含囊腔性肺癌的MSCT特点及病理对照分析

MSCT Features of Lung Cancer Associated with Cysts and Comparison with Their Pathology

目的探讨含囊腔性肺癌的MSCT影像特点及病理基础。方法回顾性分析经手术病理证实的14例含囊腔性肺癌的CT及病理资料。结果 MSCT显示,肿瘤位于右肺8例,左肺6例。肿瘤直径平均(34.5±22.6)mm,肿瘤中心与肋胸膜的距离平均(24.5±10.0)mm。囊腔单发8例,多发6例,囊腔直径平均(21.1±23.2)mm。囊腔与结节的位置关系Mario分型:Ⅰ型4例,Ⅱ型1例,Ⅲ型4例,Ⅳ型5例。囊腔偏心性7例,其中囊腔位于软组织近端4例,远端2例,并行1例;囊腔存在分隔8例,其中气管血管束穿过囊腔2例;血管集束征13例,其中围气管血管束生长3例;瘤周斑片条索影7例。CT随访3例,其中囊腔缩小或无变化,软组织增大、密度增高2例,囊腔及软组织均无变化1例。14例肺癌的病理类型:腺癌12例,腺鳞癌2例。病理组织切片中发现囊腔成分3例,囊腔表面均被覆肿瘤细胞,肿瘤中心坏死1例,肿瘤内支气管扩张10例,滋养血管13例。结论含囊腔性肺癌以浸润性腺癌多见,MSCT表现有一定特征性。其形成的病理基础可能与原有囊腔基础上继发肺癌、支气管腔内肿瘤活瓣阻塞效应、肿瘤破坏肺泡结构有关。

Objective To analyse the MSCT appearance of lung cancer associated with cysts and their foundation of pathology. Methods CT and pathologic data of 14 patients with lung cancer associated with cysts confirmed by surgery and pathology were retrospectively analyzed. Results On MSCT,tumor was located in the right lung in 8 cases and in the left lung in 6 cases. The average diameter of the tumor was（ 34. 5 ± 22. 6） mm and the distance from the center of the tumor to the rib pleura was（ 24. 5 ± 10. 0） mm. Cysts were solitary in 8 cases and multiple in 6 cases. The average diameter of cysts was（ 21. 1 ± 23. 2） mm. The relationship between cysts and nodules was classified by Mario： type Ⅰ in 4 cases,type Ⅱ in 1 case,type Ⅲ in 4 cases and type Ⅳ in 5 cases. The cysts were eccentric in 7 cases,including the cysts located in the proximal soft tissue in 4 cases,remote in 2 cases and parallel in 1 case. Air-containing spaces with septae were detected in8 cases including a bronchovascular beam passed through the cavity in 2 cases. The vessel convergence sign was seen in 13 cases including tumor growth around bronchovascular beam in 3 cases,peritumoral patch cords in 7 cases. Three cases were followed up by CT scan,showing that the cysts had decreased or unchanged and soft tissues were enlarged with higher density in 2 cases,cysts and soft tissues had no change in 1 case. Pathological types of 14 cases of lung cancer included adenocarcinoma in 12 cases and adenosquamous carcinoma in 2 cases. In histopathology,cavity components were found in3 cases in which the cysts＇ surface was covered with tumor cells,tumorous central necrosis in 1 case,bronchiectasis in 10 cases and nutrient blood vessels in 13 cases. Conclusion The majority of lung cancer associated with cysts was invasive adenocarcinoma,which had specific CT characteristics. Lung cancer secondary to original cysts,one-way valve obstruction at the bronchioles and destruction of alveolar structure by tumor cells may be the pathological basis of the cancer.