纵隔类癌的临床特征、病理及CT表现分析  

Analysis of the clinical,pathological and CT features of mediastinal carcinoid

作　　者：陈明井 何玲[2] 李倩 于永梅[1] 周忠春 CHEN Mingjing;HE Ling;LI Qian;YU Yongmei;ZHOU Zhongchun(Department of Radiology,Jining No.1 People’s Hospital,Jining,Shandong Province 272000,China;Department of Radiology,Children’s Hospital of Chongqing Medical University,Chongqing 400014,China;Department of Pathology,Jining No.1 People’s Hospital,Jining,Shandong Province 272000,China;Department of Radiology,Yan’an Hospital Affiliated to Kunming Medical University,Kunming 650051,China)

机构地区：[1]济宁市第一人民医院放射科,山东济宁272000 [2]重庆医科大学附属儿童医院放射科,重庆400014 [3]济宁市第一人民医院病理科,山东济宁272000 [4]昆明医科大学附属延安医院放射科,云南昆明650051

出　　处：《实用放射学杂志》2024年第8期1259-1262,共4页Journal of Practical Radiology

摘　　要：目的分析纵隔类癌的临床特征、病理及CT表现,提高诊断准确率。方法回顾性分析4例纵隔类癌的临床、病理及影像资料。结果4例均发生于老年男性,3例术前血神经元特异性烯醇化酶(NSE)升高,另1例未查。4例均为不典型类癌;Ki-67指数为5%~25%,Syn、CD56、CK、CgA均阳性。CT表现为前纵隔偏侧生长肿块(3例偏左侧,1例双侧分布),3例沿血管间隙生长、与心包及心血管分界不清;3例体积较大、呈不规则形,1例呈类圆形;3例密度不均匀,1例密度均匀;2例伴瘤内钙化;增强CT显示病变呈轻中度渐进性强化,3例瘤内见胸廓内动脉供血;3例伴纵隔淋巴结增大,1例伴骨转移。结论纵隔类癌好发于老年男性,血NSE多升高。CT表现为前纵隔偏侧生长肿块,密度多不均匀,可伴钙化,增强后呈轻中度渐进性强化,其内可见胸廓内动脉供血。病灶较大者与邻近肺组织及心血管分界不清,常伴胸内外淋巴结转移。Objective To analyze the clinical,pathological and CT features of mediastinal carcinoid so as to improve the diagnostic accuracy.Methods The clinical,pathological and imaging data of 4 patients with mediastinal carcinoid were analyzed retrospectively.Results All 4 patients were elderly male,in which 3 cases had elevated serum neuron specific enolase(NSE)before operation and other one was not examined.All tumors were atypical carcinoid with Ki-67 expression of 5%-25%and positive expression of Syn,CD56,CK and CgA.The CT showed the lateral mass on the left(n=3)or both(n=1)sides of the anterior mediastinum,3 of which grew along the vascular space and could not be clearly demarcated from the pericardium and cardiovascular system.The lesions were large with irregular shape in 3 cases and round shape in 1 case,with heterogeneous density in 3 cases and homogeneous density in 1 case,with intratumoral calcification in 2 cases.Contrast enhanced CT showed the lesions with mild or moderate progressive enhancement,3 of which had supplying vessels from internal thoracic artery.The enlarged mediastinal lymph nodes were found in 3 cases and bone metastasis was in 1 case.Conclusion Mediastinal carcinoid is more common in elderly male,usually with elevated serum NSE.CT shows lateral mass in the anterior mediastinum with heterogeneous density,intratumoral calcification,mild or moderate progressive enhancement,and supplying vessels from internal thoracic artery.The larger lesion is indistinguishable from the adjacent lung tissue and cardiovascular system,usually with intrathoracic and extrathoracic lymph node metastasis.

关 键 词：纵隔 类癌 计算机体层成像 

分 类 号：R734.5[医药卫生—肿瘤] R814.42[医药卫生—临床医学]