原发性肺肉瘤样癌的影像学表现

Imaging features of sarcomatoid carcinoma of lung

目的旨在分析原发性肺肉瘤样癌的影像学表现特征,提高对本病的认识及影像学诊断水平。方法回顾性分析河南省人民医院2012年1月—2016年12月经病理证实的8例原发性肺肉瘤样癌的X线胸片及CT影像表现,进行总结探讨。结果 8例均表现为周围型肿块,其中左肺3例,右肺5例。病灶最大径2.6~10.5 cm,平均4.3 cm。肿块密度不均匀,2例边缘可见分叶,1例形成空洞,2例合并阻塞性肺炎。6例行增强CT扫描,病变呈不均匀斑片状强化,4例病灶伴无强化的坏死区。2例病灶位于胸膜下,邻近胸膜受侵犯。3例合并纵隔及肺门淋巴结肿大,1例肺内转移,1例侵犯食管,1例发生远处转移至颅内。病理结果显示多形性癌5例,巨细胞癌1例,癌肉瘤1例,梭形细胞癌1例。结论肺肉瘤样癌以周围型居多,体积较大,密度不均,增强后多为不均匀强化,影像表现缺乏特异性,确诊仍需依靠病理学。

Objective To investigate imaging features of sarcomatoid carcinoma of the lung.Methods Totally 8 cases of sarcomatoid carcinoma of the lung proven by pathology were collected,their images were analyzed and compared.Results All 8 cases were periphery type,of which 3 were in the left lung while the other 5 were in the right lung,diameters ranging from 2.6 cm to 10.5 cm(average 4.3 cm).Among the 8 cases,there were 2 cases with lobulation,1 with cavity,2 with obstructive pneumonia and atelectasis,2 with pleural invasion,3 with enlargement of lymph node of hilum and mediastinum,3 with metastasis.By using the enhanced CT scan,6 cases showed nonuniform enhancement,and 4 cases remarkable periphery enhanceme and weak or unobvious enhancement in the central area.Pathological manifestations:Among 8 patients there were 5 cases of pleomorphic carcinoma,1 case of spindle cell carcinoma,1 case of giant cell carcinoma,1 case carcinosarcoma.Conclusion Most cases of SC of the lung appear as large peripheral mass with cavity and lobulation.Contrast-enhanced CT is helpful in the diagnosis of SC of the lung as its nonuniform enhanced pattern,but the final diagnosis requires pathological examination.