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《中华肺部疾病杂志》[ISSN:1006-6977/CN:61-1281/TN]

卷:

期数:

2022年02期

页码:

151-156

栏目:

论著

出版日期:

2022-04-20

文章信息/Info

Title:

CT findings and pathological basis of primary nodular mass lung mucinous adenocarcinoma

作者:

望 云¹; 张正委²; 范 丽¹; 樊荣荣¹; 涂文婷¹; 刘士远¹

200003 上海,海军军医大学第二附属医院放射诊断科¹、病理科²

Author(s):

Wang Yun¹;  Zhang Zhengwei²;  Fan Li¹;  Fan Rongrong¹;  Tu Wenting¹;  Liu Shiyuan¹.

¹Department of Radiology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China; ²Department of Pathology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, China

关键词:

肺肿瘤;  黏液腺癌;  体层摄影术; X线计算机;  病理基础

Keywords:

Lung tumors;  Mucinous adenocarcinoma;  Tomography;  X-ray computer;  Pathology

分类号:

R734.2

DOI:

10.3877/cma.j.issn.1674-6902.2022.02.003

摘要:

目的 分析原发性结节肿块型肺黏液腺癌的CT表现、随访变化,以提高对本病的认识。方法 分析80例经病理证实的原发性结节肿块型肺黏液腺癌患者的病理、临床及影像资料。患者均行胸部CT检查,其中57例患者行胸部CT平扫+增强检查,8例有间隔时间2周以上的随访CT。分析病灶影像学征象及动态CT随访变化。结果 微浸润肺黏液腺癌7例,浸润性肺黏液腺癌73例。单发病灶78例,多原发病灶2例。混杂磨玻璃结节20例,实性病灶60例。69例(86.2%)位于胸膜下,49例(61.2%)位于肺下叶。占比50%以上的征象有:类圆形46例、瘤肺界面清楚毛糙45例,分叶征70例、磨玻璃征43例。平扫病灶密度均低于肌肉,轻度强化19例,中度强化30例,明显强化8例,17例病灶内可见无强化的液性区域,血管造影征15例。CT动态随访变化多样,可短期保持稳定或迅速增长,或短期内实性成分减少而磨玻璃成分增多,或长期保持不变或缓慢增长。结论 原发性结节肿块型肺黏液腺癌好发于双肺下叶及胸膜下,多呈类圆形、瘤肺界面清楚毛糙,多伴有分叶征及磨玻璃征,以轻中度强化为主。CT动态随访变化多样。结合病灶的HRCT征象、CT增强及随访变化对诊断肺黏液腺癌有一定意义。

Abstract:

Objective To explore the CT findings, follow-up changes of primary nodular mass pulmonary mucinous adenocarcinoma, so as to improve the understanding of the disease. Methods The pathological, clinical and imaging data of 80 patients with primary nodular mass lung mucinous adenocarcinoma confirmed by pathology were retrospectively analyzed. All patients underwent chest CT examination, of which 57 patients underwent enhanced chest CT examination, and 8 patients had follow-up CT with more than 2 weeks interval. Analyze the imaging signs and dynamic CT follow-up changes of the lesions. Results There were 7 cases of minimally invasive pulmonary mucinous adenocarcinoma and 73 cases of invasive pulmonary mucinous adenocarcinoma. There were 78 cases with a single lesion and 2 cases with multiple primary lesions. There were 20 cases of mixed ground glass nodules and 60 cases of solid lesions. 69 cases(86.2%)were located under the pleura and 49 cases(61.2%)were located in the lower lobe of the lung.These features accounted for more than 50% of all CT signs in 80 cases, including round shape in 46 cases(57.5%), clear and rough interface in 45 cases(56.2%), lobulation in 70 cases(87.5%), ground-glass opacity sign in 43 cases(53.8%). The density of lesions on non-enhanced CT was lower than that of muscle. There were 19 cases with mild enhancement, 30 cases with moderate enhancement, 8 case with obvious enhancement, 17 cases with non-enhanced liquid areas, and 15 cases with angiographic signs. CT dynamic follow-up changes are diverse, which can remain stable or grow rapidly in the short term, or the solid component will decrease and the ground glass component will increase in the short term, or remain unchanged or grow slowly for a long time. Conclusion Primary nodular-mass type pulmonary mucinous adenocarcinoma usually occurs in the lower lobes of the lungs and under the pleura. It is mostly round-shaped, and the tumor-lung interface is clear and rough, often accompanied by lobular signs and ground glass signs. Mainly with mild to moderate enhancement degree.CT dynamic follow-up changes are diverse. Combining the HRCT signs, CT enhancement and follow-up changes of the lesions has certain suggestive significance for the diagnosis of lung mucinous adenocarcinoma.

参考文献/References:

1 Travis WD, Brambilla E, Nicholson AG, et al. The 2015 world health organization classification of lung tumors: impact of genetic, clinical and radiologic advances since the 2004 classification[J]. J Thorac Oncol, 2015, 10(9): 1243-1260.
2 聂 凯, 于 红, 刘士远, 等. 原发性肺浸润性黏液腺癌CT征象及病理特点[J]. 实用放射学杂志, 2018, 34(9): 1335-1338, 1380.
3 王庆宜, 李万湖, 张德贤, 等. 原发性肺浸润型黏液腺癌影像学表现及病理特点[J]. 中华肿瘤防治杂志, 2020, 27(8): 647-652,657.
4 王 铮, 苏丹柯, 赖少侣, 等. 原发性肺黏液腺癌CT表现及病理基础[J]. 临床放射学杂志, 2018, 37(4): 608-611.
5 郭 荣, 卢定友. 原发性肺黏液腺癌的CT表现与病理对照研究[J]. 临床肺科杂志, 2018, 23(12): 2287-2290.
6 包盈莹, 雷永霞, 李新春, 等. 肺浸润性黏液腺癌的CT及～(18)F-FDG PET/CT表现[J]. 中国医学影像学杂志, 2019, 27(11): 815-819.
7 包 杰, 金银华, 华奇峰, 等. 结合病理对原发性肺黏液腺癌的MSCT表现分析[J]. 医学影像学杂志, 2020, 30(5): 871-874.
8 蔡雅倩, 韩 丹, 张正华, 等. 原发性肺黏液腺癌CT表现[J]. 放射学实践, 2019, 34(12): 1318-1321.
9 秦冬雪, 孙传恕, 伍建林. 原发性肺黏液腺癌的临床表现及CT征象[J]. 中国医学影像技术, 2016, 32(7): 1070-1074.
10 魏东波, 荆 燕, 董 强, 等. 肺实性结节性黏液腺癌CT特征及～(18)F-FDG特点与相关病理基础研究[J]. 医学影像学杂志, 2020, 30(10): 1825-1828.
11 梁拥辉, 郭爱菊, 师新宇, 等. 肺孤立性实性结节61例采用CT检查对黏液腺癌与结核球鉴别诊断价值的评估[J]. 中华肿瘤防治杂志, 2021, 28(1): 62-66.
12 Shim HS, Kenudson M, Zheng Z, et al. Unique genetic and survival characteristics of invasive mucinous adenocarcinoma of the lung[J].Thorac Oncol, 2015, 10: 1156-1162.
13 张 杰, 邵晋晨, 朱 蕾. 2015版WHO肺肿瘤分类解读[J]. 中华病理学杂志, 2015, 44(9): 619-624.
14 Miyata N, Endo M, Nakajima T, et al. High-resolution computed tomography findings of early mucinous adenocarcinomas and their pathologic characteristics in 22 surgically resected cases[J]. Eur J Radiol, 2015, 84(5): 993-997.
15 梁拥辉, 曹捍波, 王 梅, 等. 孤立型肺黏液腺癌与非黏液性浸润性肺腺癌的CT对比研究[J]. 临床放射学杂志, 2020, 39(12): 2415-2418.
16 吕 岩, 谢汝明, 周新华, 等. 磨玻璃晕征环绕的周围型肺癌的CT特征及病理对照观察[J]. 中国医学影像技术, 2010, 26(6): 1096-1099.
17 王 康, 李 铭, 周 翔, 等. 孤立结节型肺黏液腺癌的CT表现与病理对照研究[J]. 临床放射学杂志, 2020, 39(9): 1768-1772.
18 邵元伟, 滕敏敏, 王晓蕾, 等. 原发性肺浸润性黏液腺癌的临床病理特征与CT表现[J]. 中国临床医学影像杂志, 2020, 31(10): 719-722,726.
19 解丙坤, 史忠瑞, 潘 泉, 等. 原发性肺黏液腺癌CT表现与临床病理因素相关性分析[J]. 中华肿瘤防治杂志, 2020, 27(17): 1393-1398.
20 Lee MA, Kang J, Lee HY, et al. Spread through air spaces(STAS) in invasive mucinous adenocarcinoma of the lung: Incidence, prognostic impact, and prediction based on clinicoradiologic factors[J]. Thorac Cancer, 2020, 11(11): 3145-3154.
21 吴 婧, 王兆宇, 潘军平, 等. 肺炎型黏液腺癌的CT诊断价值[J]. 临床与病理杂志, 2017, 37(10): 2137-2143.
22 褚代芳, 金发光. 肺腺癌EGFR基因19、21外显子突变与临床病理特征及预后的关系[J/CD]. 中华肺部疾病杂志(电子版), 2021, 14(6): 711-716.

备注/Memo

备注/Memo:

基金项目: 国家自然科学基金重点项目(81930049); 上海市青年科技英才扬帆计划(20YF1449000) 上海长征医院“金字塔人才工程” 通信作者: 刘士远, Email:cjr.liushiyuan@vip.163.com

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更新日期/Last Update: 2022-04-20