肺大细胞癌的临床病理及其MDCT特征分析  

Clinicopathologic and MDCT Features of Large Cell Lung Carcinoma

作　　者：桑海波 葛祖峰 李璐 俞伉[4] 任峰[4] 姚凤明 

机构地区：[1]浙江省宁波市医疗中心李惠利东部医院-台北医学大学宁波医疗中心影像科,315000 [2]浙江奉化市人民医院影像科 [3]宁波市临床病理诊断中心-上海市肿瘤医院宁波病理中心 [4]宁波市医疗中心李惠利医院影像科

出　　处：《临床放射学杂志》2017年第11期1639-1643,共5页Journal of Clinical Radiology

摘　　要：目的探讨WHO 2015年第4版肺大细胞癌(LCLC)的临床病理及其MDCT表现。方法回顾性分析19例经新标准确诊LCLC的临床病理资料及CT影像表现。结果 19例患者中位年龄68岁(47~81岁),18例为男性,1例为女性,长期重度吸烟史14例。病灶最长径中位数3 cm(1.7~9 cm)。1例为中央型,18例为周围型;14例位于肺上叶,5例位于肺下叶;病灶无或浅分叶征5例,深分叶4例,结节聚集10例。边缘光滑型14例,模糊型5例,其中伴毛刺4例,伴棘状突起3例,包含2例同时伴毛刺和棘状突起。CT平扫发现病灶内密度不均匀9例,密度均匀9例,散在点状钙化1例。10例行增强扫描,不均匀强化7例,其中伴环形强化1例;均匀强化3例。术后病理病灶发现坏死14例。肿瘤外改变包括:胸膜黏连伴增厚5例,肿瘤与胸膜呈宽基底或大面积黏合4例,胸膜凹陷征2例;病灶周围伴炎症11例;肺门纵隔淋巴结肿大2例。结论 LCLC的CT表现具有一定特征性,最终确诊必须依赖手术病理及免疫组织化学。Objective To explore Multi-detector CT（MDCT） features of lung large cell carcinoma（LCLC）. Methods Nineteen cases of LCLC were confirmed pathologically after tumorectomy according to the 4 th edition of WHO classification of tumors of the lung（published in 2015）. MDCT manifestations and clinicopathologic data of those cases were reviewed. Results Nineteen patients（18 males,1 female） aged 47 ~ 81 years,with a median age of 68 years. Eleven were heavy smokers. The longest diameter of lesions ranged from 1. 7-9 cm（median 3 cm）. Eighteen（94. 7%） lesions were peripheral types and only one（5. 3%） was a central tumor. Fourteen lesions（73. 7%） were located in upper lobes. Five tumors（26. 3%） had non-lobulated or mildly lobulated shapes,four tumors（21. 1%） had deep lobulated shapes,and ten tumors（52. 6%） showed nodule-assembled contour. Smooth margins were found in 14 cases（73. 7%）,while poorly defined margins were in five cases（26. 3%） with burr sign in two cases,spinous process in 1case,and both burr sign and spinous process in 2 cases. On plain CT scan,tumors had heterogeneous density（47. 4%,9/19） or homogeneous density（47. 4%,9/19）,and one tumor（5. 3%,1/19） showed multi-punctate calcification. On contrast enhanced CT scan（n =10）,seven tumors（70%,7/10） showed heterogeneous enhancement with ring enhancement in one tumor,and three tumors（30%,3/10） depicted homogeneous enhancement. While 14 tumors（73. 7%,14/19） were confirmed pathologically with necrotic regions. Findings beyond tumor included pleural thickening and adhesions（n = 5）,wide basement of tumor or large interface between tumor and pleural（n = 4）,pleural retraction（n = 2）,inflammation around the tumor（n = 11）,lymphadenopathy in the hilum or mediastinum（n = 2）. Conclusion MDCT has some value in the diagnosis of LCLC. Final diagnosis must be based on pathology and immunohistochemistry after tumorectomy.

关 键 词：肺肿瘤 癌 大细胞 病理学免疫组织化学 体层摄影术 X线计算机 

分 类 号：R730.44[医药卫生—肿瘤] R734.2[医药卫生—临床医学]