肺炎型肺癌的CT表现与病理特征

摘要

目的探讨肺炎型肺癌的CT表现及病理特征，提高对肺炎型肺癌的诊断水平。资料与方法回顾性分析33例经活检及手术病理证实的肺炎型肺癌患者的CT特点及病理表现，并参照肺腺癌新分类指南进行分类。结果33例肺炎型肺癌中，CT示22例两肺多发分布，9例单叶分布，2例肺段分布。所有病例均有肺实变，21例以肺下叶实变为主，32例实变内充气支气管征，其中24例充气支气管狭窄；23例实变肺伴多发结节影；26例实变周围或远侧磨玻璃征；13例合并囊腔及蜂窝肺征。增强后18例实变肺未见明显强化，15例不均匀强化；21例实变影内可见分支走行的血管影。病理显示浸润性黏液腺癌26例，浸润性黏液腺癌混合部分乳头状或腺泡状腺癌7例。结论肺炎型肺癌呈单发或多发实变影，其内见充气支气管征，伴多发结节、磨玻璃影，可合并囊腔及蜂窝征，病灶逐渐增大、增多并向两肺播散，结合其动态变化特点，有助于提高诊断准确率。%Purpose To explore the CT manifestations and pathological features of pneumonia-type lung cancer, and to improve the diagnosis capability of pneumonia-type lung cancer. Materials and Methods CT and pathologic features of 33 cases of biopsy or surgical pathology confirmed pneumonia-type lung cancer patients were retrospectively analyzed and classified according to the new pulmonary adenocarcinoma classification. Results Among the 33 pneumonia-type lung cancer subjects, CT showed multiple distributions within both lungs in 22 cases, lateral lobe distribution in 9 cases, segmental distribution in 2 cases. Lung consolidation was found in all lesions, among them 21 cases appeared mainly as lower lobe consolidation, 32 cases as inflatable bronchial symptoms within the consolidation, including inflatable bronchoconstriction in 24 cases;consolidation with multiple pulmonary nodules found in 23 cases;ground glass shadowing around or distal to the consolidation found in 26 cases;combined with cysts or honeycomb lung symptom in 13 cases. Inhomogeneous mild enhancement of lung consolidation after enhancement found in 18 cases and inhomogeneous moderate enhancement in 15 cases;blood vessel branch shadow within the consolidation was visible in 21 cases. Pathology results revealed 26 cases of invasive mucinous adenocarcinoma, and 7 cases of invasive mucinous adenocarcinoma partial mixed with papillary or alveolar adenocarcinoma. Conclusion CT features of pneumonia-type lung cancer are single or multiple opacities, within which inflatable bronchial symptoms can be observed, with multiple nodules and ground glass shadowing, cysts or honeycomb symptom can also be found concomitant, the lesions expand, increase and spread to both lungs, taking its dynamic change features into consideration will also help to improve the diagnostic accuracy.