摘要
目的探讨原发性肺肉瘤样癌的CT影像特点,提高对原发性肺肉瘤样癌的认识,增加术前诊断的准确率。方法回顾性分析2013年11月至2016年9月苏北人民医院收治的12例经病理证实为原发性肺肉瘤样癌的临床资料、CT影像特点及治疗方法。结果 12例患者均为单发,周围型8例,中央型4例,直径为0. 7~8. 6(4. 5±1. 9) cm,5例位于左肺,7例位于右肺。CT均表现为肺内肿块(n=11)或结节(n=1),病灶呈类圆形伴有钙化(n=1),棘突征(n=5),分叶征(n=5),毛刺征(n=2),累及胸膜(n=8),伴纵隔淋巴结肿大(n=3),肺门淋巴结肿大(n=3),骨转移(n=2),左下肢及脾转移(n=1)。CT平扫均呈不均匀软组织密度肿块,CT值为14~38(21±14) HU,增强扫描肿块呈分层强化(n=11),增强后边缘CT值为47~60(57. 2±14) HU,低密度区CT值为19~29(25. 3±6. 3) HU。本组病例中发现占位后行手术切除的4例患者中有2例好转后出院,余放弃治疗。结论肺肉瘤样癌以周围型为主,生长迅速,CT上有相对特征性的表现,平扫可见不均匀软组织密度肿块,增强扫描肿块大多呈分层强化方式,确诊需依靠组织病理学检查。
Objective To investigate the CT characteristics of primary pulmonary sarcomatoid carcinoma（PSC）,and to improve the knowledge of this disease and increase the accuracy of preoperative diagnosis. Methods The clinical data,CT manifestations and therapeutic method of 12 patients with primary PSC confirmed by pathology from November 2013 to September 2016 in Northern Jiangsu People′s Hospital were reviewed retrospectively. Results All lesions were unilateral.Eight lesions were peripheral and four lesions were central tumors,including 5 in left lung and 7 in right lung.The mean diameter of the lesions was（4.5±1.9）cm（range 0.7 to 8.6 cm）.CT showed all cases presented with a spheroid solid lung mass（ n =11）or nodule（ n =1）,and all lesions were quasi-circular,with calcification（ n =1）,spinous protuberance（ n = 5）,lobulated（ n =5）,spicule sign（ n =2）,pleural invasion（ n =8）,mediastinal lymph nodes metastases（ n =3）,hilar lymph nodes metastases（ n =3）,osseous metastasis（ n =2）,left lower extremity and splenic metastasis（ n =1）.CT presented all cases had large neoplasms with inhomogeneous density,with a mean value of（21±14）HU（range 14 to 38 HU）,which showed irregular hierarchical heterogeneous contrast enhancement after injection of contrast media.The value of high enhancement areas was（57.2±14）HU（range 47 to 60 HU）,while the low attenuation was（25.3±6.3）HU（range 19 to 29 HU）（ n =11）.In these cases,there were 4 cases being resected by surgical operation,of which 2 patients′condition had improved,and the rest abandoned treatment. Conclusion Most cases of primary PSC appear as larger peripheral mass,and the tumor grows rapidly.CT features of primary PSC are distinctive relatively in certain extent,and all cases had large neoplasms with inheterogeneous density on the unenhanced CT films,which showed hierarchical contrast enhancement after injection of contrast media.The histopathological examination is still the most reliable way to
作者
王猛
田彤彤
朱庆强
彭云
尚松安
张洪英
吴晶涛
Wang Meng;Tian Tongtong;Zhu Qingqiang;Peng Yun;Shang Song＇an;Zhang Hongying;Wu Jingtao(Clinical Medical College,Yangzhou University,Yangzhou 225000,China;Northern Jiangsu People＇s Hospital,Yangzhou 225000,China;Xiangya Medical College of South Central University,Changsha 410013,China)
出处
《中华消化病与影像杂志（电子版）》
2018年第4期152-157,共6页
Chinese Journal of Digestion and Medical Imageology(Electronic Edition)
基金
国家自然科学基金(8157070366)
江苏省青年医学重点人才(QNRC2016349)
扬州市基础研究计划(自然科学基金)面上项目(YZ2015100)
关键词
肺肉瘤样癌
体层摄影术
X线计算机
Pulmonary sarcomatoid carcinoma
Tomography,X-ray computed
