Ciniglio Appiani M, Verillaud B, Bresson D, Sauvaget E, Blancal J-P, Guichard J-P, Saint Maurice J-P, Wassef M, Karligkiotis A, Kania R, Herman P
ENT Section, Department of Sensory Organs, Sapienza University of Rome, Italy;
ENT Department, Lariboisière Hospital, Assistance Publique, Hopitaux de Paris, Paris 7 University, Paris, France;
Acta Otorhinolaryngol Ital. 2015 Oct;35(5):355-61. doi: 10.14639/0392-100X-533.
Fibro-osseous benign lesions rarely affect the sinonasal tract and are divided into 3 different entities, namely osteoma, fibrous dysplasia and ossifying fibroma. They share several clinical, radiological and histological similarities, but have different behaviours. Ossifying fibroma, and in particular the "juvenile" histological subtype, may have a locally aggressive evolution and a high risk for recurrence if removal is incomplete. The purpose of the present study is to compare the clinical behaviour of ossifying fibroma with the other benign fibro-osseous lesions; highlight different behaviour between the histological subtypes; compare the advantages, limitations and outcomes of an endoscopic endonasal approach with reports in the literature. We retrospectively reviewed 11 patients treated for sinonasal ossifying fibroma at a tertiary care centre. All patients underwent CT scan, and MRI was performed in cases of cranial base involvement or recurrence. Pre-operative biopsy was performed in cases where it was possible to use an endoscopic approach. One patient underwent pre-operative embolisation with ipsilateral visual loss after the procedure. Depending on its location, removal of the tumour was performed using an endoscopic (n = 7), or an external (n = 3) or combined (n = 1) approach. Histopathologically, 5 patients presented the conventional type, 5 the juvenile psammomatoid variant, which was associated in 1 case with an aneurismal bone cyst, and 1 case presented the trabecular juvenile variant. Three patients affected by the juvenile psammomatoid histological variant presented invasion of the skull base and underwent a subtotal removal that subsequently required, due to the regrowth of the remnant, a transbasal approach. Clinical, radiological and histological findings should all be considered to establish differential diagnosis among fibrous osseous lesions. More studies are necessary to conclude if the localisation and extension of the disease at the time of diagnosis is more important than the histological variant. An endoscopic approach is the first choice in most of cases even if an external open approach may be necessary in selected patients.
纤维骨性良性病变很少累及鼻窦，可分为3种不同类型，即骨瘤、骨纤维异常增殖症和骨化性纤维瘤。它们在临床、放射学和组织学上有一些相似之处，但行为不同。骨化性纤维瘤，尤其是“青少年”组织学亚型，可能具有局部侵袭性进展，如果切除不完全则复发风险高。本研究的目的是比较骨化性纤维瘤与其他良性纤维骨性病变的临床行为；突出组织学亚型之间的不同行为；将鼻内镜下经鼻入路的优势、局限性和结果与文献报道进行比较。我们回顾性分析了一家三级医疗中心治疗的11例鼻窦骨化性纤维瘤患者。所有患者均接受了CT扫描，颅底受累或复发的病例进行了MRI检查。在可以采用内镜入路的情况下进行了术前活检。1例患者在术前栓塞术后出现同侧视力丧失。根据肿瘤位置，采用内镜（n = 7）、外部（n = 3）或联合（n = 1）入路切除肿瘤。组织病理学检查显示，5例为传统型，5例为青少年砂粒样变型，其中1例伴有动脉瘤样骨囊肿，1例为小梁状青少年变型。3例受青少年砂粒样组织学变型影响的患者出现颅底侵犯，接受了次全切除，随后由于残留肿瘤复发，需要采用经颅底入路。应综合考虑临床、放射学和组织学检查结果，以对纤维骨性病变进行鉴别诊断。若要得出诊断时疾病的定位和范围是否比组织学变型更重要的结论，还需要更多研究。在大多数情况下，内镜入路是首选，即使在部分患者中可能需要采用外部开放入路。
