孤立型肺黏液腺癌多层螺旋CT特点与病理特征的研究

The investigation of the characteristics of multislice spiral CT in solitary pulmonary mucinous adenocarcinoma and its relationship with pathology

目的探讨孤立型肺黏液腺癌的多层螺旋CT特点及与病理学关系。方法回顾性分析2010年3月至2018年5月16例经病理证实的孤立型肺黏液腺癌患者的临床资料、CT特点和病理特征，观察病灶的数量、分布、分型、大小、形态、边界、密度、邻近结构改变以及强化表现，并与病理结果进行对照分析。结果16例单发病灶分布以肺叶为单位，下叶13例、中叶1例、上叶2例，其中位于胸膜下12例。中央型2例、周围型14例。肿瘤最长径1.2 ~ 3.0 cm，平均（2.1 ± 0.9）cm。圆形或类圆形11例，不规则形5例；边界清晰8例，边界不光整并伴有毛刺征6例；有浅或深分叶改变12例；病灶内部见小空泡2例；有血管聚集征表现2例。多层螺旋CT平扫示病灶密度低于同层面肌肉密度，增强扫描示病灶呈均匀或不均匀的轻中度持续强化。镜下可见肿瘤细胞的胞质内含有并分泌出大量黏液，且黏液具有流动性。肿瘤细胞大多贴在细胞壁上，部分脱落的肿瘤细胞漂浮在黏液中，随黏液流动。结论如果病灶影像学表现中出现肿瘤分布、形态与重力因素相关，增强扫描呈条样强化，且肿瘤较大时亦无侵犯胸膜、无胸腔积液以及无转移表现时应高度怀疑孤立型肺黏液腺癌。

ObjectiveTo investigate the characteristics of multislice spiral CT in solitary pulmonary mucinous adenocarcinoma and its relationship with pathology.MethodsThe clinical data, CT characteristics and pathological features of 16 patients with solitary pulmonary mucinous adenocarcinoma confirmed by pathology from March 2010 to May 2018 were analyzed, and the number, distribution, size, shape, boundary, density, adjacent structure changes and intensifying performance were observed and compared with pathological results.ResultsThe single lesion was distributed in the lung lobe in 16 cases, in the lower lobe in 13 cases, in the middle lobe in 1 case, and in the upper lobe in 2 cases, of which 12 cases were located under the pleura. There were 2 cases of central type and 14 cases of peripheral type. The longest diameter of tumor was 1.2 - 3.0 cm, with an average of （2.1 ± 0.9） cm. Eleven lesions were round or approximately round, 5 lesions were irregular, 8 lesions had clear boundary, 6 lesions had irregular boundary and burr sign, 12 lesions had shallow or deep lobulation, 2 lesions had small vacuoles and 2 lesions had vascular aggregation. Multislice spiral CT plain scan showed that the density of lesions was lower than that of the same level muscle density. Enhanced scanning showed mild to moderate homogeneous or heterogeneous enhancement. Microscopic examination revealed that the cytoplasm of tumor cells contained large amounts of mucus and mucus was fluid. Most of the tumor cells were attached to the cell wall. Some of the tumor cells were floating in mucus and flowing with mucus.ConclusionsIf the tumor distribution and morphology is associated with the gravity factor, the enhanced scan is stripe like, and there is no invasion of the pleural, no pleural effusion and no metastasis when the tumor is large, and the solitary pulmonary mucinous adenocarcinoma should be highly suspected.