原发性肺肉瘤样癌的影像学表现与临床病理对照

目的:探讨原发性肺肉瘤样癌的影像学表现及临床病理特点。方法:回顾性分析经手术病理证实的肺肉瘤样癌11例的影像学表现和临床病理所见,并复习文献。结果:11例肺肉瘤样癌中,中央型3例,周围型8例,病变部位以上叶为多,肿块直径较大(大于5cm者9例),8例淋巴结转移,胸膜受侵7例。组织学检查:梭形细胞癌1例,其余10例由梭形细胞与上皮细胞两种成分混合构成,梭形细胞具有肉瘤样生长方式,上皮成分主要为鳞癌和腺癌,其中鳞癌6例,腺癌4例,两种成分可见移行过渡,免疫组化检查11例,梭形细胞成分的上皮标记(CK)为阳性。结论:肺肉瘤样癌罕见,临床无特异性,影像学表现虽有一些特征,但确诊依靠病理检查。

Primany pulmonany sarcomatoid carcinoma: imaging findings and pathology

Objective:To study the imaging and clincopathologic features of primany pulmonary sarcomatoid carcinoma(PSC).Methods:Imaging findings and clinicopathologic manifestations of PSC proved by operation and pathology in 11cases were reported and review of literature.Results:PSC may be divided into 2 types: the peripheral types(n=8) and central types(n=3).Majority of the lesions was located in the upper lobe of the lung(n=6).Diameter of the tumor most over 5cm (n=9).Metastasic of the tumor into lymph nodes were noticed in 8 cases.The pleura were attached 7 cases of all patients.Microscopically,one is spindle cell carcinoma,other cases are composed of two kinds of cells.One is spindle cell and the other is epithelial cell.The proportion of spindle cells is similar to sarcoma.The proportion of epithelial cells are squamous cell carcinoma and adenocarcinoma.A clear demarcation between two proportions was not found.Immunohistochemically,epithelial markers in spindle cell areas were positive in 11 cases.Conclusion:PSC is rare clinically,it has no specific features.Although PSC has some relatively characteristic imaging findings,it is depended on pathologic examination to establish the diagnosis.