囊腔型肺癌的CT表现特点及病理基础探讨

A study on CT characteristics and its pathological basis of thin-walled cystic lung cancer

目的:探讨囊腔型肺癌的CT特征及其对应的病理学表现,提高诊断水平。方法:回顾性分析2012年1月-2017年12月本院收治的30例囊腔型肺癌患者的临床影像资料,所有患者经手术、纤维支气管镜或经皮穿刺病理活检证实。30例中男17例、女13例,年龄39~77岁,平均(60.77±10.12)岁。结果:①CT特点:囊腔大小0.89~6.65 cm,平均(2.46±1.27)cm。病灶位于双肺外周23例(76.67%),囊腔形态规则24例(80.00%)。(90.00%)囊壁厚薄不均27例,囊壁均匀增厚3例(10.00%)。囊内有分隔19例(63.33%),囊壁内/外缘可见磨玻璃影16例(53.33%),(70.00%)病灶边缘不规则21例,囊壁外缘可见血管征20例(66.67%)。②病理表现:30例中腺癌26例(86.67%),鳞癌3例(10.00%),腺鳞癌1例(3.33%)。光镜下显示囊内分隔由纤维组织、支气管、血管、肿瘤细胞组成,囊壁见肿瘤细胞、血管和纤维组织,CT上囊壁内/外缘磨玻璃影与贴肺泡壁生长的肿瘤细胞相关。结论:囊腔型肺癌是一种特殊类型的肺癌,它具有典型的CT特点及病理改变,熟悉和掌握这些特点有助于提高术前诊断准确性。

Objective:The purpose of this study was to explore the CT features and its corresponding pathological basis of thin-walled cystic lung cancer aimed to improve the diagnostic level.Methods:The clinical and MSCT data of 30 patients[17 male and 13 female,aged 39~77 years with mean age of(60.77±10.12)years]with thin-walled cystic lung cancer confirmed by surgery,fiberoptic bronchoscopy or percutaneous biopsy from January 2010 to December 2017 were retrospectively analyzed.Results:①CT features:the size of the cyst was 0.89~6.65cm,averaged(2.46±1.27)cm.Lesions occurred in the peripheral lung area in 23 patients(76.67%),with regular shape of cystic airspace in 24 patients(80.00%).Non-uniform cystic wall was found in 27 cases(90.00%),and uniform cystic wall in 3 cysts(10.00%),cystic septation in 19(63.33%),ground glass opacity around the cyst in16(53.33%),irregular edge in 21(70.00%),and marginal vascular sign in 20 patients(66.67%).②Pathological basis:Among the 30 patients,adenocarcinoma was found in 26 patients(86.67%),squamous cell carcinoma in 3(10.00%),and adenosquamous carcinoma in one(3.33%).Under the microscope,septations within the cyst were composed of fibrous tissue produced,bronchus,blood vessels and tumor cells,cyst walls seen fibrous tissue,blood vessels and tumor cells,ground glass opacity on the inside or outer edge of the cysts on CT images was related to tumor cells growing along the alveolar wall.Conclusion:Cystic lung cancer is a special type of lung cancer,and has typical CT and pathological features,which can help us improve the accuracy of preoperative diagnosis.