肺多形性癌的CT和临床病理特征  

CT and clinicopathology features of pulmonary pleomorphic carcinoma

作　　者：刘艳芳 任刚[1] 蔡嵘[3] 汪心韵[1] LIU yan-fang;REN Gang;CAI Rong(Department of Radiology,Xin Hua Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院放射科,上海200092 [2]保山市人民医院CT室,云南678000 [3]上海交通大学医学院附属瑞金医院放疗科,上海200092

出　　处：《放射学实践》2023年第3期285-289,共5页Radiologic Practice

摘　　要：目的:探讨肺多形性癌的CT特征,并与临床病理进行对照分析。方法:回顾性分析上海交通大学医学院附属新华医院2012年10月-2021年10月收治的23例肺多形性癌患者的临床和病理资料。结果:男20例,女3例,年龄38~81岁,平均年龄64岁。4例为中央型,19例为周围型,近胸膜下16例。位于左肺上叶4例,左肺下叶5例,右肺上叶11例,右肺下叶3例。肿块直径约2.0~8.3 cm,平均5.2 cm。肿块边界光滑11例,分叶8例,毛刺10例。CT平扫18例以软组织密度为主,1例以囊性密度为主,4例为空洞肿块。12例行CT增强扫描,其中8例肿块边缘呈厚薄不均的类环形或花环状强化,6例见“浮冰样”改变。瘤周出现磨玻璃密度影13例,累及胸膜17例,伴肺门和(或)纵隔淋巴结肿大8例。病理诊断均为肺多形性癌,其中梭形细胞伴腺癌9例,梭形细胞伴鳞癌3例,梭形细胞癌伴鳞癌及腺癌3例,梭形细胞癌伴大细胞癌1例,梭形细胞及巨细胞伴腺癌1例,巨细胞伴腺癌2例,其余4例病检未详细说明多形性成分。16例行基因检测,EGFR基因突变2例,ALK相关易位1例。结论:肺多形性癌好发于老年吸烟男性,CT表现有一定特征,以周围型居多,常位于右肺上叶近胸膜下,边缘光滑,以软组织密度为主,体积较大,内部易出现坏死,增强扫描肿块边缘呈厚薄不均的类环形强化,有“浮冰样”改变,瘤周出现磨玻璃密度阴影,易侵犯胸膜、伴肺门及纵隔淋巴结转移,确诊需依靠病理及免疫组化,病理上以腺癌或鳞癌合并梭形细胞成分最常见,可伴有基因突变。Objective:To investigate the CT findings of pulmonary pleomorphic carcinoma and compare them with clinical pathological features.Methods:The clinical and pathological data of 23 patients with pulmonary pleomorphic carcinoma admitted to Xinhua Hospital Affiliated to Medical College of Shanghai Jiaotong University from October 2012 to October 2021 were retrospectively analyzed.Results:There were 20 males and 3 females,aged from 38 to 81 years,with an average age of 64 years.4 cases were central type,19 cases were peripheral type and 16 cases were near subpleural type.There were 4 cases in the upper lobe of the left lung,5 cases in the lower lobe of the left lung,11 cases in the upper lobe of the right lung and 3 cases in the lower lobe of the right lung.The diameter of the mass was about 2.0~8.3cm,with an average diameter of 5.2cm.The tumor boundary was smooth in 11 cases,lobulated in 8 cases and burr in 10 cases.CT scan showed soft tissue density in 18 cases,cystic density in 1 case and cavity mass in 4 cases.Enhanced CT scan was performed in 12 cases,of which 8 cases showed uneven thickness ring like or flower ring enhancement at the edge of the mass,and 6 cases showed"floating ice like"changes.The pathological diagnosis was pulmonary pleomorphic carcinoma,including 9 cases of spindle cell with adenocarcinoma,3 cases of spindle cell with squamous cell carcinoma,3 cases of spindle cell carcinoma with squamous cell carcinoma and adenocarcinoma,1 case of spindle cell carcinoma with large cell carcinoma,1 case of spindle cell and giant cell with adenocarcinoma,and 2 cases of giant cell with adenocarcinoma.The pleomorphic components were not described in detail in the rest 4 cases.16 cases underwent gene detection,including 2 cases of EGFR gene mutation and 1 case of ALK-related translocation.Conclusion:Pulmonary pleomorphic carcinoma is prone to occur in elderly smoking men.CT findings have certain characteristics,most of them are peripheral type,often located near the pleura in the upper lobe of the right lung,with

关 键 词：肺肿瘤 多形性癌 体层摄影术 X线计算机 病理 

分 类 号：R814.42[医药卫生—影像医学与核医学] R734.2[医药卫生—放射医学]