原发性肺淋巴上皮瘤样癌的CT及PET/CT表现与病理对照
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摘要
目的探讨原发性肺淋巴上皮瘤样癌(LELC)的CT和PET/CT表现及其病理特点。方法回顾性分析经手术或穿刺活检病理证实的127例原发性肺LELC患者的临床、影像及病理资料。127例患者均行胸部CT平扫,其中117例行CT增强扫描;38例行PET/CT检查。观察其影像学表现并与病理进行对照。结果 127例LELC中,中央型45例(45/127,35%),周围型82例(82/127,65%)。病灶最大径1.0～12.3 cm,平均(5.00±2.41)cm。结节或团块型118例,其中单发112例,多发6例;叶或段实变型9例。99例(99/127,78%)边界清晰,100例(100/127,79%)边缘分叶,毛刺征49例(49/127,39%)。88例(88/127,69%)平扫密度均匀,空洞17例(17/127,13%)、钙化14例(14/127,11%)、坏死8例(8/127,6%)。增强后病灶多呈渐进性强化,57例(57/96,59%)动脉期瘤内可见血管影。89例(89/127,70%)可见气管或支气管受累、包埋,74例(74/127,58%)合并阻塞性炎症/肺不张。89例(89/127,70%)合并肺门及/或纵隔淋巴结肿大。38例PET/CT检查病灶内标准摄取值(SUV)最大值范围为2.1～28.5,平均13.00±6.65。镜下病理分型Regaud型82例,Schmincke型35例,所有病例EBER均阳性。结论原发性肺LELC多表现为密度均匀、边界清晰、边缘分叶的结节或团块,呈渐进性强化,动脉期多可见瘤内新生血管影,支气管多受累、包埋,氟代脱氧葡萄糖(~(18)F-FDG)呈明显高摄取。
Objective To investigate the CT,PET/CT and pathologic features of the primary pulmonary Lymphoepithelioma-like Carcinoma(LELC). Methods The clinical,imaging and pathological data of 127 patients with LELC,who were proved by surgery or biopsy pathology,were retrospectively analyzed.117 patients underwent contrast enhanced CT scan,only 10 patients underwent CT scan without contrast injection,38 patients also underwent PET/CT scan.Imaging findings were analyzed and correlated with pathologic features.All cases were proved primary pulmonary LELC with exclusion of the cases of nasopharyngeal lymphoepithelioma-like carcinoma. Results 45 central tumors(45/127,35%)and 82 peripheral tumors(82/127,65%)were identified based on the location of the tumor.The maximum diameter of the tumor ranged from 1.0 to 12.3 cm(mean 5.00±2.41 cm).The tumor displayed as solitary nodule or mass in 112 cases,as multiple nodules in 6 cases,as lobar or segmental consolidation in 9 cases.The tumor displayed well-defined margin in 99 cases(99/127,78%),lobular sign in 100 cases(100/127,79%),spicule sign in 49 cases(49/127,39%),cavitation in 17 cases(17/127,13%),calcification in 14 cases(14/127,11%),and necrosis in 8 cases(8/127,6%).88 cases showed homogeneous density in non-enhanced CT(88/127,69%).Most of the tumors demonstrated gradual enhancement,while small vessels inside the tumor were found in 57 cases(57/96,59%).The encasement of trachea or bronchus was found in 89 cases(89/127,70%).Obstructive inflammation or atelectasis was found in 74 cases(74/127,58%).Hilar and/or mediastinal lymphadenopathy was seen in 89 patients(89/127,70%).38 cases with PET/CT scan demonstrated avid FDG uptake with SUV ranged from 2.1 to 28.5(mean 13.00±6.65). The pathologic classification included 82 cases of Regaud type and 35 cases of Schmincke type.EBER was positive in all cases. Conclusion The primary pulmonary LELC demonstrate well-defined margin,lobulated sign,homogeneous density in non-enhanced CT,gradual enhancement and small vessels inside the tumor.
Objective To investigate the CT,PET/CT and pathologic features of the primary pulmonary Lymphoepithelioma-like Carcinoma(LELC). Methods The clinical,imaging and pathological data of 127 patients with LELC,who were proved by surgery or biopsy pathology,were retrospectively analyzed.117 patients underwent contrast enhanced CT scan,only 10 patients underwent CT scan without contrast injection,38 patients also underwent PET/CT scan.Imaging findings were analyzed and correlated with pathologic features.All cases were proved primary pulmonary LELC with exclusion of the cases of nasopharyngeal lymphoepithelioma-like carcinoma. Results 45 central tumors(45/127,35%)and 82 peripheral tumors(82/127,65%)were identified based on the location of the tumor.The maximum diameter of the tumor ranged from 1.0 to 12.3 cm(mean 5.00±2.41 cm).The tumor displayed as solitary nodule or mass in 112 cases,as multiple nodules in 6 cases,as lobar or segmental consolidation in 9 cases.The tumor displayed well-defined margin in 99 cases(99/127,78%),lobular sign in 100 cases(100/127,79%),spicule sign in 49 cases(49/127,39%),cavitation in 17 cases(17/127,13%),calcification in 14 cases(14/127,11%),and necrosis in 8 cases(8/127,6%).88 cases showed homogeneous density in non-enhanced CT(88/127,69%).Most of the tumors demonstrated gradual enhancement,while small vessels inside the tumor were found in 57 cases(57/96,59%).The encasement of trachea or bronchus was found in 89 cases(89/127,70%).Obstructive inflammation or atelectasis was found in 74 cases(74/127,58%).Hilar and/or mediastinal lymphadenopathy was seen in 89 patients(89/127,70%).38 cases with PET/CT scan demonstrated avid FDG uptake with SUV ranged from 2.1 to 28.5(mean 13.00±6.65). The pathologic classification included 82 cases of Regaud type and 35 cases of Schmincke type.EBER was positive in all cases. Conclusion The primary pulmonary LELC demonstrate well-defined margin,lobulated sign,homogeneous density in non-enhanced CT,gradual enhancement and small vessels inside the tumor.
引文
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11 韩安家,熊敏,顾莹莹,等.肺淋巴上皮瘤样癌临床病理特点和预后[J].中华病理学杂志,2001,30:328-331.
12 王则胜,熊国胜,胡虹,等.原发性气管淋巴上皮瘤样癌1例 [J].中国肿瘤临床,2002,29:488.
2 Travis WD,Brambilla E,Burke AP,et al.WHO classification of tumours of lung,pleura,thymus and heart [M].4th ed.Lyon:IARC Press,2015.
3 Jiang WY,Wang R,Pan XF,et al.Clinicopathological features and prognosis of primary pulmonary lymphoepithelioma-like carcinoma[J].J Thorac Dis,2016,8:2610-2616.
4 Liang Y,Wang L,Zhu Y,et al.Primary pulmonary lymphoepithelioma-like carcinoma:fifty-two patients with long-term follow-up[J].Cancer,2012,118:4748-4758.
5 Ma H,Wu Y,Lin Y,et al.Computed tomography characteristics of primary pulmonary lymphoepithelioma-like carcinoma in 41 patients[J].Eur J Radiol,2013,82:1343-1346.
6 Hoxworth JM,Hanks DK,Araoz PA,et al.Lymphoepithelioma-like carcinoma of the lung:radiologic features of an uncommon primary pulmonary neoplasm[J].AJR,2006,186:1294-1299.
7 Jeong JS,Kim SR,Park SY,et al.A Case of Primary Pulmonary Lymphoepithelioma-like Carcinoma Misdiagnosed as Adenocarcinoma[J].Tuberc Respir Dis (Seoul),2013,75:170-173.
8 蒋牧良,龙莉玲,秦雯,等.原发性肺淋巴上皮瘤样癌影像表现与病理分析 [J].中华放射学杂志,2016,50:91-94.
9 陆国秀,郝珊瑚,王治国,等.18F-FDG PET/CT显像对原发性肺淋巴上皮瘤样癌的诊断价值[J].中华核医学与分子影像杂志,2015,35:438-441.
10 梁辉清,曾庆思,袁国奇,等.原发性肺淋巴上皮瘤样癌的CT表现 [J].中国医学影像技术,2014,30:1203-1206.
11 韩安家,熊敏,顾莹莹,等.肺淋巴上皮瘤样癌临床病理特点和预后[J].中华病理学杂志,2001,30:328-331.
12 王则胜,熊国胜,胡虹,等.原发性气管淋巴上皮瘤样癌1例 [J].中国肿瘤临床,2002,29:488.