GECAPE GRUPO DE ESTUDOS RADIOLÓGICO DA CABEÇA E PESCOÇO

Apresentação em tema: "GECAPE GRUPO DE ESTUDOS RADIOLÓGICO DA CABEÇA E PESCOÇO"— Transcrição da apresentação:

1 GECAPE GRUPO DE ESTUDOS RADIOLÓGICO DA CABEÇA E PESCOÇO
ANTONIO DE PADUA MESQUITA MAIA FILHO R4 CABEÇA E PESCOÇO Grupo de cabeça e pescoço do INRAD e ICESP.

2 M.C.A.L. feminino, 39 anos

3

4

5

6

7 Pós operatório

8

9

10

11

12

13 ?

14 Papiloma invertido

15 Papiloma nasossinusal
São tumores benignos da fossa nasal ou dos seios paranasais, derivados do epitélio schneideriano. São subdivididos em; Papiloma invertido (47%) Fungiforme (50%) Cilíndrico (3%) Sao chamados de papiloma por serem amolecidos ao toque e facilmente sangrantes.

16 Papiloma invertido Localização: parede nasal lateral ao nível do meato médio, fossas nasais ou nos seios paranasais (menor frequência). QC: H > F, anos, assintomático, pode causar irritação, epistaxe,sinusite. Patogênese: indefinida (CDKN2B, HPV ???) Associação: Carcinoma escamoso. Histologia: inversão do epitélio hiperplásico que cresce para o interior do estroma subjacente

17 Papiloma invertido Aspecto de imagem TC:
Massa com atenuação de partes moles (pode ter calcificações) Remodelamento, afilamento, erosão, esclerose óssea (efeito de massa) Hipertose óssea correlaciona com local de origem do tumor. The identification of the origin of an inverted papilloma is very important for the complete extirpation of such tumors, because most recurrent tumors were localized to the same site as the primary tumors. Therefore, the CT-based determination of the locations of areas of focal hyperostosis corresponded to the actual (surgically determined) tumor origin in 89.1% of cases. When the origins of inverted papilloma were correlated with the areas of focal hyperostosis on CT, areas of cone- shaped hyperostosis always coincided with actual tumor ori- gin, without exception. On the contrary, some of plaquelike hyperostotic area failed to predict the origin of inverted papilloma. preoperative identification of the tumor origin would be helpful in choosing a proper surgical approach. Preoperative CT-based detection of tumor origin may be especially helpful in case of frontal sinus disease.

18 Lee D et al. AJNR Am J Neuroradiol 2007;28:618-621
The identification of the origin of an inverted papilloma is very important for the complete extirpation of such tumors, because most recurrent tumors were localized to the same site as the primary tumors. Therefore, the CT-based determination of the locations of areas of focal hyperostosis corresponded to the actual (surgically determined) tumor origin in 89.1% of cases. When the origins of inverted papilloma were correlated with the areas of focal hyperostosis on CT, areas of cone- shaped hyperostosis always coincided with actual tumor ori- gin, without exception. On the contrary, some of plaquelike hyperostotic area failed to predict the origin of inverted papilloma. preoperative identification of the tumor origin would be helpful in choosing a proper surgical approach. Preoperative CT-based detection of tumor origin may be especially helpful in case of frontal sinus disease. A área de hiperostose correspondeu a origem cirúrgica do tumor em 89,1% dos casos, , falhando em alguns casos de hiperostose em placa. Lee D et al. AJNR Am J Neuroradiol 2007;28: Lee D et al. AJNR Am J Neuroradiol 2007;28:

19 Lee D et al. AJNR Am J Neuroradiol 2007;28:618-621
The identification of the origin of an inverted papilloma is very important for the complete extirpation of such tumors, because most recurrent tumors were localized to the same site as the primary tumors. Therefore, the CT-based determination of the locations of areas of focal hyperostosis corresponded to the actual (surgically determined) tumor origin in 89.1% of cases. When the origins of inverted papilloma were correlated with the areas of focal hyperostosis on CT, areas of cone- shaped hyperostosis always coincided with actual tumor ori- gin, without exception. On the contrary, some of plaquelike hyperostotic area failed to predict the origin of inverted papilloma. preoperative identification of the tumor origin would be helpful in choosing a proper surgical approach. Preoperative CT-based detection of tumor origin may be especially helpful in case of frontal sinus disease. Lee D et al. AJNR Am J Neuroradiol 2007;28: Lee D et al. AJN©2007 by American Society of Neuroradiology.

20 Papiloma invertido Aspecto de imagem na RM: Hipo ou isossinal em T1.
Iso ou hiperssinal em T2. Realce cerebriforme Perda focal do realce cerebriforme (perda de sinal pode indicar local de lesão maligna associada). Realce cerebriforme – epitelio (alta celularidade metaplasica) = hipossinal em T2 e menor impregnacão pelo contraste. Estroma edematoso = hiperssinal em T2 e maior realce pos contraste.

21 Jeon T et al. AJNR Am J Neuroradiol 2008;29:1556-1560
There was a significant statistical difference in the prevalence of a CCP between IP and other malignant sinonasal tumors (P < .0001). Differentiation of IP from other malignant sinonasal tumors is often difficult because of a significant overlap of the imaging features. Our study showed a significant statistical difference in the prevalence of a CCP between IP (30 of 30 [100%]) and other malignant sinonasal tumors (17 of 128 [13%])

22 Jeon T et al. AJNR Am J Neuroradiol 2008;29:1556-1560
Characteristic MR imaging appearance of a CCP in IP. Coronal T2-weighted (A) and contrast-enhanced fat-suppressed T1-weighted (B) MR images show alternating hypointense and hyperintense striations throughout the tumor involving the left maxillary sinus and ... Characteristic MR imaging appearance of a CCP in IP. Coronal T2-weighted (A) and contrast-enhanced fat-suppressed T1-weighted (B) MR images show alternating hypointense and hyperintense striations throughout the tumor involving the left maxillary sinus and nasal cavity. Jeon T et al. AJNR Am J Neuroradiol 2008;29: ©2008 by American Society of Neuroradiology

23 Jeon T et al. AJNR Am J Neuroradiol 2008;29:1556-1560
In contrast, in 8 IPs concomitant with SCC, the areas of a focal loss of a CCP were demonstrated in 4 (50%), 3 of which also showed aggressive bone destruction with extrasinonasal extension on MR images (Fig 2A). In contrast, in 8 IPs concomitant with SCC, the areas of a focal loss of a CCP were demonstrated in 4 (50%), 3 of which also showed aggressive bone destruction with extrasinonasal extension on MR images

24 Papiloma invertido Tratamento: Excisão cirúrgica e cauterização da base do papiloma. Pode ocorrer recidiva. Dificil diferenciação entre fibrose pós-cirúrgica e recidiva.

25