表现为双肺多发空洞影的原发或转移性恶性肿瘤的临床特点  

The clinical features of primary or metastatic malignancies presenting with multiple lung cavities

作　　者：陈文慧[1] 张雪丽[1] 张镭[2] 翟晓丽[2] 张予辉[1] 韦萍[3] 代华平[1] 

机构地区：[1]首都医科大学附属北京朝阳医院呼吸与危重症医学科,100020 [2]首都医科大学附属北京朝阳医院放射科,100020 [3]首都医科大学附属北京朝阳医院病理科,100020

出　　处：《中华结核和呼吸杂志》2016年第2期88-92,共5页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：国家自然科学基金（81270123）

摘　　要：目的 探讨以双肺多发空洞影为主要表现的恶性肿瘤患者的临床、影像与病理学特点.方法 回顾性分析2006年6月至2013年8月我院影像科资料库中胸部高分辨率CT符合双肺多发空洞影（≥3个）的38例肺恶性肿瘤患者.肺原发性恶性肿瘤30例,肺转移恶性肿瘤8例,包括胃肠道肿瘤6例,外阴及头皮恶性肿瘤各1例.男17例,女21例,年龄32～ 83岁,中位年龄63岁.结果 肺原发肿瘤最常见的临床表现为咳嗽、咳痰（22/30例）.影像学空洞类型主要包括不规则厚壁空洞12例,小环形空洞24例,囊腔样空洞11例,空洞伴周围磨玻璃影及实变影11例.空洞病变通常与结节、肿块、磨玻璃影共存（32/38,84％）.空洞内软组织分隔常见（17/38,45％）.空洞伴周围磨玻璃影或大片实变影及空洞液平仅见于肺腺癌,包括5例黏液腺癌.无论是肺部原发肿瘤还是转移性肿瘤,腺癌均为最常见的组织学类型（分别为29/30例和6/8例）.肺鳞状细胞癌、外阴腺鳞癌和头皮血管肉瘤各1例.空洞形成的可能机制包括肿瘤中心坏死、黏液分泌、乳头状肿瘤形成的含气囊性区域和“活瓣”机制.结论 表现为双肺多发空洞影的恶性肿瘤中腺癌是最常见的组织学类型,临床表现无特异性,影像学表现为空洞形态多种多样,易误诊为良性病变,诊断时需提高警惕.Objective To evaluate the clinical,radiological and pathological features of primary or metastatic malignancies presenting with multiple lung cavities.Methods A total of 38 cases met the inclusion criteria and had adequate imaging data for retrospective review between June 2006 and August 2013.There were 30 cases of primary lung cancer,and 8 cases of pulmonary metastasis including 6 gastrointestinal tract malignancies,1 vulva malignancy and 1 scalp malignancy.There were 21 females and 17 males,with a median age of 63 years.Results Cough and expectoration were the most common clinical manifestations of primary lung cancer（22/30）.There were 4 main types of lung cavities,including thickwalled cavities（n =12）,circular cavities （n =24）,thin-walled cavities or cystic cavities （n =11）,cavities or multi-cystic changes within airspace consolidation or ground glass opacity（n =11）.The cavitary lesions were often accompanied by pulmonary nodules,mass and ground glass opacity（32/38,84%）.The presence of internal soft-tissue septa in the cavity was commonly seen（17/38,45%）.The 4th type of cavity and presence of air-fluid levels were only found in lung adenocarcinoma,including 5 cases of mucinous adenocarcinoma.In both primary lung cancers and metastatic tumors,adenocarcinoma was the most common histological type （29/30 and 6/8,respectively）.The other histological types included 1 case of lung squamous cell carcinoma,1 vulva adenosquamous carcinoma and 1 scalp angiosarcoma.The possible mechanisms of cavity formation included necrosis,mucin-secretion air-containing cystic spaces in papillary tumors and the check-valve mechanism.Conclusions Adenocarcinoma was the most common histological type in multiple cavitary primary lung cancers and metastatic tumors.These cavities showed varied radiological features and were easy to be misdiagnosed as benign cavitary lung diseases.

关 键 词：肺肿瘤 多发空洞 

分 类 号：R734.2[医药卫生—肿瘤]