胸部Castleman病的X线和CT表现与病理对照  

Intrathoracic Castleman Disease: Radiological Features with Histopathologic Correlation

作　　者：王仁贵[1] 宾怀有[2] 那佳[3] 朱学俊[4] 王仪生[1] 唐光健[1] 蒋学祥[1] 高玉洁[1] 

机构地区：[1]北京大学第一医院医学影像科,100034 [2]广西柳州市工人医院放射科 [3]北京大学第一医院病理科,100034 [4]北京大学第一医院皮肤科,100034

出　　处：《临床放射学杂志》2002年第8期605-608,共4页Journal of Clinical Radiology

摘　　要：目的　讨论胸部Castleman病X线和CT表现以及病理特征。资料与方法　胸部Castleman病 12例 ,男 5例 ,女 7例 ,平均年龄 35岁。局限型 10例 ,弥漫型 2例。均经手术和病理证实。结果　病理上包括透明血管型 10例和浆细胞型 2例。X线和CT扫描 :10例局限型为平均直径 4.9cm大小的单发软组织肿块 ,位于中纵隔或肺门者4例 ,前纵隔和后纵隔各 3例。平扫CT值平均 40HU ,增强扫描呈早期显著均匀强化 ,CT值平均 133HU ,延迟扫描仍持续强化 ,CT值平均 92HU ,2例伴有中央区分支状钙化。 2例弥漫型表现为双侧中等量胸腔积液 ,纵隔内多个直径1～ 2cm大小的淋巴结 ,胸膜下小结节影和支气管血管束周围结节影。术前CT误诊率为 83.3%。结论　胸部局限型Castleman病以强化明显或中央伴有分支状钙化的巨大孤立肿物为特征 ,CT增强扫描有助于明确诊断和临床分型。弥漫型Castleman病的影像学表现复杂多样 ,确诊主要依靠病理和免疫组织化学检查。Objective To discuss CT signs of Castleman disease (CD) and to study the correlation of CT features with pathologic findings. Materials and Methods Twelve patients, including 5 males and 7 females with a mean age of 35 years, with pathologically proved CD were collected in this study. The disease was divided into localized type (n=10) and disseminated type (n=2). The clinical data, surgical and pathological results and CT signs were retrospectively analyzed.Results In 10 cases with localized type of CD, the lesion presented as a solitary soft tissue mass with a mean diameter of 4.9cm, which located in the middle mediastinum or at hilus of the lung (n=4), in the anterior mediastinum (n=3) or in the posterior mediastinum (n=3). On plain CT scan, the mean CT value was 40HU. After contrast administration, obvious homogeneous enhancement was observed in early arterial phase with a mean CT value of 133HU, the enhancement remained on delayed scans with a mean CT value of 92Hu. Ramified calcification in the central area of the lesion was seen in 2 cases. In 2 cases with disseminated type of CD, bilateral pleural effusion, diffuse mediastinal lymphadenopathy, and subpleural and peribronchial nodules were seen. The preoperative misdiagnosis by CT was 83.3%.Conclusion Intrathoracic localized CD is characterized by the presence of a solitary mass with marked enhancement and/or central ramified calcification. Disseminated CD carries no specific CT signs, its verification is mainly based on pathologic and immunohistochemical examinations.

关 键 词：CT表现 X线表现 病理特征 诊断 胸部 Cstleman病 

分 类 号：R551.2[医药卫生—血液循环系统疾病]