非活动性肺结核病变与肺癌并存的影像表现

Radiological Manifestations of Inactive Pulmonary Tuberculosis Coexisting with Lung Cancer

目的:探讨非活动性肺结核病变与肺癌并存的影像表现以及二者可能存在的因果线索。方法:对52例具有非活动性肺结核病变与肺癌并存的X线和CT表现进行了回顾性分析;46例肺癌经病理/细胞学检查证实,腺癌37例,肺泡癌3例,鳞癌6例,6例具有典型的临床和影像学表现。结果:52例胸部影像学表现均为非活动性肺结核病变,45例涉及上叶尖后段(86.5%)。94%为(49/52)为周围型肺癌,3例中央型;周围型肺癌检出时多表现为单一的结节或肿块,78%位于上叶,92%与肺结核同处于一侧肺,78%与肺结核处于同一肺叶;CT检出前的早期小肺癌多表现为混杂于结核病灶中的灶状或斑片状影。结论:与肺结核并存的肺癌多为周围型,好发生于上肺叶,对尚缺乏一定影像学特征的小肺癌与非活动性结核病灶杂处一叶肺时,鉴别颇难,有赖追踪。本文观察到发生于非活动性肺结核病变的后续肺癌间存在着解剖学关联。

Objective:To investigate the imaging manifestations of coexistence of inactive pulmonary tuberculosis and lung cancer and the possible causal clues of the two.Methods:The X-ray and CT findings of 52 cases with inactive pulmonary tuberculosis and lung cancer were retrospectively analyzed;46 cases of lung cancer were confirmed by pathological/cytological examination,37 cases of adenocarcinoma,3 cases of alveolar carcinoma,and 6 cases of squamous cell carcinoma.6 cases had typical clinical and imaging findings.Results:All 52 cases had inactive pulmonary tuberculosis lesions on chest imaging,and 45 cases involved the posterior segment of the upper lobe(86.5%).94%(49/52)were peripheral type lung cancer,3 cases were central type;peripheral type lung cancer was mostly a single nodule or mass when detected,78%were located in the upper lobe,and 92%were located in the same lung as tuberculosis.78%were located in the same lobe as pulmonary tuberculosis;early-stage small lung cancer before CT detection mostly showed focal or patchy shadows mixed with tuberculosis lesions.Conclusion:Lung cancer coexisting with pulmonary tuberculosis is mostly peripheral type,and it occurs in the upper lobe.It is difficult to identify small lung cancer that lacks certain imaging features and inactive tuberculosis lesions scattered in one lobe of lung,and it is necessary to follow up.Here we observe an anatomical association between subsequent lung cancers that develop in inactive tuberculosis lesions.