4例原发性肺肉瘤样癌的影像表现(附文献复习)

Imaging findings of primary lung sarcomatoid carcinoma(and literature review)

目的探讨原发性肺肉瘤样癌(PLSC)的影像表现,提高对该病的认识。方法对经病理证实的4例PLSC的临床、X线胸片、CT和病理资料进行回顾性分析。结果 4例PLSCX线胸片和CT均表现为肺内直径3.0cm～7.5cm团块状实质性病灶;肿块均为周围型;2例肿块边界清楚,密度均匀;2例病灶呈浅分叶状,有短毛刺;4例肿块均侵犯邻近胸膜;2例纵隔淋巴结肿大;1例左侧肾上腺转移。病理及免疫组化检查显示3例单一肉瘤样癌,1例多形性癌为肉瘤样癌伴腺癌Ⅱ～Ⅲ级;4例波形蛋白(Vim)及细胞角蛋白(CK)均阳性,1例上皮膜抗原(EMA)阳性,1例S-100阳性。结论周围型PLSC在CT上具有相对特征性表现,免疫组织化学Vimentin、CK有助于确诊。

【Objective】To investigate the imaging features of primary lung sarcomatoid carcinoma（PLSC） for improving knowledge of PLSC.【Methods】The clinical,X-ray chest plain flims,CT images and immunohistochemical data of all 4 cases of pathologically proved PLSC were retrospectively analyzed.【Results】All 4 cases presented the solid pulmonary masses ranged from 3.0 cm to 7.5 cm in diameter and were peripheral tumors found with X-ray film and CT.Two cases showed the homogeneous masses in density with clear margin;while other two cases showed the lobulated marginal with short sentus of tumors.All 4 cases had pleural invasion.Two cases had mediastinal lymph nodes metastasis.One case had left adrenal gland metastasis.Pathologically and immunohistochemically,three cases were unity sarcomatoid carcinoma and one was pleomorphic sarcomatoid carcinoma which was sarcomatoid carcinoma with glandular carcinoma.Vimentin and cytokeratin were positive in all 4 cases.EMA was positive in one and S-100 was positive in another one.【Conclusions】There were some relatively specific features of peripheral PLSC on CT.The immunohistochemical staining of Vimentin,CK may be helpful for diagnosis.