细支气管肺泡癌的CT与病理对照研究

CT Pathologic Correlation in Bronchioloalveolar Carcinoma

目的：探讨细支气管肺泡癌（ＢＡＣ）的ＣＴ表现的病理基础。材料与方法：对７３例ＢＡＣ进行回顾性分析。所有病例均经手术或活检得到组织病理学证实。记录病灶边缘及内部特点，与病理切片对照。结果：在孤立结节型，ＣＴ显示病灶分叶６３例，毛刺６０例，胸膜凹陷５４例，血管集束征４７例，病灶内假腔３３例，病灶与胸膜间气肿１８例，磨玻璃改变１２例。ＣＴ特征以肺泡型ＢＡＣ显示最典型，以粘液型显示最不典型。肿瘤粗星状毛刺与肺泡间隔增厚和肿瘤细胞沿肺泡间隔生长有关。病灶内假腔除与支气管断面有关外，多为肺泡腔破坏融合所致。磨玻璃改变多见于肺泡型ＢＡＣ。在弥散型，ＢＡＣ在ＣＴ上可表现为实变或伴蜂窝改变，也可为多发结节。１０例弥散型ＢＡＣ中６例为粘液型。结论：认识ＢＡＣ的ＣＴ表现和病理基础。

Objective: To correlate the histology with the CT appearance of bronchioloalveolar carcinoma (BAC).Materials and Methods:We retrospectively reviewed CT and pathologic examinations in 73 BACs proved by surgery or biopsy. In each case, tumor lung interface and internal characteristics of BAC were recorded and correlated with histopathologic findings.Results:In solitary nodular form, CT showed lobulations in 63, spiculations in 60, plural tags in 54, bronchovascular bundles in 47, psuedocavitation in 33, peripheral emphysema in 18 and ground glass change in 12 cases with BAC. The CT appearance of BAC was most typical in alveolar type and atypical in mucous type. Coarse star shaped spiculation in CT was correlated with tumor infiltration and desmoplastic reaction. Internal psuedocavitation corresponded to air containing dilatated alveoli and patent bronchioles. Ground glass appearance was commonly seen in alveolar type of BAC. In diffuse form, CT showed consolidation, or with honeycomb appearance, or showed mutiple nodules. Among 10 cases of diffuse form of BAC, 6 were mucous type.Conclusion: It is important to recognize the CT appearance and histopathology of BAC in order to improve diagnostic ability.