原发性肺肉瘤样癌的影像特征及病理表现  

Imaging features and pathological manifestations of primary pulmonary sarcomatoid carcinoma

作　　者：李洪江[1] 周玉凤[1] 夏淦林[1] 李春笋[2] 

机构地区：[1]南通市肿瘤医院南通大学附属肿瘤医院影像科,江苏南通226361 [2]南通市肿瘤医院南通大学附属肿瘤医院病理科,江苏南通226361

出　　处：《实用放射学杂志》2014年第2期223-226,共4页Journal of Practical Radiology

摘　　要：目的 分析原发性肺肉瘤样癌的影像特征及病理表现,提高对该病的认识及影像诊断水平.方法 回顾分析经病理证实的11例原发性肺肉瘤样癌的影像及病理表现特点.结果 11例均表现为周围型肿块,位于肺上叶8例,下叶2例,中叶1例.病灶最大径3.1～12.5 cm,平均5.3 cm.肿块边缘见分叶9例、毛刺4例;密度较均匀3例,不均匀的8例病灶内见斑片状低密度坏死区,其中4例形成空洞,1例见斑片、弧线状钙化.10例增强扫描,4例病灶边缘呈厚薄不均的环形结节样持续强化,伴中央不均匀斑片状强化及无强化的坏死区,6例呈不均匀斑片状强化.9例病灶位于胸膜下,邻近胸膜受侵犯.11例中梭形细胞癌、癌肉瘤、肺母细胞瘤各1例,多形性癌8例.结论 发生在肺上叶胸膜下的较大肿块,伴有胸膜侵犯,增强扫描肿块边缘呈厚薄不均的环形结节样持续强化,中央呈斑片状不均匀强化或为无强化的液化坏死区,或伴有肿块内斑片、弧线状钙化,为原发性肺肉瘤样癌的影像特征,确诊需依靠组织病理学检查.Objective To analyze the imaging features and pathological manifestations of primary pulmonary sarcomatoid carcinoma （PSC） in order to improve the recognition and diagnosis ability.Methods The imaging manifestations and pathological features of 11 patients with pathologically proved primary PSC were retrospectively analyzed.Results All the lesions were peripheral,8 cases were located in superior lobe of lung,1 in middle lobe and 2 in lower lobe.The mean diameter of these lesions was 5.3 cm,ranging from 3.1 to 12.5 cm.Among the cases,9 cases with lobulation and 4 cases with spiculation.The tumors showed homogeneous density in 3 cases,and heterogeneous density in 8 cases with patchy low density necrotic area.Among them,4 cases with cavity and 1 with patchy,arc shape calcification.Among the 10 cases of enhanced scan,4 lesions showed peripheral continuously enhancement with irregular heterogeneous ring nodular sharp,associated with the central uneven patchy strengthening and no enhancement necrotic areas.Uneven patchy enhancement was showed in 6 cases.9 lesions located at subpleural region with adjacent pleural invasion.Among the 11 cases,8 cases were pleomorphic carcinoma,and the other 3 cases were spindle cell carcinoma type,carcinosarcoma type,and pulmonary blastoma type retrospectively.Conclusion The imaging features of primary pulmonary sarcomatoid carcinoma have distinctive characteristic in certain extent,but the final diagnosis still depends on histopathological examination.

关 键 词：肺肿瘤 肉瘤样癌 计算机体层成像 

分 类 号：R734.2[医药卫生—肿瘤] R814.42[医药卫生—临床医学]