30例原发性肺肉瘤样癌的CT表现

Findings on Computerized Tomography of Primary Pulmonary Sarcomatoid Carcinoma in 30 Patients

目的:探讨原发性肺肉瘤样癌(PSC)的CT表现,提高对该疾病的认识。方法:回顾性分析30例经病理证实的原发性肺肉瘤样癌患者的临床病理资料及CT表现。结果:周围型27例,中央型3例;肿瘤直径3.0～9.2 cm,平均5.7 cm;右肺上叶10例、中叶1例、下叶8例,左肺上叶7例、下叶4例;肿瘤形态不规则13例,类圆形或卵圆形12例,浅或深分叶5例;边缘较光整者15例,毛糙者14例,1例因中央型肿块伴阻塞性肺不张致边界欠清。CT平扫密度均匀者9例,密度不均匀者21例,瘤内可见空洞者6例,伴钙化者4例;18例行CT增强扫描,中心呈不明显强化或不规则斑片状强化,周边呈厚薄不均环形强化。17例伴肺门和(或)纵隔淋巴结肿大,12例侵犯胸膜或胸壁组织,其中5例伴有邻近骨质破坏,5例出现转移。结论:原发性肺肉瘤样癌的增强CT表现具有一定特征性,但确诊仍需依靠病理。

Objective： To investigate the CT findings on primary pulmonary sarcomatoid carcinoma （ PSC ） and to improve knowledge on PSC. Methods： The chest CT findings and clinicopathological information on 30 patients with pathology-confirmed primary pulmonary sarcomatoid carcinoma were reviewed retrospectively. Results： Of the 30 tumors, 27 were peripheral, and 3 were central. The mean maximum diameter of the lesions was 5.7 cm （ ranging from 3.0 cm to 9.2 cm ）. Ten lesions were found located in the right upper lobe, one in the right middle lobe, 8 in the right lower lobe, 7 in the left upper lobe, and 4 in the left lower lobe. Among these lesions, 13 were irregular, 12 were oval or ovoid, and 5 were shallowly or deeply lobulated. A well-defined margin was seen in 15 cases and an ill-defined margin in 14 cases. One central case had obstructive atelectasis, with ill-defined and barbed margins. A plain scan of CT demonstrated that 9 masses were homogeneous in density, and the other 21 were inhomogeneous. A cavity was seen in 6 of the total tumors and calcification in 4. After enhancement scanning for 18 cases, no enhancement or irregular patchy enhancement was found in the central part of the tumors. However, an irregular ring-like enhancement was found around the tumors. A total of 17 cases had hilar or mediastinal lymphadenectasis. Pleural or chest wall invasion was found in 12 cases, of which 5 were with adjacent bone destruction and 5 with metastasis. Conclusion： Although PSC has some relatively specific CT features after enhancement, the diagnosis of the disease primarily depends on the pathology.