原发性肺肉瘤样癌的CT表现与病理特点

Computed Tomographic and Pathological Features of Primary Pulmonary Sarcomatoid Carcinoma

目的探讨原发性肺肉瘤样癌(PSC)的CT表现与诊断价值。方法回顾性分析20例PSC患者的临床、影像资料,并与病理结果进行对照。结果 18例患者表现为单发肺肿块,2例患者表现为多发肺肿块,共22个肿块。5个肿块位于肺门区,17个位于肺周,其中11个肿块大于5 cm。9个肿块边界光滑,11个肿块边缘可见短粗毛刺和/或深分叶,2个肿块边界不清。2个肿块有胸膜凹陷征,14个肿块呈宽基底胸膜增厚。10个肿块平扫密度均匀,7个肿块内可见低密度区,5个肿块可见空洞。15例行增强CT检查,15个肿块呈不规则环形和/或斑片状强化,2个肿块呈均匀轻度强化。6例患者单侧或双侧肺门和/或纵隔肿大淋巴结。病理诊断多形细胞癌16例,梭形细胞癌4例。免疫组织化学检查13例抗细胞角蛋白单克隆抗体阳性,15例波形蛋白阳性,8例细胞角质蛋白阳性,1例上皮细胞膜抗原阳性,8例甲状腺转录因子-1阳性。结论原发性PSC的影像表现具有一定特点,但确诊需要靠病理结合免疫组织化学检查。

Objective To investigate the computed tomographic（ CT） and pathological features of primary pulmonary sarcomatoid carcinoma（ PSC）. Methods The clinical data and CT images of 20 patients with pathologically confirmed PSC were retrospectively analyzed. Results Solitary pulmonary mass was identified in18 patients and multiple pulmonary masses in 2 patients,amounting to 22 masses. There were 17 peripheral masses and 5 central masses,including 11 masses larger than 5 cm. The smooth margin was identified in 9 masses,deep lobulation and / or spinous protuberance in 11 masses,and ill-defined margin in 2 masses. Pleural indentation was identified in 2 masses and pleural thickening with wide basement was identified in 14 masses. On plain CT,cavity was observed in 5 masses,hypo-density in 7 masses,and homogeneous density in 10 masses. On contrast-enhanced CT scanning,irregular ring / patchy enhancement were shown in 15 masses and slightly homogenous enhancement in 2 masses. Of all patients,6 patients had unilateral or bilateral hilar and / or mediastinal lymphadenopathy. There were 16 pleomorphic carcinomas and 4 spindle cell carcinomas. Immunohistochemically,anti-pan cytokeratin antibody was positive in 13 patients,cytokeratin was positive in 8 patients,Vimentin was positive in 15 patients,epithelial membrane antigen was positive in 1 patient,and thyroid transcription factor-1was positive in 8 patients. Conclusion PSC has some specific CT features; however,the final confirmation of PSC still depends on pathological and immunohistochemical examinations.