继发性肺结核与腺癌肺粘液腺癌的影像分析  

Image Analysis of Secondary Tuberculosis and Lung Adenocarcinoma

作　　者：潘咏梅 王群 张蕊 

机构地区：[1]黑龙江省传染病防治院,黑龙江哈尔滨150500

出　　处：《世界最新医学信息文摘》2017年第22期3-5,9,共4页World Latest Medicine Information Electronic Version

摘　　要：目的肺粘液腺癌是肺腺癌的一种特殊类型,由于肿瘤细胞能分泌黏液,使其影像与病理上有一定的特异性,病理表现为高柱样上皮细胞沿肺泡壁生长,肺泡腔内充满黏液,典型者形成黏液湖。方法通过收集易被误诊的腺癌影像图片及病理诊断证明易被误诊为结核的影像图片。结果所有患者均接受胸部CT检查,其CT表现多样:包括块状影、大片状实变影、多发结节、空洞、胸膜增厚、胸腔积液、纵隔淋巴结肿大等,最多见表现为不规则或类圆形团块,轻度强化,浅分叶,有毛刺,可伴胸膜凹陷。结论 (1)肺原发性粘液腺癌(PPMA)大多为周围型肺癌,无特异的(典型的)临床表现及影像学表现,唯一的确诊方法是病理组织学检查;(2)免疫组化检查不仅可以确定粘液腺癌的组织来源,还可能帮助判断预后;PPMA患者的病理有必要常规做免疫组化检查;(3)发现肺部占位且有血清肿瘤标志物升高、中老年人等高危因素时,应该及早明确诊断,以免贻误病情;(4)VATS是PPMA的安全、有效、准确的诊断及治疗方法;(5)经过及时诊治,早期PPMA的预后良好,晚期PPMA可发生胸膜、肺内、骨、脑、肝、肾上腺、甲状腺转移,预后差;(6)PPMA的转移可能以淋巴转移途径为主;(7)PPMA具有一定的异质性,应根据其病理采取个体化治疗。Objective pulmonary mucinous adenocarcinoma is a special type of lung adenocarcinoma, because tumor cells can secrete mucus, its image and pathology has some certain specificity, pathogenic manifestation includes high column epithelial cells growing along alveolar wall. and there was full mucus in alveolar cavity, and typical cases had mucus lake. Methods collect images of easily misdiagnosed adenocarcinoma and of easily misdiagnosed tuberculosis through pathological diagnosis. Resu Its all patients were examined by chest CT, and CT manifestations included： massive shadow, patchy consolidations, multiple nodules. cavity, pleural thickening and pleural effusion, mediastinal lymph node enlargement and etc, and the most common manifestations include irregular or quasi circular mass. mild enhancement, shallow lobulation, burr, with pleural indentation. Conclusion 1, primary pulmonary mucinous adenocarcinoma （PPMA） mainly showed peripheral lung cancer, without specific （typical） clinical manifestations and image findings, the only definite diagnosis was histopathologic examination; 2, immunohistochemical examination can not only determine histologic origin of mucinous adenocarcinoma, but is helpful for prognosis diagnosis; 3, if there were high risk factors of pulmonary occupying lesions, increasing serum tumor markers, elderly patients, it was necessary to early diagnose to avoid delaying disease; 4.VATS was a safe. effective and accurate diagnosis and treatment method for PPMA; 5 after timely diagnosis and treatment, prognosis of early PPMA was good, and advanced PPMA may showed metastasis of pleura, lung, bone, brain, liver, adrenal gland and thyroid, with poor prognosis; 6, PPMA metastasis may be dominated by lymph node metastasis; 7, PPMA has some certain heterogeneity, individualized treatment showed be applied according to pathological situation.

关 键 词：肺结核 肺腺癌 粘液腺癌 分类 鉴别 

分 类 号：R734.2[医药卫生—肿瘤]