肺黏液性腺癌的临床及CT表现和病理特点

Mucin-producing adenocarcinoma of lung: clinical manifestations, CT findings and pathological features

目的 :研究肺黏液性腺癌患者的临床表现及CT和病理学特征,以进一步提高医师对肺黏液性腺癌的认识。方法:收集43例经病理学证实的肺黏液性腺癌患者的临床及CT影像资料,回顾性分析其病灶分布的范围、大小、部位及其CT影像特征,并对其诊断要点进行评价。结果:43例肺黏液性腺癌患者中,31例出现咳嗽,15例咳痰,6例痰液为大量泡沫样,6例痰中带血,5例有低热,2例出现胸痛。CT检查显示,31例患者的病灶呈两肺多发性分布,9例为叶性分布,3例为节段性分布。所有患者均存在实变,34例分布于外周,15例伴有不规则小结节,38例存在空气支气管征,25例的支气管有轻度僵硬、狭窄,11例叶间裂向外突出,18例实变影分布不均匀,13例可见不规则小囊腔,17例实变周围或远侧有磨玻璃样影,7例CT显示血管征。结论:肺黏液性腺癌患者的临床表现无特异性,CT图像上可表现为典型的外周分布,可见空气支气管征、不规则小结节、叶间裂外突、多发小囊腔样改变等,但这些特征与细菌性肺炎间很难区分。对抗菌药物反应不好的肺炎患者,应警惕肺黏液性腺癌可能,需及时进行肺活检以明确诊断。

Objective： To investigate the clinical manifestations, CT findings and pathologic features of mucinproducing adenocarcinoma（MPA） of lung for improving the understanding of this disease. Methods： The clinical and imaging data from 43 patients with pathologically confirmed mucin-producing adenocarcinoma of lung were retrospectively analyzed, and characteristic CT lesion pattern, tumor size, tumor location and other predicting signs were evaluated.Results： The clinical symptom were cough（31 cases）, sputum（15 cases）,frothy sputum（6 cases）, bloody in sputum（6 cases）,low fever（5 cases）, chest pain（2 cases）. CT imaging revealed that 31 patients had bilateral and multi-lobar lesions; 9patients had lobar lesions; and 3 patients had segmental lesions. All the patients had pulmonary consolidation on chest imaging, 34 patients had peripheral lung lesions, 15 patients had ill-defining diffuse nodules;38 patients had air bronchogram, 25 patients had mild stenosis of bronchus, 11 patients had bulging of interlobar fissure, 18 patients had heterogeneous consolidation, 13 patients hadcystic airspaces, 17 patients had ground glass shadow around or distal to the consolidation, and CT angiogram sign was seen in7 cases. Conclusions： Clinical manifestations of MPA are not specific.CT findings of mucin-producing adenocarcinoma of lung have a wide spectrum, showing peripheral consolidation, air bronchogram, bulging of interlobar fissure, CT angiogram sign, cystic airspaces. It is difficult to differentiate MPA from infectious pneumonia. Biopsy of the lung lesion is necessary to elucidate the diagnosis.