原发性肺巨细胞癌CT特点及病理对照分析

CT characteristics and pathological control analysis of primary pulmonary giant cell carcinoma

目的探讨原发性肺巨细胞癌(GCCL)的CT及病理特征,以提高对该病的认识。方法对照分析14例经病理证实的原发性GCCL临床、病理、影像资料。结果本组14例均为单发;10例周围型,4例中央型;肿瘤最大直径11 cm,最小直径3 cm;9例位于上肺;1例跨右肺中下叶;4例无明显分叶毛刺;7例与胸膜呈宽基底相连,临近胸膜和(或)肋骨受侵;1例中央型侵犯心包膜,上腔静脉内癌栓形成;93.9%(13/14)病灶内见大小不等坏死区,58.3%(7/12)CT增强扫描病灶实质表现为不均匀厚环或薄环强化,33.3%(4/12)表现为不均匀片状强化。免疫组化:CK7阳性率91.7%(11/12);Vimentin阳性率为100%(8/8);Vimentin、CK7均阳性率100%(8/8);分子病理EGFR基因突变率22.2%。结论原发性肺巨细胞癌的CT表现具有一定特点,充分认识这些征象对提高其诊断准确率极其重要。

Objective To explore the CT and pathological features of primary pulmonary giant cell carcinoma(GCCL),and to improve the understanding of the disease.Methods The clinical,pathological and imaging data of 14 cases of primary GCCL confirmed by pathology were analyzed.Results Solitary pulmonary mass was identified in 14 patients.10 lesions were peripheral and 4 lesions were central tumors.Lesions were transfoliar growth.9 lesions were located in the superior lung.The size ranged from 3 to 11 cm.The edge of the lesion was smooth in 4 cases.In 7 cases,the pleura was broadly abutment adjacent to the pleura and or the ribs were invaded.The pericardium was invaded in 1 case,and the tumor thrombus was formed in the superior vena cava.13 cases showed nonu-niform density.7 cases(58.3%)of the patients had mild to moderate annular enhancement and 33.3%(4/12)showed uneven patchy reinforcement at the edge of the arterial phase.Vimentin positive rate was 100%(8/8);Vimentin,and CK 7 all positive rate was 100%(8/8);Molecular immunohistochemical EGFR gene mutation rate was 22.2%.Conclusion The imaging manifestations of primary giant cell carcinoma of the lung have certain characteristics.It is very important to fully recognize these signs to improve the accuracy of diagnosis.