纵隔神经内分泌癌的CT表现

The CT manifestations of mediastinal neuroendocrine carcinoma

目的探讨纵隔神经内分泌癌(MNEC)的CT影像表现,以提高对本病的认识。方法选取22例经病理证实的MNEC的CT影像资料。结果病理小细胞癌4例,大细胞癌1例,不典型类癌4例,类癌3例,未明确病理分型10例;神经内分泌标记物Syn、CgA、CD56及NSE表达率达59%~91%。病灶轴位最大径平均7.5 cm,前纵隔及前中纵隔17例,形态分叶状18例。5例病灶含钙化,为点片状、条状及团状钙化影。增强后中度或明显强化20例(强化值22~67 HU),均见坏死囊变,其中多发肿瘤迂曲血管8例。病灶周围脂肪间隙消失或模糊20例,均累及纵隔胸膜。纵隔血管受到不同程度侵犯10例。累及气管或食管4例。淋巴结转移18例。远处转移12例,包括肺、肝、骨、膈肌脚、小脑及胰腺。结论MNEC好发于中老年男性,具有体积大、血供丰富、易坏死、侵袭性高、易转移的特点,CT表现结合临床特点有助于提高诊断准确率。

Objective To investigate CT imaging manifestations of mediastinal neuroendocrine carcinoma(MNEC),so as to improve the understanding of the disease.Methods CT imaging data of 22 cases with MNEC confirmed by pathology were retrospectively analyzed.Results There were 20 males and 2 females,aged 42~85 years.Pathology included 4 cases of small cell carcinoma,1 case of large cell carcinoma,4 cases of atypical carcinoid,3 cases of carcinoid,and 10 cases of unclear pathological classification.The expression rate of neuroendocrine markers of Syn,CgA,CD56 and NSE reached 59%~91%.The maximum axial diameter of the lesion was 7.5 cm on average,17 cases located at anterior and anterior-middle mediastinum.There were 18 cases with lobulated shape,and 5 cases with calcification in the lesion,which showed dots,strips,and mass calcification.There were 20 cases with moderate or obvious enhancement(enhancement value 22~67 HU),all showed necrotic cystic changes,and 8 cases presented with multiple tumor tortuous vessels.The fat gap around the lesion disappeared or blurred,20 cases involved the mediastinal pleura,10 cases of mediastinal vessels were violated to varying degrees,and 4 cases were involved in trachea and esophagus.There 18 cases with lymph node metastasis,12 cases with distant metastasis,including lung,liver,bone,diaphragm foot,cerebellum and pancreas.Conclusion MNEC tends to occur in middle-aged and elderly men.It has the characteristics of large size,rich blood supply,easy necrosis,high invasiveness,and easy metastasis.CT findings combined with clinical features can help improve the diagnostic accuracy.