肺肉瘤样癌的影像学表现及临床病理分析

Radiological analysis of pulmonary sarcomatoid carcinoma correlated with clinical and pathological findings

目的:分析肺肉瘤样癌(PSC)的影像学表现,并与临床病理相对照,以提高诊断准确性。方法:回顾性分析经手术和病理证实的8例PSC,术前分别经X线、CT平扫及增强扫描,复习影像表现并与手术病理对照。结果:8例病灶中,6例为单发,其中右肺4例,左肺2例;2例为多发病灶(并肺内转移),原发灶均位于左肺。7例患者行CT扫描:平扫均可见肺内病灶:巨大类球形肿块者5例,不规则结节者3例;增强扫描前者多呈"肉瘤样"强化方式,即肿块呈不均匀强化,周边强化明显,中央坏死区轻度强化或不强化;后者强化方式不一,1例全瘤不均匀强化,2例周边强化。7例PSC中合并空洞者1例(合并真菌感染),毛刺征1例,纵隔及肺门淋巴结转移3例,胸水2例,胸膜结节3例,阻塞性肺不张1例,阻塞性炎症2例,肺外转移(肝、脑)2例,肺内转移2例,邻近肋骨破坏1例。组织学类型:梭形细胞癌1例,其余7例由梭形细胞与上皮细胞两种成分构成。免疫组化显示:CK(++～+++)7例;Vimentin(++～+++)6例,CEA(+++)1例。结论:PSC临床无特异性,影像学表现大多具有肺癌和肉瘤的双重特征,确诊要靠病理检查。

Objective： To investigate the value of radiography in the diagnosis of pulmonary sarcomatoid carcinoma（PSC） correlated with the clinical and pathological findings. Methods： Eight patients with PSC proven by surgery and pathology, underwent radiographic examination （X-ray and CT）. The images were reviewed retrospectively and correlated with pathological manifestation. Results： In 8 cases, 6 cases had single mass （4 in right lung, 2 in left hmg）, and 2 had more than one mass. Seven patients underwent CT examination. The pre-contrast CT films of 5 cases exhibited large globular masses, and 3 showed irregular node. After administration of contrast medium, most of them had a heterogeneous enhancement. The CT films also showed other features： cavity in 1 （with fungus）, spiculation sign in 1, enlargement of lymph node of the hilum and mediastinum in 3, pleural fluid in 2, pleural nodes in 3, pulmonary atelectasis in 1, obstructive pneumonia in 2, metastasis out of the lung in 2, metastasis of the lung in 2 and rib destruction in 1. Microscopically, 1 was spindle cell carcinoma, oth- er 7 cases were composed of spindle cell and epithelial cell. hnmunohistochemically, CK was positive （＋＋-＋＋＋） in 7 cases, and Vimentin （＋＋-＋＋＋） in 6 cases, CEA （＋＋＋） in 1 case. Conclusion： Although PSC has no specific clinical features, it had both lung cancer and sarcomatoid features in most of the radiological signs. Finally, it is dependent on pathologic examination to establish the diagnosis.