肺少见神经内分泌肿瘤的CT诊断(附38例分析)

CT diagnosis of rare pulmonary neuroendocrine tumor

目的:分析和总结肺少见神经内分泌肿瘤(TC、AC、LCNEC)的临床及CT征象,提高此类疾病的诊断准确性。方法:回顾性分析2011年3月—2017年2月在南京中医药大学附属医院及江苏省肿瘤医院经病理证实的38例肺少见神经内分泌肿瘤患者的临床及MSCT资料,其中典型类癌(TC)12例、不典型类癌(AC)11例、大细胞肺神经内分泌肿瘤(LCNEC)15例。结果:(1)临床症状:三组TC患者的发病年龄最轻,LCNEC患者的发病年龄最大(P=0.000);LCNEC多有长期大量吸烟史(P=0.034)。(2)瘤体征象:TC、AC均以中央型多见,TC好发于肺叶支气管,AC好发于肺段支气管;LCNEC以周围型多见,好发于胸膜下肺实质(P=0.000);TC病灶最小,LCNEC病灶最大(P=0.021);TC病灶以圆形或类圆形多见(P=0.032),LCNEC病灶形态多样,更易呈现狭长形改变(P=0.005);TC病灶边缘光滑锐利,LCNEC病灶边缘多有分叶征(P=0.001);TC强化程度最高;LCNEC坏死更多见(P=0.030),强化程度最低(P=0.012)。(3)继发征象:TC较AC及LCNEC更易继发阻塞性肺不张(P=0.009);LCNEC更易出现肺门和/或纵隔淋巴结转移(P=0.003)及胸膜受累(P=0.000)。(4)伴随征象:LCNEC更易合并弥漫性肺气肿等慢性肺部疾病改变(P=0.019)。结论:肺少见神经内分泌肿瘤的MSCT表现具有一定的特征性,MSCT有助于本病的诊断和鉴别诊断。

Objective：To investgate the clinical and CT findings of rare pulmonary neuroendocrine tumor,in order to improve the accuracy of diagnosis. Methods：A retrospective study of 38 patients both in affiliated hospital of Nanjing univer- sity of TCM and Jiangsu cancer hospital from March 2011 to February 2017 was made. The clinical and MSCT findings were analyzed. Of the 38 patients,there were 12 cases with typical carcinoid tumor （TP）, 11 cases with atypical carcinoid tumor （AC）, and 15 cases with large cell neuroendocrine tumor （LCNEC）. Results： （1） Clinical symptoms：the patient was the youngest in TC group,and the oldest in LCNEC group （P= 0. 000） ;the patients in LCNEC group had a long history of smoking （P = 0. 034）. （2）Tumor signs：Most TCs and ACs were of central type, their predilection sites were lobar bronchi and segmental bronchi, respectively;while most LCNECs were of peripheral type, and were often found in subpleural pulmo- nary parenchyma （P=0. 000）. The lesions were the smallest in TC group,and the lesions were the largest in LCNEC group （P=0. 021）. Most TC lesions were seen in round or oval （P=0. 032）;LCNEC lesions had various shapes,and its occur- rence rate of narrow and elongated changes was the highest compared with TCs and ACs （P=0. 005）. The edge of the TC lesions was smooth and sharp,and the edge of the LCNEC lesions was Iobulated （P= 0. 001）. After contrast administra tion, TC lesions had the most obvious enhancement, and the LCNEC lesions had the most necrosis （P=0. 030） and little en- hancement （P=0. 012）. （3） Secondary signs：TCs was more likely to cause secondary atelectasis than ACs and LCNECs （P=0. 009） ;LCNEC had the highest degree of malignancy and was more likely to show hilar and/or mediastinal lymph node metastasis （P= 0. 003） and pleura invasion （P= 0. 000）. （4）Accompanying symptoms：compared with TC and AC pa- tients, LCNEC patients were more often combined with COPD （P=0. 019）. Conclusion： Rare pulmonary neuroendocrine tumors have certain characteristic imaging findings, MSCT is helpful in diagnosis and differential diagnosis.