42例硬化性肺细胞瘤的CT特殊征象及病理分析

Analysis of special CT signs and pathology in 42 cases of pulmonary sclerosing pneumocytoma

目的探讨硬化性肺细胞瘤(PSP)的CT特殊征象及病理学特点,以提高临床对PSP的认识及诊断水平。方法收集经术后病理证实的42例PSP患者的临床记录、螺旋CT图像与组织病理学报告,观察病灶的大小、分布、形态、强化特征、CT特殊征象和病理学特征。结果42例患者中,男女比例为1∶13;其中行增强扫描23例,无明显强化1例,轻度强化7例,中度强化8例,高度强化7例。病灶外观呈圆形、类圆形34例,不规则形态6例,磨玻璃状2例。血管贴边征阳性16例,晕征7例,空气新月征9例,跨裂征6例,钙化20例。行免疫组化检查者23例,其中CK阳性18例,EMA阳性19例,Vimentin阳性15例,CD34阳性9例,KI-67<5%18例,TTF-1阳性22例,PR阳性2例。结论"血管贴边征""空气新月征""晕征""跨裂征"及"钙化"作为PSP的CT特殊表现,为PSP诊断提供重要依据,TTF-1是确诊PSP的特异性指标,CK、EM高阳性率支持PSP来源于原始呼吸道上皮细胞,KI-67<5%高阳性率支持PSP良性属性。

Objective To explore the special CT signs and pathological features of pulmonary sclerosing pneumocytoma(PSP),so as to improve the clinical understanding and diagnosis levels of PSP.Methods Clinical records,spiral CT images and histopathological reports of 42 patients with PSP confirmed by postoperative pathology were collected,and the size,distribution,shape,enhancement features,special CT signs and pathological features of the lesions were observed.Results In 42 patients,the ratio of male to female was 1:13.Among them,23 cases recived enhanced scanning,1 case was no obvious enhancement,7 cases were light enhancement,8 cases were moderate enhancement,7 cases were high enhancement.The appearance of the focus was round,quasi round in 34 cases,irregular in 6 cases and ground glass in 2 cases.A total of 16 cases were positive for vascular marginal sign,7 cases were halo sign,9 cases were air crescent sign,6 cases were trans split sign,20 cases were calcification.Immunohistochemical examination was performed in 23 cases,among them,18 cases were CK positive,19 cases were EMA positive,15 cases were Vimentin positive,9 cases were CD34 positive,18 cases were Ki-67<5%,22 cases were TTF-1 positive,and 2 cases were PR positive.Conclusion"Vascular marginal sign""air crescent sign""halo sign""trans split sign"and"calcification"are the special CT manifestations of PSP,which provide important basis for the diagnosis of PSP.TTF-1 is the specific index for the diagnosis of PSP.The high positive rate of CK and EM supports that PSP comes from the primitive epithelial cell of respiratory tract,and the high positive rate of Ki-67<5%supports the benign attribute of PSP.