几种少见形态肺癌影像学表现及其病理基础的初步分析

Unusually shaped lung cancer-HRCT findings and pathologic analysis

目的:初步探讨少见形态肺癌的影像学特征及其病理学基础。方法:从既往诊断以及手术病理证实的265例周围型肺癌中,挑选出少见形态肺癌19例,对其胸部平片、普通CT和HRCT等影像学表现和病理学基础进行回顾性分析。进一步对其进行形态学分类。结果:本组少见形态肺癌19例,全部19例少见形态肺癌误诊为肺癌以外疾病或推迟诊断者有10例,达53%。19例少见形态肺癌中,分为5种特殊的征象,即手指征、葫芦征、阿米巴伪足征、网格征、花边征。病理观察显示,这些征象分别系肿瘤向外围不规则进展、带有细支气管肺泡癌成分的肺腺癌外围呈肺泡内覆壁生长并向外规则或不规则进展、肿瘤中心致密实性改变、纤维化以及对支气管结构牵拉等作用相关。结论:上述5种少见形态肺癌反映了其特定的病理学基础,充分认识和深入研究这些征象具有重要价值。

Objective：To investigate chest film,CT and HRCT findings of lung cancers taking unusual shape and their correlation with specific histopathologic characteristics.Methods：19 patients with unusual shape lung cancer（Between January 1990 and December 2008） were retrospectively reviewed.Chest film,CT and HRCT findings and their correlation with specific histopathologic characteristics were analyzed.According X-ray and CT findings the lung cancers were further classified.Results：19 lung cancers confirmed by operation and pathology were selected as unusual shape lung cancer.10（53%） were misdiagnosed or delayed.19 cancers were divided into 5 type including finger sign,bottle-gourd sign,pseudopod sign,graticule sign,gimp sign.Pathologically in finger sign and bottle-gourd sign,tumor were growed outward irregularly￡？in pseudopod sign graticule sign and gimp sign,peripherally BAC as a subtype of adenocarcinoma with intraalveolar spread and lepidic growth slowly along an intact interstitial framework regularly or irregularly￡？The presence of intratumoral radiolucencies may be secondary to patent intratumoral bronchioles,localized bronchiectasis or may be produced by fibrosis with honeycombing.Conclusion：The present 5 types of unusual shape lung cancer were well correlated with the specific histopathologic characteristics,familiarity of witch can help identify these lung cancers and may enable a more accurate diagnosis in such cases.