acb8334014aa, content=学习了，谢谢谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1bb241978, createdName=phoebeyan520, createdTime=Wed Jul 25 07:49:36 CST 2018, time=2018-07-25, status=1, ipAttribution=)]
    2018-07-28 1e145228m78(暂无匿称)

    学习了，谢谢作者分享!

    0

  9. 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23:41:04 CST 2018, time=2018-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334014, encodeId=acb8334014aa, content=学习了，谢谢谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1bb241978, createdName=phoebeyan520, createdTime=Wed Jul 25 07:49:36 CST 2018, time=2018-07-25, status=1, ipAttribution=)]
    2018-07-27 1e145228m78(暂无匿称)

    学习了，谢谢作者分享!

    0

  10. 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encodeId=2012334e2502, content=学习了，谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Sat Jul 28 14:28:41 CST 2018, time=2018-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334582, encodeId=239a33458267, content=学习了，谢谢作者分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3xJXLtMtt5B40XXuPjn9xn1rBhrM6fHLkX1hI86ZoWoPJkgDkZuJNKkBfBHOcRd1fAdezg7JlHNOokohdAp3WkI/0, createdBy=32c81964262, createdName=1e145228m78(暂无匿称), createdTime=Fri Jul 27 23:41:04 CST 2018, time=2018-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=334014, encodeId=acb8334014aa, content=学习了，谢谢谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1bb241978, createdName=phoebeyan520, createdTime=Wed Jul 25 07:49:36 CST 2018, time=2018-07-25, status=1, ipAttribution=)]
    2018-07-25 phoebeyan520

    学习了，谢谢谢谢

    0

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