原发性肺睾丸核蛋白癌的临床影像及病理分析

Clinical Imaging and Pathology Analysis of Primary Pulmonary Nuclear Protein in Testis Carcinoma

目的探讨原发性肺睾丸核蛋白(NUT)癌的临床病理表现及CT影像特征。方法回顾性分析2020年2月至2022年5月郑州大学第一附属医院5例经病理诊断为肺NUT癌患者的临床及影像资料,对比CT影像学及病理学表现,分析其CT特点。结果5例肺NUT癌患者中,男2例,女3例,年龄19~64(47.20±15.79)岁,临床表现为咳嗽2例,声音嘶哑1例,胸闷1例,体检发现1例,病程1周~4个月。4例(80%)表现为不均匀分叶状肿块,2例(40%)位于左肺上叶,3例(60%)分别位于左肺门、右肺下叶和左肺下叶,最大径为1.4~13.6 cm,多数为不规则形,边缘多为分叶状,密度不均匀,病灶内均无钙化及累及胸膜,多伴有坏死、囊变,强化程度各异。转移多为纵隔淋巴结转移,亦出现肺内转移、骨转移、肝转移。结论对于中央型肺肿块、病情进展快、初治反应差的患者,应考虑NUT癌的可能性,应尽快进行抗NUT免疫组织化学染色,必要时结合基因检测,CT成像对于肺NUT癌的分期、管理、治疗反应评估和监测是必不可少的。

Objective To investigate the clinicopathological manifestations and computed tomography imaging features of primary pulmonary nuclear protein in testis(NUT)carcinoma.Methods The clinical and computed tomography imaging data of 5 patients with pathologically diagnosed pulmonary NUT carcinoma in the First Affiliated Hospital of Zhengzhou University from February 2020 to May 2022 were retrospectively analyzed.The imaging characteristics and pathology were compared.The CT features were analyzed.Results Among the five cases,there were 2 males and 3 females,aged 19-64(47.20±15.79)years,with clinical manifestations of cough in 2 cases,hoarseness in 1 case,chest tightness in 1 case,and physical examination findings in 1 case,with a disease duration of 1 week to 4 months.Four cases(80%)of the lung NUT carcinomas presented as heterogeneous lobulated masses,2 cases(40%)were located in the upper lobe of the left lung,and 3 cases(60%)located in the left hilum,the lower lobe of the right lung and the lower lobe of the left lung,respectively,with a maximum diameter of 1.4-13.6 cm,mostly irregular in shape,with lobulated margins and heterogeneous density,without calcification and involvement of the pleura in any of the lesions,mostly accompanied by necrosis and cystic changes,the degree of enhancement varies.Metastases were mostly mediastinal lymph node metastases,but also intrapulmonary metastases,bone metastases and liver metastases.Conclusion For patients with central lung masses,rapid disease progression and poor response to initial treatment,the possibility of NUT cancer should be considered and anti-NUT immunohistochemical staining should be performed as soon as possible,combined with genetic testing if necessary.CT imaging is essential for staging,management,treatment response assessment and monitoring of pulmonary NUT cancer.