不同侵袭程度原发性肺淋巴上皮样癌的CT特征及临床病理表现

CT features and clinical pathological presentations of primary pulmonary lymphoepithelioma-like carcinoma with varying degrees of invasion

目的:探讨不同侵袭程度的原发性肺淋巴上皮样癌(pLELC)的影像特征及临床病理表现,旨在提高对该病的认识及诊断。方法:回顾性分析103例经病理证实的pLELC患者的术前CT影像表现、临床及病理资料,所有患者均行胸部CT平扫,其中88例行胸部CT增强检查。结果:103例pLELC患者按侵袭程度分为可切除组(Ⅰ~ⅢA期,62例),晚期不可切除组(ⅢB~Ⅳ期,41例)。影像上,可切除组常表现周围型(58/62,93.5%),多数近中线结构(33/62,53.2%),病灶多表现为圆形或类圆形(37/62,59.7%),伴局部“晕征”(41/62,66.1%),且多数与胸膜关系密切(47/62,75.8%);而不可切除的组中央型及周围型差异不明显(20 vs.21),多数近中线结构(38/41,92.7%),易累及胸膜(35/41,85.4%)、出现血管漂浮/包埋(34/41,82.9%),多数存在分叶(28/41,68.3%)、阻塞性炎症(34/41,82.9%)、邻近支气管累及(26/41,63.4%)及淋巴结增大/转移(37/41,90.2%)。结论:可切除原发性肺淋巴上皮样癌CT表现具有一定的特征性,尤其是近中线结构、圆形或类圆形,伴“晕征”并与胸膜关系密切时有一定提示意义,有助于该病的早期诊断。但随着分期的进展,病灶易向中线结构、胸膜及淋巴结侵犯,并可表现出血管漂浮/包埋、分叶及邻近支气管受累等恶性征象。

Objective:To investigate the imaging features and clinical pathological presentations of primary pulmonary lymphoepithelioma-like carcinoma(pLELC)with varying degrees of invasion,aiming to enhance understanding and diagnosis of this disease.Methods:The preoperative CT imaging findings,clinical data and pathological data of 103 patients with pathologically confirmed pLELC were retrospectively analyzed.All patients underwent chest CT scans,with 88 cases undergoing contrast-enhanced chest CT examinations.Results:103 patients with pLELC were divided into resectable group(stageⅠ~ⅢA,62 cases)and unresectable group(stageⅢB~Ⅳ,41 cases)based on the degree of invasion.In terms of imaging findings,the resectable group often exhibited peripheral pattern(58/62,93.5%),mostly located near midline structures(33/62,53.2%),and appearing as round or oval shapes(37/62,59.7%),with local"halo"sign(41/62,66.1%),and most of them were closely related to the pleura(47/62,75.8%).On the other hand,in the unresectable group,the central and peripheral types showed no significant difference(20 vs.21).Most lesions were located near the midline structures(38/41,92.7%)and exhibited characteristics such as pleural involvement(35/41,85.4%),vascular floating/encasement(34/41,82.9%),lobulation(28/41,68.3%),obstructive inflammation(34/41,82.9%),involvement of adjacent bronchi(26/41,63.4%),and lymph node enlargement/metastasis(37/41,90.2%).Conclusion:Resectable pLELC exhibits certain characteristic features on CT imaging,especially when located near midline structures,appearing as round or oval shapes,accompanied by a"halo"sign,and showing close proximity to the pleura.These features have suggestive significance and aid in the early diagnosis of the disease.However,as the staging progresses,the lesions are more likely to invade midline structures,pleura,and lymph nodes,and may demonstrate malignant features such as vascular floating/encasement,lobulation,and involvement of adjacent bronchi.