囊性肺癌的HRCT表现及病理类型研究  

A study on the findings and pathology of cystic lung cancer in HRCT

作　　者：陈代文 陈自谦 许尚文 李辉 付丽媛 CHEN Daiwen;CHEN Ziqian;XU Shangwen;LI Hui;FU Liyuan(Department of Radiology,The 900th Hospital of Joint Logistic Support Force,Fuzhou 350025,China)

机构地区：[1]联勤保障部队第九〇〇医院放射诊断科,福州350025

出　　处：《功能与分子医学影像学（电子版）》2020年第3期1888-1893,共6页Functional and Molecular Medical Imaging(Electronic Edition)

摘　　要：目的分析51例囊性肺癌患者的高分辨率CT(HRCT)征象与病理类型及表现,以提高对这类肿瘤征象的理解与认识,并探讨囊性肺癌形成的病理机制。方法回顾性分析2010年1月~2019年12月联勤保障部队第九〇〇医院经多排螺旋CT胸部检查发现及经病理证实的囊性肺癌51例,对其临床、影像及病理资料进行分析。结果51例囊性肺癌患者中,除20例有呼吸系统症状外,其余均体检发现;51例均为单发病灶,病灶在右肺上叶13例,右肺中叶3例,右肺下叶15例,左肺上叶11例,左肺下叶9例;病变大小1.95~18.55 cm2;出现“分叶征”51例(100﹪),“毛刺征”48例(91.1﹪),“胸膜凹陷征”38例(74.5﹪),囊腔形态不规则36例(70.5﹪),腔内含血管13例(25.5﹪),囊腔内分隔25例(49.1﹪),囊腔内壁结节40例(78.4﹪)。51例患者中,经病理证实腺鳞癌4例,鳞癌4例,腺癌43例。结论绝大多数囊性肺癌的病理类型为腺癌。在CT图像上,一般表现为典型的周围型肺癌征象。囊性肺癌形成的病理机制主要是肿瘤沿肺泡壁或细支气管生长,并形成单向阀门瓣,肺泡内因压力逐渐增大导致肺泡壁破坏融合形成囊腔。Objective To improve the understanding of tumor signs,and explore the pathological mechanism of cystic lung cancer by analyzing the findings in HRCT on the pathological types and manifestations of cystic lung cancer.Methods 51 cases of pathologically confirmed lung cystic lung cancer in 900th Hospital of Joint Logistics Support Force from January 2010 to December 2019 were retrospectively analyzed.The clinical and imaging data were collected and analyzed,and compared with pathological types,so as to observe the pathological basis of cystic cavity formation.Results There were 51 patients,37 males and 14 females.The age was 24~83 years old,with an average age of 56 years.Tumors were all found in physical exams except for 20 cases with respiratory symptoms.Among these 51 cases,13 cases occurred in the upper lobe of the right lung,3 cases in the middle lobe of the right lung,and 15 cases in the lower lobe of the right lung.There were 11 cases in upper lobe of left lung and 9 cases in lower lobe of left lung;51 cases(100﹪)had lobulation sign,48 cases(91.1﹪)had burr sign,38 cases(74.5﹪)had pleural indentation sign,36 cases(70.5﹪)had irregular cystic cavity shape,13 cases(25.5﹪)had intraluminal blood vessels,25 cases(49.1﹪)had intercapsular septum,and 40 cases(78.4﹪)had inner wall nodules.There were 4 cases of adenosquamous carcinoma,4 cases of squamous cell carcinoma and 43 cases of adenocarcinoma.The normal alveolar wall was replaced by tumor cells,and the alveolar walls were destroyed and fused to form a cystic cavity.Conclusions The pathological type of most of the cystic lung cancer cases is adenocarcinoma.In CT images,there are typical signs of peripheral lung cancer.The main pathological mechanism of cystic formation is that the tumor grows along the alveolar wall or bronchiole,and forms a unidirectional valve.

关 键 词：囊性肺癌 高分辨率CT 病理 

分 类 号：R445.3[医药卫生—影像医学与核医学] R734.2[医药卫生—诊断学]