肺淋巴上皮瘤样癌CT表现

CT findings of pulmonary lymphoepithelioma-like carcinoma

目的探讨肺淋巴上皮瘤样癌(LELC)的CT表现。方法回顾性分析244例经病理证实的肺LELC的CT表现。结果 244例LELC中,中央型132例(132/244,54.10%),周围型112例(112/244,45.90%);肿瘤最大径1.2～13.1 cm,平均(5.42±2.64)cm;结节型49例(49/244,20.08%),肿块型195例(195/244,79.92%);169例(169/244,69.26%)边界清晰, 183例(183/244,75.00%)见分叶征,104例(104/244,42.62%)病灶边缘见毛刺;184例(184/244,75.41%)病灶紧贴纵隔,111例(111/244,45.49%)见"类胸膜尾征"改变。CT平扫158例(158/244,64.75%)病灶密度均匀,增强后中度强化160例(160/223,71.75%),145例(145/193,75.13%)呈渐进强化,108例(108/193,55.96%)动脉期病灶内见血管受侵变细和异常细小杂乱的血管影,81例(81/193,41.97%)动脉期病灶内见血管包埋征。185例(185/244,75.82%)见支气管包埋和/或闭塞。124例(124/244,50.82%)病灶周围见磨玻璃密度影,81例(81/244,33.20%)间质增厚,132例(132/244,54.10%)伴阻塞性肺炎或肺不张。167例(167/244,68.44%)肺门和/或纵隔淋巴结肿大。结论右肺中叶、两肺下叶纵隔胸膜旁肿块,边界清、浅分叶,伴类胸膜尾征、增强动脉期血管包埋征、周围肺区磨玻璃密度影及网格增粗影和淋巴结肿大是肺LELC的相对特征性CT表现。

Objective To investigate CT findings of pulmonary lymphoepithelioma-like carcinoma(LELC). Methods CT findings of 244 patients with pathologically proved pulmonary LELC were analyzed retrospectively. All patients underwent nonenhancement CT scan, 226 of them also underwent contrast-enhanced CT scan. Results Totally 132(132/244, 54.10%) central tumors and 112(112/244, 45.90%) peripheral tumors were identified. The maximum diameter of lesion was ranged from 1.2 cm to 13.1 cm, with average(5.42±2.64)cm. The lesions were characterized with 49(49/244, 20.08%) nodules and 195(195/244, 79.92%) masses. Totally 169(169/244, 69.26%) tumors were found with well-defined borders, 183(183/244, 75.00%) showed lobulations, and 104(104/244, 42.62%) showed spiculation. The tumor located closely with the mediastinum in 184 cases(184/244, 75.41%), while pleural change of tail sign was observed in 111 cases(111/244, 45.49%). The tumor showed homogeneous density on nonenhancement CT in 158 cases(158/244, 64.75%), moderate enhancement in 160 cases(160/223, 71.75%), gradually enhancement in 145 cases(145/193, 75.13%), while 108 cases(108/193, 55.96%) showed abnormal small vessels and 81 cases(81/193, 41.97%) showed vascular encasements. Bronchial encasement and/or stenosis was found in 185 cases(185/244, 75.82%). Ground-glass opacity around the lesion was detected in 124 cases(124/244, 50.82%), when interstitial thickening was noticed in 81 cases(81/244, 33.20%) and obstructive pneumonia or pulmonary atelectasis was found in 132 cases(132/244, 54.10%). Hilar and/or mediastinal lymph node enlargement was found in 167 cases(167/244, 68.44%). Conclusion Most pulmonary LELC occurres in right middle lobe and bilateral lower lobe of lung, and appeares as well-defined and slight lobulated tumor with enlarged lymph nodes. Vascular encasements, closely associated with mediastinum, pleural change of tail sign, ground-glass opacity and interstitial thickening are comparative characteristics of pulmonary LELC.