肺肉瘤样癌CT诊断与文献回顾

CT diagnosis of pulmonary sarcomatoid carcinoma and literature review

目的探讨肺肉瘤样癌(PSC)CT表现并对相关文献进行回顾。方法回顾性分析陕西省人民医院2015年1月至2020年3月住院诊治的10例PSC患者的CT表现、病理及免疫组化资料。结果10例患者均表现出肺内单发占位性病变,为周围性分布,其中右肺上叶2例,右肺下叶2例,左肺下叶2例,左肺上下叶跨叶生长4例;病灶最大直径10.8 cm,平均直径(5.3±3.7)cm;5例形态不规则,2例周围多发短毛刺,3例病变周围形成大小不等的空洞;增强扫描病变呈轻-中度不均匀强化改变,中央坏死区不强化。免疫组化显示:上皮细胞角蛋白(CK)、波形蛋白阳性7例,上皮细胞膜抗原(EMA)阳性3例。结论PSC在CT平扫及增强图像上具有一些特征表现,可为临床诊断提供帮助,明确诊断需结合病理及免疫组化。

Objective To investigate the CT findings of pulmonary sarcomatoid carcinoma(PSC)and review the relevant literature.Methods The CT findings,pathological and immunohistochemical data of 10 patients with PSC hospitalized in Shaanxi provincial people's hospital from January 2015 to March 2020 were analyzed retrospectively.Results All 10 patients showed single space occupying lesions in the lung,which were peripheral distribution,including 2 cases in the upper lobe of the right lung,2 cases in the lower lobe of the right lung,2 cases in the lower lobe of the left lung,and 4 cases in the upper and lower lobe of the left lung;the maximum diameter of the lesion was 10.8 cm,and the average diameter was(5.3±3.7)cm;5 cases showed irregular morphologies,2 cases showed multiple short spiculation around,and 3 cases formed cavities of different sizes around the lesions;on contrast-enhanced scan,the lesions showed mild to moderate uneven enhancement,and the central necrotic area was not enhanced.Immunohistochemistry showed that 7 cases were positive for epithelial cytokeratin(CK)and vimentin,and 3 cases were positive for epithelial cell membrane antigen(EMA).Conclusion PSC has some characteristics on plain and enhanced CT images,which can provide help for clinical diagnosis.The definite diagnosis needs to be combined with pathology and immunohistochemistry.