Becker M, Moulin G, Kurt A M, Zbären P, Dulgerov P, Marchal F, Zanaret P, Lehmann W, Rüfenacht D A, Terrier F
Department of Radiology, Geneva University Hospital, Switzerland.
Eur Radiol. 1998;8(9):1541-51. doi: 10.1007/s003300050584.
The objective of this study was to analyze the radiologic features of atypical forms of squamous cell cancer and correlate them with clinical, endoscopic, and histopathologic findings. The CT and MRI images of 31 patients with atypical forms of squamous cell carcinoma were reviewed retrospectively and the radiologic findings were correlated with clinical, endoscopic, and histopathologic findings. Histopathologic diagnoses included undifferentiated carcinoma of nasopharyngeal type (n = 8), verrucous carcinoma (n = 18), spindle cell carcinoma (n = 3), and basaloid cell carcinoma (n = 2). Undifferentiated carcinoma of nasopharyngeal type was located in the supraglottis or piriform sinus beneath an intact mucosa and initial endoscopic biopsy was most often negative. The discrepancy between an intact mucosa at endoscopy and a solid mass with homogenous enhancement at CT or MRI was characteristic for these tumors and warranted further investigations to obtain the definitive histologic diagnosis. Verrucous carcinoma displayed characteristic clinical, radiologic, and pathologic features, namely, an exophytic tumor arising from the glottic level displaying a rugged surface with finger-like projections but with only minor submucosal infiltration. Spindle cell carcinoma appeared as a polypoid mass with a thin stalk arising from the supraglottis. Basaloid cell carcinoma displayed a distinct lobulated enhancement pattern which was observed on contrast-enhanced T1-weighted SE images. Although the MR and CT features of atypical forms of squamous cell carcinoma cannot be considered pathognomonic they should raise the differential diagnosis even if endoscopic biopsy has been negative. The radiologist's awareness of the appearance of these unusual tumors on CT and MR images may greatly facilitate the diagnostic work-up and helps to guide the endoscopist to the adequate biopsy site in order to establish the correct diagnosis.
本研究的目的是分析非典型鳞状细胞癌的放射学特征，并将其与临床、内镜及组织病理学检查结果相关联。回顾性分析了31例非典型鳞状细胞癌患者的CT和MRI图像，并将放射学表现与临床、内镜及组织病理学检查结果进行关联。组织病理学诊断包括鼻咽型未分化癌（n = 8）、疣状癌（n = 18）、梭形细胞癌（n = 3）和基底细胞癌（n = 2）。鼻咽型未分化癌位于声门上区或梨状窝，黏膜完整，初次内镜活检大多为阴性。内镜下黏膜完整而CT或MRI显示均匀强化的实性肿块，这种差异是这些肿瘤的特征，需要进一步检查以获得明确的组织学诊断。疣状癌具有特征性的临床、放射学和病理学表现，即起源于声门水平的外生性肿瘤，表面凹凸不平，有指状突起，但仅有轻微的黏膜下浸润。梭形细胞癌表现为起源于声门上区的带细蒂的息肉样肿块。基底细胞癌在对比增强T1加权SE图像上显示出独特的分叶状强化模式。虽然非典型鳞状细胞癌的MR和CT表现不能被视为具有确诊意义，但即使内镜活检为阴性，也应引起鉴别诊断的重视。放射科医生对这些不常见肿瘤在CT和MR图像上表现的认识，可能会极大地促进诊断工作，并有助于指导内镜医生找到合适的活检部位以确立正确的诊断。
