肺肠型腺癌影像学表现并文献复习

Imaging features of pulmonary enteric adenocarcinoma and review of literatures

目的讨论肺肠型腺癌的影像学表现。方法回顾性分析2017年8-10月诊治的1例肺肠型腺癌患者的临床资料及影像学资料,并复习相关文献。以"pulmonary enteric adenocarcinoma"和"intestinal type of lung adenocarcinoma"为检索词,在PubMed数据库检索,检索时间截止至2018年2月,共检索到相关英文文献21篇,报道患者98例。以"肺肠型腺癌"为检索词,在万方数据库检索,检索时间截止至2018年2月,检索到相关中文文献6篇,报道患者15例。经阅读除外资料不详者的文献,最终筛选获得66例,联合本例患者,对67例进行分析。结果患者女,69岁,间断咳嗽、咳痰伴痰中带血1月余,胸部CT主要表现为左肺下叶团片状模糊影,其内可见空泡影。肺代谢示左肺下叶病变未见明确灶性葡萄糖高代谢。67例患者首发症状以咳嗽、咳痰、咯血等呼吸系统症状多见,发病部位以右肺多见(43/67),胸部CT主要表现为实性占位,少数病例表现为片状模糊影,内伴有空泡影。22例患者行肺代谢检查,肺代谢主要表现为病变区葡萄糖代谢不均匀增高,偶有病例葡萄糖代谢未见增高。结论肺肠型腺癌的影像学表现易与肺炎、肺脓肿以及转移瘤混淆,确诊需排除胃肠道肿瘤。

Objective To discuss the imaging features of pulmonary enteric adenocarcinoma(PEAC).Methods The clinical and imaging data of one case of PEAC admitted in hospital from August 2017 to October 2017 were retrospectively analyzed,and the related literatures were reviewed.The"pulmonary enteric adenocarcinoma"and"intestinal type of lung adenocarcinoma"were used as the search terms,literatures were searched in the PubMed database until February 2018.98 patients were reported in 21 related English literatures.Using the same method,literatures were searched in Wanfang database.15 patients were reported in six relevant Chinese literatures.After reading the literatures,66 cases were finally selected.In combination with this case,67 cases were analyzed.Results The female patient was 69 years old.The symptoms consisted mainly of intermittent cough,expectoration and blood in phlegm for one month.The CT feature was flake fuzzy shadow in left lower lobe with vacuole shadow inside.Lung metabolism showed there was no clear focal high glucose metabolism in left lower lobe lesions.The most common first symptoms in 67 patients were symptoms of respiratory system,such as cough,expectoration,hemoptysis.The most common site of PAEC was in right lung(43/67).It was mainly solid masses on chest CT examination,but a few cases showed flake fuzzy shadow with vacuole shadow inside.22 cases accepted pulmonary metabolism examination.The glucose metabolism was increased in most cases,but it was not increased in a few cases.Conclusions Imaging features of PEAC were easily confused with pneumonia,lung abscess,metastases from colorectal cancer.The diagnosis needs to rule out gastrointestinal tumors.