肺不典型腺瘤样增生的影像与病理对照分析  

Atypical adenomatous hyperplasia of the lung:correlation of radiographic and pathologic findings

作　　者：王建卫[1] 张宏图[2] 马霄虹[1] 吴宁[1] 

机构地区：[1]中国医学科学院 中国协和医科大学 肿瘤医院影像诊断科,北京100021 [2]中国医学科学院 中国协和医科大学 肿瘤医院病理科,北京100021

出　　处：《中华放射学杂志》2007年第5期483-486,共4页Chinese Journal of Radiology

摘　　要：目的分析肺不典型腺瘤样增生(AAH)的影像表现,并与病理对照,旨在提高对 AAH影像表现的认识。方法回顾性分析由手术及病理证实的8例 AAH 的影像表现,所有患者均摄 X 线胸片并经高分辨率 CT(HRCT)及增强扫描,均为女性,中位年龄56岁。由影像科医师及病理科医师共同阅片,将影像学结果与病理学结果进行对照分析。结果胸部正侧位片3例未检出病变,5例参照 CT 可以辨别出小类结节或淡片影。CT 8例均见肺结节影,其中右肺上叶4例,右肺中叶1例,右肺下叶1例,左肺上叶2例。最大20.0 mm×18.1 mm,最小5.0 mm×4.1 mm。HRCT 均为非实性结节,密度不均匀,平均 CT 值最高为-362.7 HU,最低为-485.6 HU,平均为(-423.0±47.0)HU;4例可见空气支气管征、空泡。病变均为类圆形,边界较清晰,边缘有浅分叶者2例。未见毛刺征和胸膜牵拉征。镜下表现为结节边界清楚,与周围肺组织分界明显;肺泡间隔轻度增厚,上皮细胞沿肺泡间隔增生,细胞间排列紧密,但无重叠及挤压;核质比例轻度失调,有轻度异形性。结论有助于AAH 影像诊断的指标为:(1)偶尔发现的肺结节,无症状;(2)病变通常直径≤10 mm;(3)HRCT 表现为非实性结节,可有空泡或空气支气管征;(4)HRCT 无毛刺征和胸膜牵拉征等表现。最终确诊仍需组织学证据。Objective To study radiographic features of atypical adenomatous hyperplasia （AAH） of lung and correlate them with their pathologic findings, so as to improve the imaging diagnose. Methods The imaging features of 8 patients with pathology- proved AAH were reviewed. All patients were women with age ranging from 35 to 74 years. All cases had chest radiography and HRCT. The radiographic findings were studied retrospectively and correlated with those of pat hology. Results On chest X-ray, the foci in five patients presented as nodule-like area of a bit high attenuation, while the chest radiograph in the other three patients were negative. On HRCT, all 8 patients presented as non-solid nodules. All lesions were round or oval shaped with well-defined margin （n = 4） or poor-defined margin （n = 3）. The greatest dimension of the lesions ranged from 5.0 mm to 20. 0 mm. Their CT value ranged from - 362. 7 HU to - 485.6 HU, the mean CT value was（ -423.0 ±47. 0） HU. Air bronchograms and/or bubbles were seen in 5 lesions. Coarse spiculation and pleural tag was not seen in any lesion. Before operation, all the nodules did not change in size over a follow-up period from one month to six months. Pathologic findings showed atypical epithelial cell proliferation along thickened alveolar septa without alveolar collapse. Conclusion AAH should be considered in cases with the following features： （1） nodules are found in lung cancer screening or incidentally detected; （2） the diameter of the nodule is usually less than 10 mm; （3） the lesion presented as non-solid nodule on HRCT, air bronchogram and/or bubble sign can be seen; （4） no coarse spiculation and plural tag was seen.

关 键 词：肺肿瘤 放射摄影术 体层摄影术 X线计算机 病理学 

分 类 号：R734.2[医药卫生—肿瘤]