原发性肺浸润性黏液腺癌的CT征象与临床病理表现分析  

CT and clinical pathological features analysis of primary pulmonary invasive mucinous adenocarcinoma

作　　者：朱宝森 刘洋[3] 于鑫鑫 张帅 黄勇[4] 聂佩[5] 邓艳 崔瑾 李莎 王锡明 王琨 ZHU Baosen;LIU Yang;YU Xinxin;ZHANG Shuai;HUANG Yong;NIE Pei;DENG Yan;CUI Jin;LI Sha;WANG Ximing;WANG Kun(Department of Medical Imaging,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China)

机构地区：[1]山东大学齐鲁医学院,山东济南250102 [2]山东第一医科大学附属省立医院/山东省立医院医学影像科,山东济南250021 [3]山东中医药大学附属医院放射科,山东济南250014 [4]山东第一医科大学附属肿瘤医院/山东省肿瘤医院/山东省肿瘤防治研究院影像科,山东济南250117 [5]青岛大学附属医院放射科,山东青岛266000 [6]山东大学齐鲁医院放射科,山东济南250012

出　　处：《中国中西医结合影像学杂志》2023年第5期497-502,共6页Chinese Imaging Journal of Integrated Traditional and Western Medicine

基　　金：国家自然科学基金面上项目(82271993,81871354)。

摘　　要：目的:探讨原发性肺浸润性黏液腺癌(PIMA)的CT征象和相关临床病理特征,提高对该病的认识及诊断水平。方法:回顾性分析经穿刺活检或手术病理证实的300例PIMA患者的临床、病理和影像学资料。根据CT表现将PIMA患者分为结节肿块型组194例,肺炎型组106例。比较2组的CT征象、临床特征及病理学表现。结果:2组的年龄、发热、咳嗽、咳痰、最大径、病灶分布、磨玻璃征、空气支气管征、含气腔隙、分叶征、边界模糊、叶间裂膨隆、卫星灶、淋巴结肿大、胸膜相贴征、胸腔积液、胸膜增厚、无强化低密度区、强化程度和血管造影征比较,差异均有统计学意义(均P<0.05);2组其他临床表现和胸膜牵拉、毛刺征比较,差异均无统计学意义(均P> 0.05)。病理特征为柱状、杯状肿瘤细胞,以附壁型生长为主,分泌大量黏蛋白,使得胞质及肺泡内充满黏液,胞核位于基底部。结论:结节肿块型与肺炎型PIMA具有不同的临床表现、病理学特征与CT表现。CT表现能较好地反映其病理学基础,结合临床表现,有助于早期识别、诊断PIMA。Objective:To explore CT and clinical pathological features of primary pulmonary invasive mucinous adenocarcinoma(PIMA)and improve the diagnostic level of this disease.Methods:The clinical,pathological and imaging data of 300 patients with PIMA confirmed by puncture biopsy or surgical pathology were retrospectively analyzed.300 PIMA patients were divided into the solitary-type group(194 cases)and the pneumonic-type group(106 cases)according to CT features,and the CT,clinical and pathological features between the two groups were compared.Results:There were statistically significant differences between the two groups in age,fever,cough,sputum,the maximum diameter,lesion extent,ground glass sign,air bronchial sign,air-containing lacunae,lobar sign,blurred border sign,bulging fissure sign,satellite foci,lymph node enlargement,pleural adhering sign,pleural effusion,pleural thickening,nonenhancing hypodense area,enhancement degree and angiographic sign(all P<0.05),while there were no statistically significant differences in other clinical features,pleural traction and burr signs(all P>0.05).The pathological features of the columnar and cup-shaped tumor cells was that grew mainly in mural type,secreted a large amount of mucin,filled the cytoplasm and alveoli with mucus,and the nucleus was located at the base.Conclusions:Single-type PIMA and pneumonic-type PIMA have different clinical,pathological and CT manifestations,and CT manifestations can well reflect their pathological basis,what is more,combined with clinical manifestations,CT manifestations can help to identify and diagnose PIMA at an early stage.

关 键 词：肺腺癌 黏液腺癌 体层摄影术 X线计算机 病理学 

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