目的 分析40岁以下肺癌患者的病理类型及分化程度,评价CT影像学表现特征及其诊断价值.资料与方法 回顾性分析2009-01～12共80例经病理诊断为肺癌的40岁以下患者的临床及影像学资料.结果 患者从出现症状到明确诊断平均(4.4±0.4)个月,确诊时出现转移63例,占78.75％;腺癌50例,小细胞癌23例,鳞癌5例,细支气管肺泡癌1例,大细胞癌1例.其中36例可辨别分化程度,中高分化3例,中分化15例,中低分化7例,低分化11例;中央型肺癌38例,CT表现为支气管截断或狭窄33例,分叶16例,肺不张及阻塞性炎症23例;周围型肺癌42例,CT表现为分叶34例,毛刺22例,血管集束16例,胸膜凹陷17例.结论 40岁以下人群肺癌以腺癌和小细胞癌为主,其中中央型肺癌以小细胞肺癌及腺癌为主,周围型肺癌以腺癌为主,分化程度较差;患者确诊时多发生转移.%Purpose To analyze the different pathological types and tumor cell differentiation in lung cancer patients under 40 years old, and to evaluate the role of CT imaging. Materials and Methods 80 patients under 40 years old with pathology proven lung cancer were included. The pathological types, clinical and imaging data were retrospectively analyzed. Results The average duration from symptom onset to diagnosis was (4.4+0.4) months. 63 (78.75%) patients presented with pulmonary or extrapulmonory metastasis when they were diagnosed. Among 80 patients, there were 50 adenocarcinoma, 23 small cell lung cancer, 5 squamous-celled carcinoma, 1 bronchiole alveolar carcinoma, and 1 large cell carcinoma. In 36 patients with discernible degree of differentiation, there were 3 lesions with high-moderate differentiation, 15 lesions with moderate differentiation, 7 lesions with low-moderate differentiation, and 11 lesions with poor differentiation. There were 38 patients with central bronchogenic carcinoma and 42 with peripheral lung cancer on CT images. Central bronchogenic carcinoma presented as bronchial stenosis or interruption in 33 patients, mass tabulation in 16 patients, and atelectasis in 23 patients. Peripheral lung cancer showed tabulation in 34 patients, speculations in 22 patients, vascular convergence in 16 patients, and pleural indentation in 17 patients. Conclusion Adenocarcinoma and small cell lung cancer are most common in patient under 40 years old with lung cancer. Peripheral lung cancer is usually poorly differentiated adenocarcinoma, while central bronchogenic carcinoma is adenocarcinom or small cell lung cancer. Young patients with lung cancer often metastasize when they are diagnosed.
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