原发性肺腺样囊性癌的CT表现

CT Manifestations of Primary Pulmonary Adenoid Cystic Carcinoma

目的分析原发性肺腺样囊性癌(ACC)的CT表现,以提高对其的认识及诊断水平。方法回顾性分析经病理证实的36例原发性肺ACC的CT表现及临床资料。结果本组中央型病变33例,其中位于气管18例,左主支气管3例,右主支气管5例;累及同侧多支支气管者7例。周围型病变3例。病灶呈气管腔内外浸润型肿物20例,5例与甲状腺、3例与食管壁分界不清;呈相邻多支支气管管壁弥漫增厚型7例;呈气管腔内型肿物6例,呈肺内无毛刺的分叶状肿物3例。ACC平扫密度均低于胸壁密度,3例伴少许钙化,轻度强化20例,中度强化10例。合并阻塞性肺炎12例、肺不张7例,纵隔淋巴结肿大3例,肺门淋巴结肿大1例,2例伴多发肺转移。结论原发性肺ACC好发于大气管,多表现为浸润气管腔内外型、管壁弥漫增厚型及气管腔内型肿物,少数为周围型肿物,强化程度较轻,CT扫描可准确显示病灶及周围情况,为临床诊疗提供重要信息。

Objective To explore the CT features of primary pulmonary adenoid cystic carcinoma(ACC).Methods The CT images and clinical data of 36 patients with primary pulmonary ACC were analyzed retrospectively.Results There were 33 cases of central lesion in this group,and ACC were located in trachea in 18 cases,left main bronchus in 3 case,right main bronchus in 5 cases,involve both main bronchus and lobar bronchus in 7 cases.Peripheral in 3 cases.20 cases presented tra-and-extraluminal lesions located in airways,5 cases and 3 cases respectively presented unclear boundary with thyroid and esophagus;7 cases presented diffuse wall thickening lesions,6 cases presented intraluminal lesions,3 cases presented sublobe Peripheral mass which no sentus.All cases showed low density which lower than adjacent chest wall muscle on plain scan,showed calcification in 3 cases.20 cases appeared slightly enhancement and 10 cases appeared middling enhancement on enhanced.12 cases complicated with obstructive pneumonia,7 cases complicated with atelectasis.Mediastinal lymph nodes were seen in 3 cases,hilar lymph node were seen in 1 patient.Multiple intrapulmonary metastasis were found in 2 cases.Conclusion Primary pulmonary ACC are most occur in major airways and present intra-and-extraluminal tumor or diffuse wall thickening tumor or intraluminal tumor with wide base.minority cases present peripheral tumor.most cases show slightly enhancement.CT images can provides precise information about the tumor for clinical diagnosis and treatment.