孤立结节型肺黏液腺癌的CT表现与病理对照研究  

Solitary Nodule Pulmonary Mucinous Adenocarcinoma-Comparison of CT Findings and Pathology

作　　者：王康[1] 李铭[2] 周翔[1] 王超 陈亚峰[1] 彭屹峰[1] 盛霞[3] 黄坊 郭志强 WANG Kang;LI Ming;ZHOU Xiang(Department of Radiology,Putuo Hospital,Shanghai Chinese Medicine University,Shanghai 200061,P.R.China)

机构地区：[1]上海中医药大学附属普陀医院放射科,200061 [2]华东医院放射科,上海200040 [3]上海中医药大学附属普陀医院病理科,200061 [4]上海中医药大学附属普陀医院胸外科,200061

出　　处：《临床放射学杂志》2020年第9期1768-1772,共5页Journal of Clinical Radiology

基　　金：上海卫健委-智慧医疗医学影像重大项目(编号:2018ZHYL0103);国家科技部-国家重点研发计划(编号:2017YFC0112900)

摘　　要：目的探讨孤立结节型肺黏液腺癌CT影像成因、表现特点及其病理基础。方法回顾性分析16例经手术病理证实的孤立结节型肺黏液腺癌CT影像资料,其中12例病变部位作高分辨率CT(HRCT)薄层扫描及多平面容积重组(MPVR),另有9例行增强扫描,分析病灶分布、形态、密度特征并与之病理比较。结果16例病例中,病灶分布在胸膜、叶间裂旁占81.3%(13/16)。原位腺癌(AIS)及微浸润腺癌(MIA)含空泡征100%(3/3),浸润性黏液腺癌(IMA)空泡征69.2%(9/13);AIS及MIA见肿瘤微血管征100%(3/3),IMA 46.2%(6/13);MIA出现灶周磨玻璃影50%(1/2),IMA出现46.2%(6/13);IMA有浅分叶38.5%(5/13),细短毛刺30.8%(4/13),"胸膜牵拉征"38.5%(5/13)。9例患者增强扫描呈轻中度强化,强化程度(21.7±15.2)HU。16例结节型黏液腺癌均无淋巴结和远处转移。结论孤立结节型肺黏液腺癌在胸膜、叶间裂旁多见,灶内空泡征及肿瘤微血管征在AIS、MIA出现率最高,灶周磨玻璃影也是肺黏液腺癌一个重要征象。Objective To explore imaging origins and characteristics and pathologic basis of CT images in solitary nodule mucous adenocarcinoma of lung in an early stage.Methods A retrospective analysis of CT imaging characteristic performances in the 16 cases of solitary nodular mucous adenocarcinoma was confirmed by surgical pathology,including 12 cases with HRCT thin layer scanning and MPVR lesion reconstruction.9 cases underwent CT enhancement scanning,and the characteristics of the lesion distribution,shape,density were analyzed compared with the pathology.Results The distribution of the lesion next to pleura and interlobar fissure accounted for 81.3%in 16 cases(13/16).The carcinoma in situ and minimally invasive carcinoma with bubble-like sign accounted for 100%(3/3),which accounted for 69.2%(9/13)in invasive carcinoma.The carcinoma in situ and minimally invasive carcinoma with tumor microvascular sign accounted for 100%(3/3),which accounted for 46.2%(6/13)in invasive carcinoma.The minimally invasive carcinoma with sign of ground-glass opacities around the lesion accounted for 50%(1/2),which accounted for 46.2%(6/13)in invasive carcinoma.The invasive carcinoma with shallow lobulation sign accounted for 38.5%(5/13),which with fine short burr sign accounted for 30.8%(4/13),and which with pleural retraction sign accounted for 38.5%(5/13).The lesions in 9 patients showed mild-to-moderate enhancement with amplitude of(21.7±15.2)HU.No lymph node or distant metastasis was found in 16 cases.Conclusion The distribution of the lesion next to pleura and interlobar fissure were more observed in solitary nodular lung mucous adenocarcinoma.The sign of small bubble-like and tumor microvascular were mostly observed at both in situ and minimally invasive cases.The ground-glass opacities around the lesion was also an important sign observed in solitary nodular mucous adenocarcinoma of lung.

关 键 词：肺癌 粘液腺癌 体层摄影术 X线计算机 病理 

分 类 号：R734.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学]