原发性肺淋巴上皮瘤样癌影像表现与病理分析

Imaging and pathological analysis of primary pulmonary lymphoepithelioma-like carcinoma

目的探讨原发性肺淋巴上皮瘤样癌（LELC）的影像表现与病理特征。方法回顾性分析2010年1月至2015年3月13例经手术病理证实的原发性肺LELC的影像及组织病理学资料。男9例、女4例；年龄17—72岁，中位年龄52岁。全部患者均接受X线检查，其中2例接受CT平扫，8例接受CT平扫及增强，1例接受MRI平扫。由2名经验丰富的胸部放射科医师分别对影像资料进行特征性分析，包括病灶的部位、数量、形态、大小、密度等，并协商达成一致。11例行手术切除，2例行穿刺活检，所有标本均行HE染色，6例行免疫组织化学染色。结果13例原发性肺LELC均为单侧发病，其中周围型9例、中央型4例，11例呈分叶状，7例见毛刺，3例见血管集束征，2例见包绕血管，4例见胸膜凹陷征，1例见点状钙化。病灶大小1.3～11．0cm，平均（4．4±2．7）cm。CT平扫病灶密度均匀，平扫CT值22～48HU，平均（34±10）HU；动脉期CT值33～70HU，平均（53±13）HU；静脉期CT值43～86HU，平均（66±14）HU；MRI扫描呈稍长T1、稍长T2改变，信号均匀。病理示该肿瘤为多形性上皮性肿瘤，肿瘤细胞体积较大呈合体性，核大呈空泡状，周围见大量淋巴细胞浸润和大量纤维组织或伴有胶原化。免疫组织化学细胞角蛋白（CK）、P63、CK5／6（＋），CK14（－）支持诊断。结论原发性肺LELC影像表现具有一定特征性，病理形态学及免疫组织化学检查可以明确诊断。

Objective To discuss the imaging findings and pathological features of primary pulmonary lymphoepithelioma-hke carcinoma （LELC）. Methods Imaging and pathological data of 13 patients （9 male and 4 female, age from 17 to 72 years, median age 52 years） with pathology-proven primary pulmonary LELC from January 2010 to March 2015 were retrospectively analyzed. Thirteen patients underwent X-ray examination, two of them underwent non-enhanced CT scan, eight underwent non-enhanced and enhanced CT scans, one underwent non-enhanced MR scan. All imaging data including location, number, shape, size and density of lesions were analyzed by two experienced chest radiologists respectively and reached an agreement after consultations. Surgery was performed in 11 cases and aspiration biopsy in 2 cases. HE staining was performed in all cases and immunohistochemistry staining in 6 cases. Results All thirteen primary pulmonary LELC were unilateral. Nine peripheral tumors and four central tumors were identified. Lobulations （n=11）, spiculas （n=7）, vessel convergences （n=3）, vascular eneasements （n=2）, pleural indentations （n=4） and punctuate calcification sign （n=l） were seen in the CT images. Thirteen tumors had diameters ranging from 1.3-11.0 cm, average diameter of （4.4 ± 2.7） cm, and all showed homogeneous density in non-enhanced CT. CT value ranged from 22-48 HU, average value of （34± 10） HU, and during arterial phase it ranged from 33-70 HU, average value of （53±13） HU; and during venous phase it ranged from 43-86 HU, average value of （66±14） HU; the tumor had long T1 and long T2 signal in non-enhanced MR scan, and signals were homogeneous. Pathologically, the tumor was from pleomorphie epithelial with large cells, syncytia in the infiltration of lymphoeytes or accompanied with collagenzation. Large nucleus showed vacuole-shape. Immunochemistry CK（＋ ）, P63（＋ ）, CK5/6（＋ ）, CK14（-） supported the diagnosis of LELC. Conclusions There are certain imaging characteristics for primary pulmonary LELC. Histopathological and immunohistochemistry examination could provide the definitive diagnose.