结、直肠癌术后孤立性肺转移

Solitary Lung Metastasis after Resection of Colorectal Carcinoma

目的：探讨结、直肠癌术后肺孤立性转移瘤的影像表现，与原发肺癌的鉴别。材料与方法：３１年间１３例结、直肠癌术后肺孤立肿物，均经手术切除及病理证实。转移性腺癌１１例１３次，原发肺癌２例。结、直肠癌切除与肺转移瘤切除间隔时间为３～９６个月，中位３３个月。均有正侧位胸片，病灶体层和ＣＴ各６例。结果：肿物直径１．５～８．５ｃｍ（中位３．４ｃｍ），类圆形３例，椭圆形８例１０个，浅分叶１０例；边缘光整８例１０个，不光整３例，毛刺１例。平片密度均匀１１例次。６例ＣＴ中５例见肿物位于肺外周；发现瘤内弥漫性斑片状钙化１例，不均匀低密度区、毛刺、胸膜凹陷各３例。结论：（１）结、直肠癌术后孤立性肺转移以边缘光整的圆／椭圆形肿物为多；（２）少数可表现为与肺原发癌相似；肿物内可有弥漫钙化；（３）ＣＴ对于确定肿物部位、数目、密度、边缘形态明显优于平片。

Objective: To evaluate the image findings of the solitary metastasis after resection of colorectal carcinoma, in order to distinguish from the primary lung cancer.Materials and Methods:In 31 years, 13 cases (15 episodes) with a solitary lung mass after colorectal carcinoma resection were excised and pathology proved. Eleven cases (13 episodes) had solitary metastasis and 2 had primary lung cancer. All had PA and lateral chest films, linear tomography and CT were available in 6 cases.Results:The interval of colorectal carcinoma resection and excision of lung metastasis were 3～96 months (medium, 33 months). On chest film, the size of metastatic tumors were 1.5～8.5cm (medium, 3.4cm). Three cases were spherical and 8 were oval in shape, 10 were slightly lobulated, 8 cases (10 masses) were well defined, 3 were poorly defined in the contour, 1 had spiculation. All of the masses showed homogeneous density. On CT, 5 of the 6 masses located in the peripheral region of the lung. CT depicted diffuse patch calcification in 1 mass which was not shown on chest films. There were heterogeneous low density areas, spiculation, pleural indentation in 3 cases respectively.Conclusion: (1) Most of the solitary pulmonary metastasis of colorectal carcinoma were well defined spherical/oval mass; (2) some of them were similar to primary lung cancer. Diffuse calcification could be found inside metastatic nodule; (3) CT provided more information than chest films in evaluating location, number, density, contour, and shape of the mass.