原发性肺淋巴上皮瘤样癌CT特征分析

CT features of Primary pulmonary lymphoepithelial carcinoma

目的探讨原发性肺淋巴上皮瘤样癌(PPLELC)CT特征。方法回顾性分析2015年1月至2022年10月经手术病理证实86例肺淋巴上皮瘤样癌CT表现。结果86例PPLELC患者中,单发病灶80例(80/86,93%),多发病灶6例(6/86,7%);周围型47例(47/86,54.7%),中央型39例(39/86,45.3%);肿瘤最大径0.6~10.67 cm,平均(4.3±2.8)cm;结节型19例(19/86,22.1%),肿块型67例(67/86,77.9%);肿瘤边界清楚66例(66/86,74.4%),分叶征74例(74/86,86.0%),毛刺征26例(26/86,30.2%);48例(48/86,55.8%)病灶平扫密度均匀,54例(54/77,70.1%)病灶均匀强化;47例(47/77,61.0%)肺动脉期病灶内部见“血管包埋征”,35例(35/86,40.7%)见支气管包埋征,32例(32/86,37.2%)合并阻塞性肺炎,14例(14/86,16.3%)见癌性淋巴管炎。51例(51/86,59.3%)病灶累及胸膜,64例(64/86,74.4%)伴纵隔、肺门淋巴结转移。结论肺淋巴上皮瘤样癌的CT表现多为单发、体积较大、边界清、密度均匀、持续明显强化肿块,肿块易包绕支气管,“血管包埋征”是其CT特征之一,确诊须依赖病理、免疫组织化学分析。

Objective To investigate the CT features of primary pulmonary lymphoepithelial carcinoma.Methods The CT findings of 86 cases with lpulmonary lymphoepithelial carcinoma confirmed by operation and pathology from January 2015 to October 2022 were retrospectively analyzed.Results The pulmonary lymphoepithelial carcinoma was demonstrated as a solitary nodule/mass in 80 cases(80/86,93%),multiple nodules/masses in 6 cases(6/86,7%);totally 39(39/86,45.3%)central tumors and 47(47/86,54.7%)peripheral tumors were identified.The maximum diameter of lesion was ranged from 0.6 cm to 10.67 cm,with average(4.3±2.8)cm.Totally 66(66/86,74.4%)tumors were found with well defined borders,74(74/86,86.0%)showed lobulations,and 26(26/86,30.2%)showed spiculation.The tumor showed homogeneous density on nonenhancement CT in 48 cases(48/86,55.8%),homogeneous enhancement in 54 cases(54/77,70.1%),while 47 cases(47/77,61.0%)showed vascular encasements in the arterial stage,bronchial encasement was found in 32 cases(32/86,40.7%).Obstructive pneumonia was found in 32 cases(35/86,37.2%),cancer lymphangitis was found in 14 cases(14/86,16.3%).The lesion involved the pleura was found in 51 case(51/86,59.3%),Hilar and/or mediastinal lymph node enlargement was found in 64 cases(64/86,74.4%).Conclusion The CTfindingsof pulmonary lymphoepithelial carcinoma are mostly single largemass,clear boundary,uniform density,sustained obviously uniform mass,Bronchial encasement;which is one of the CT features of"vascular encasements",but the final diagnosis should depend on surgical pathology and immunohistochemical analysis.