拟似肺癌的肺结核螺旋CT表现特征及其手术病理发现

Pulmonary Tuberculosis Mimicking Lung Cancer: Correlation between Helical CT Features and Surgical-Pathological Findings

目的 探讨误诊为肺癌的肺结核螺旋CT表现特征与手术病理所见的相关性。资料与方法 搜集术前误诊为肺癌 ,但经手术病理证实为肺结核 30例。全部病例均行螺旋CT扫描 ,回顾性地评价螺旋CT表现与手术及病理改变的关系。结果 (1) 2 5例CT表现为肿块或结节 ,其中密度不均 2 1例 ,空洞 12例 ,卫星病灶 2 2例。 2 0例行增强扫描 ,6 0 % (12 / 2 0 )呈外周部分或环状强化 ,4 0 % (8/ 2 0 )无明显强化。病理为上皮样细胞及纤维组织包裹干酪样物质。 (2 ) 5例表现为肺叶、段实变或不张 ,其中表现为叶、段实变 3例 ,支气管狭窄伴肺不张 2例。病变密度不均匀 5例 ,多发小空洞 4例 ,钙化灶 2例 ,卫星病灶 5例 ,2例病变周围有支气管扩张。病理为干酪灶与增殖结节融合。结论 病变的形态、密度、强化特征以及卫星病灶。

Objective To investigate the correlation between helical CT features and surgical pathological findings in pulmonary tuberculosis misdiagnosed as lung cancer.Materials and Methods Helical CT scanning was performed in 30 patients with pathologically proved pulmonary tuberculosis but misdiagnosed as lung cancer before operation. CT findings were retrospectively analyzed, and a comparison between CT signs and pathological results was made. Results (1) The lesion appeared as nodule or mass in 25 cases, with inhomogeneous density (21/25), cavitation (12/25) or satellite foci (22/25). Enhanced scanning was carried out in 20 cases, of which peripheral or ring shaped enhancement was seen in 12 and no enhancement in 8. Pathologically, the enhanced tissue corresponded to the caseous material encapsulated by fibrous tissue. (2) Lobar or segmental consolidation was seen in 3, bronchial stenosis with atelectasis in 2 cases. The lesion showed inhomogeneous density (n=5), with multiple small cavities (n=4), calcifications (n=2), satellite foci (n=5) or peripheral bronchiectasis (n=2). Pathologically, the lesion was a mixture of caseous substance and proliferative nodules. Conclusion Helical CT features, including lesion's shape, density and enhancement pattern, the presence of satellite foci and peripheral bronchiectasis, are helpful for the differentiation of atypical tuberculosis with lung cancer.