肺原发黏液腺癌的CT征象分析
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摘要
目的探讨肺原发黏液腺癌(PPMA)的CT表现特点。方法回顾性分析经手术、气管镜或CT引导下穿刺活检病理证实的50例PPMA患者CT表现,并对结节肿块型和肺炎型(大片状和斑片状)病变间接征象发生率行连续校正卡方检验分析。结果在50例PPMA中,中央型2例,周围型48例;累及1个肺叶47例,其中位于两肺下叶33例,右肺中上叶10例,左肺上叶4例;累及右肺多肺叶3例。结节肿块型24例,肺炎型24例(大片状16例,斑片状8例),指套状2例;增强后轻度强化48例,中度强化2例;淋巴结转移9例,胸腔积液5例。在结节肿块型中实性21例,混合磨玻璃3例。最大直径0.8～12 cm,边缘大多清楚常伴分叶,也可伴毛刺、胸膜凹陷征、充气支气管征及空洞空泡,钙化少见。大片状病灶均沿胸膜下铸形生长,增强后见血管造影征15例。斑片形病灶边缘清楚或模糊,叶内播散1例。单指和多指套状各1例,边缘光整,密度均匀;气管、支气管播散1例。结节肿块型与肺炎型病灶淋巴结、胸腔及肺内转移发生率比较均无统计学差异(P>0.05)。结论 PPMA CT表现多种多样,其中肺炎型表现具有特点,如出现两下肺大片影伴增强血管造影征,有助于该肿瘤的诊断。
Objective To investigate the CT imaging features of Primary pulmonary mucinous adenocarcinoma(PPMA). Methods The CT findings of 50 cases of PPMA diagnosed by operation,bronchoscopy or CT guided biopsy were retrospectively analyzed,and the incidence of indirect signs with the nodular mass and inflammatory performance form(shape and patch shape) were comparatively analyzed by continuous calibration card square inspection. Results In the 50 cases of PPMA,the lesions were located in the central type(n=2)and the peripheral type(n=48); involved single pulmonary lobe(n=47) which were in the lower lobe of the lung(n=33),in the upper right lobe(n=10) and in the upper lobe of left lung(n=4); involved multiple lobes in the right lung(n=10). Among them,there were nodular mass(n=24),pneumonia type(n=24) namely large patchy(n=16)and patchy patchy(n=8),and fingersets(n=2). There were 48 cases with mild enhancement and 2 cases with moderate enhancement. There were 9 cases of lymph node metastasis and 5 cases of pleural effusion. In nodular mass form which had solid density shadow(n=21),mixed ground-glass(n=3),the largest diameter from 0.8 cm to 12 cm,majority of margins were clear and lobulated,as well with spiculations,pleural depression,air bronchogram,vacuole and empty cavity signs,calcification is rare. The large patchy lesions were cast under the pleura,and "angiogram sign" were found post-contrast in 15 cases. The edge of the patchy lesion was clear or indistinct,and 1 case had arborization. The fingersets had each 1 case of single finger and multiple fingers,with smooth edge and uniform density,spread along the trachea and bronchi in 1 case. There was no statistical difference in the incidence of lymph nodes,pleural and lung metastasis between nodular mass and pneumonia type(P>0.05). Conclusion The CT features of PPMA are numerous and varied,therefore,the manifestation of the pneumonia-type has specific characteristics. If the lower lobe of the lungs has the large patchy lesion and "angiogram sign" post-contrast,it will help to hint the diagnosis of PPMA.
Objective To investigate the CT imaging features of Primary pulmonary mucinous adenocarcinoma(PPMA). Methods The CT findings of 50 cases of PPMA diagnosed by operation,bronchoscopy or CT guided biopsy were retrospectively analyzed,and the incidence of indirect signs with the nodular mass and inflammatory performance form(shape and patch shape) were comparatively analyzed by continuous calibration card square inspection. Results In the 50 cases of PPMA,the lesions were located in the central type(n=2)and the peripheral type(n=48); involved single pulmonary lobe(n=47) which were in the lower lobe of the lung(n=33),in the upper right lobe(n=10) and in the upper lobe of left lung(n=4); involved multiple lobes in the right lung(n=10). Among them,there were nodular mass(n=24),pneumonia type(n=24) namely large patchy(n=16)and patchy patchy(n=8),and fingersets(n=2). There were 48 cases with mild enhancement and 2 cases with moderate enhancement. There were 9 cases of lymph node metastasis and 5 cases of pleural effusion. In nodular mass form which had solid density shadow(n=21),mixed ground-glass(n=3),the largest diameter from 0.8 cm to 12 cm,majority of margins were clear and lobulated,as well with spiculations,pleural depression,air bronchogram,vacuole and empty cavity signs,calcification is rare. The large patchy lesions were cast under the pleura,and "angiogram sign" were found post-contrast in 15 cases. The edge of the patchy lesion was clear or indistinct,and 1 case had arborization. The fingersets had each 1 case of single finger and multiple fingers,with smooth edge and uniform density,spread along the trachea and bronchi in 1 case. There was no statistical difference in the incidence of lymph nodes,pleural and lung metastasis between nodular mass and pneumonia type(P>0.05). Conclusion The CT features of PPMA are numerous and varied,therefore,the manifestation of the pneumonia-type has specific characteristics. If the lower lobe of the lungs has the large patchy lesion and "angiogram sign" post-contrast,it will help to hint the diagnosis of PPMA.
引文
1 Yoshizawa A,Motoi N,Ricly CJ,et al.Impact of proposed IASLC/ATS/ERS/classification of lung adenocarcinoma:prognostic subgroups and implications for further revision of staging based on analysis of 514 stage 1 case[J].Mod Pathol,2011,24:653-654.
2王晓梅,王靖红,吴重重,等.原发性肺浸润型黏液腺癌的多层螺旋CT表现[J].中国医学影像学杂志,2015,23:691-694.
3朱璐,牟安娜,祝洪义,等.孤立性原发性肺黏液腺癌的CT征象分析[J].实用医学杂志,2014,30:2867-2868.
4涂灿,邓生德,汪建华,等.原发性肺黏液腺癌的影像学表现[J].中国全科医学,2015,18:1849-1853.
5宾怀有,龙腾河,滕才钧.原发性肺黏液腺癌的CT表现与病理学对照研究[J].广西医学,2014,36:527-529.
6 Popat N,Raghavan N,Mc Ivor RA.Severe bronchorrhea in a patient with bronchioloalveolar carcinoma[J].Chest,2012,141:513-514.
7张杰,邵晋晨,朱蕾.2015版WHO肺肿瘤分类解读[J].中华病理学杂志,2015,44:619-624.
8 Hata A,Katakami N,Fujita S,et al.Frequency of EGFR and KRASmutations in Japanese patients with lung adenocarcinoma with features of the mueinous subtype of bronchioloalveolar carcinoma[J].JThorac Oncol,2010,5:1197-1200.
9陈晓燕,阙瑞华,黎辉.原发性肺黏液腺癌结合病理MSCT表现分析[J].中国医疗器械信息,2017,23:25-26,78.
10秦冬雪,孙传恕,伍建林.原发性肺黏液腺癌的临床表现及CT征象[J].中国医学影像技术,2016,32:1070-1074.
11 Sawada E,Nambu A,Motosugi U,et a1.Localized mueinous bronchioloalveolar carcinoma of the lung:thin-section computed tomography and fluorodeoxyglucose positron emission tomography findings[J].Jpn J Radiol,2010,28:251-258.
12张凤令,程钢,贺文,等.原发性肺黏液腺癌的CT表现[J].中华临床医师杂志(电子版),2016,10:744-746.
13王迪,于红.肺黏液腺癌的影像学与病理学研究进展[J].国际医学放射学杂志,2012,35:426-429.
2王晓梅,王靖红,吴重重,等.原发性肺浸润型黏液腺癌的多层螺旋CT表现[J].中国医学影像学杂志,2015,23:691-694.
3朱璐,牟安娜,祝洪义,等.孤立性原发性肺黏液腺癌的CT征象分析[J].实用医学杂志,2014,30:2867-2868.
4涂灿,邓生德,汪建华,等.原发性肺黏液腺癌的影像学表现[J].中国全科医学,2015,18:1849-1853.
5宾怀有,龙腾河,滕才钧.原发性肺黏液腺癌的CT表现与病理学对照研究[J].广西医学,2014,36:527-529.
6 Popat N,Raghavan N,Mc Ivor RA.Severe bronchorrhea in a patient with bronchioloalveolar carcinoma[J].Chest,2012,141:513-514.
7张杰,邵晋晨,朱蕾.2015版WHO肺肿瘤分类解读[J].中华病理学杂志,2015,44:619-624.
8 Hata A,Katakami N,Fujita S,et al.Frequency of EGFR and KRASmutations in Japanese patients with lung adenocarcinoma with features of the mueinous subtype of bronchioloalveolar carcinoma[J].JThorac Oncol,2010,5:1197-1200.
9陈晓燕,阙瑞华,黎辉.原发性肺黏液腺癌结合病理MSCT表现分析[J].中国医疗器械信息,2017,23:25-26,78.
10秦冬雪,孙传恕,伍建林.原发性肺黏液腺癌的临床表现及CT征象[J].中国医学影像技术,2016,32:1070-1074.
11 Sawada E,Nambu A,Motosugi U,et a1.Localized mueinous bronchioloalveolar carcinoma of the lung:thin-section computed tomography and fluorodeoxyglucose positron emission tomography findings[J].Jpn J Radiol,2010,28:251-258.
12张凤令,程钢,贺文,等.原发性肺黏液腺癌的CT表现[J].中华临床医师杂志(电子版),2016,10:744-746.
13王迪,于红.肺黏液腺癌的影像学与病理学研究进展[J].国际医学放射学杂志,2012,35:426-429.