原发性肺淋巴上皮瘤样癌的CT表现及文献复习

CT findings and literature review of primary pulmonary lymphoepithelioma-like carcinoma

目的探讨原发性肺淋巴上皮瘤样癌(LELC)的CT表现及鉴别诊断。方法回顾性分析我院经手术病理证实的8例原发性肺LELC的临床病理及CT资料,并复习相关文献。结果 CT主要表现为单发的类圆形肿块,中央型1例,周围型7例,其中左肺3例,右肺5例,直径2.0~7.3 cm,平均直径(4.1±1.6) cm。边界清楚,密度多均匀,6例边缘呈浅分叶状,1例伴血管包埋征,6例伴有纵隔及肺门淋巴结肿大。增强扫描显示8例均表现为轻度或中度不均匀强化,2例伴小斑片状液化坏死。结论原发性肺LELC的CT表现有一定特征性,但单凭CT诊断仍有一定困难,最终确诊还需依据手术病理及免疫组化分析。

Objective To investigate the CT features and differentiation of primary pulmonary lymphoepitheliomalike carcinoma（LELC）. Methods The clinicopathology and CT data of 8 cases with primary pulmonary LELC confirmed by operation and pathology were retrospectively analyzed. Results The cases with primary pulmonary LELC mainly manifested as single round mass on CT images, including 1 central tumor and 7 peripheral tumors. The tumors occurred in left lobe in 3 cases and in right lobe in 5 cases. The diameters ranged from 2.0 to 7.3 cm and average diameter was 4.1 ±1.6 cm. CT findings of pulmonary LELC consisted of well-defined border, uniform density, superficial lobulation（6 cases）, vascular encasement（1 case）, and lymphadenopathy in mediastinum or hilar（6 cases）. On contrast-enhanced scanning, the tumors presented mild or moderate inhomogeneous enhancement in 8 cases, and showed small plaque liquefaction necrosis in 2 of them. Conclusion Primary pulmonary LELC has certain CT characteristics, but it is still difficult to diagnose through CT alone. The final diagnosis should depend on surgical pathology and immunohistochemical analysis.