原发性肺肉瘤样癌的CT表现与病理特点  

Computed tomographic and pathological features of primary pulmonary sarcomatoid carcinoma

作　　者：潘历波 赵学武 薛龙梅 贾霞 李若豪 王曙升 Pan Libo;Zhao Xuewu;Xue Longmei;Jia Xia;Li Ruohao;Wang Shusheng(CT Room,Shaanxi Province Tumor Hospital,Shaanxi Xi'an 710061,China)

机构地区：[1]陕西省肿瘤医院CT室

出　　处：《现代肿瘤医学》2019年第19期3504-3507,共4页Journal of Modern Oncology

基　　金：陕西省自然科学基础研究计划(编号:2018JM7095)

摘　　要：目的:探讨原发性肺肉瘤样癌(PSC)的CT表现与病理特点。方法:回顾性分析30例PSC患者的临床、影像资料,并与病理结果进行对照。结果:30例患者,单发26例,多发4例(合并肺内转移),其中中央型5例,周围型25例;19例位于上肺,9例位于下肺,2例跨叶生长;肿块最大直径约12.6cm,最小直径约1.5cm,平均为(6.5±3.4)cm;18例肿块边缘可见分叶、棘突,18例肿块密度不均匀,3例可见空洞,2例伴钙化。16例行增强CT检查,肿块呈不规则环形和/或斑片状强化;13例患者单侧或双侧肺门和/或纵隔肿大淋巴结,椎体及肋骨受累者7例,胸腔积液9例,6例伴肝、脑、肾上腺等转移。免疫组织化学检查30例广谱细胞角蛋白(CK-pan)均为阳性,26例波形蛋白(Vimentin)阳性,12例细胞角质蛋白7(CK7)阳性,3例上皮细胞膜抗原(epithelial membrane antigen,EMA)阳性,11例甲状腺转录因子-1(thyroid transcription factor-1,TTF-1)阳性。结论:肺肉瘤样癌以周围型为主,CT上有相对特征性的表现,平扫可见不均匀软组织密度肿块,肿块多有坏死液化区,增强扫描肿块大多呈不均匀性强化,但确诊需要靠病理结合免疫组织化学检查。Objective:To investigate the computed tomographic(CT) and pathological features of primary pulmonary sarcomatoid carcinoma(PSC).Methods:The clinical data and CT images of 30 patients with pathologically confirmed PSC were retrospectively analyzed.Results:Solitary pulmonary mass was identified in 26 patients and multiple pulmonary masses in 4 patients.25 lesions were peripheral and 5 lesions were central tumors.2 lesions were transfoliar growth.The mean diameter of the lesions was(6.5±3.4)cm(range 1.5 to 12.6 cm).The lesions appeared rough edge in 18 patients(with deep or shallow lobulation or speculate protuberance).On plain CT,18 cases showed nonuniform density with punctiform calcification in 2 patients,cavity in 3 patients.On contrast-enhanced CT scanning,irregular ring/patchy enhancement were shown in 16 patients.Of all patients,13 patients had unilateral or bilateral hilar and/or mediastinal lymphadenopathy vertebral and rib involvement in 7 cases,pleural effusion in 9 cases,6 cases with liver,brain and adrenal metastasis.Immunohistochemically,anti-pan cytokeratin antibody was positive in 30 patients,cytokeratin 7 was positive in 12 patients.Vimentin was positive in 26 patients,epithelial membrane antigen was positive in 3 patients,and thyroid transcription factor-1 was positive in 11 patients.Conclusion:Most cases of primary PSC appear as larger peripheral mass,and the tumor grows rapidly.CT features of primary PSC are distinctive relatively in certain extent,and all cases had large neoplasms with inheterogeneous density on the unenhanced CT films,which showed hierarchical contrast enhancement after injection of contrast media.The histopathological examination is still the most reliable way to make the final diagnosis.

关 键 词：肺肉瘤样癌 X线体层摄影 病理 

分 类 号：R734.2[医药卫生—肿瘤]