原发性肺肉瘤样癌的CT诊断及鉴别诊断

目的通过探讨肺肉瘤样癌的临床症状、病理学特征A．CT表现，提高对本病的认识。方法总结8例资料完整的原发性肺肉瘤样癌的『临床表现，病理学特征及cT表现。所有病例均行手术切除肿物或病理活检，病理诊断明确为原发性肺肉瘤样癌。结果临床表现为咳嗽、咳痰、气促、胸闷、胸痛等呼吸系统症状。病理切片提示为大细胞或梭型肿瘤浸润，瘤细胞胞浆丰富红染，免疫组化染色Vinmentin、CK、EMA（＋）等阳性。cT表现多为肺部团块影，边缘不清，病灶密度不均匀，增强扫描呈不均匀强化，伴肺门及纵隔淋巴结肿大，远处转移及局部组织破坏多见。结论肺的肉瘤样癌临床表现及cT表现上无特异性，不易与普通肺癌及肺肉瘤相鉴别，需要结合病理及免疫组化结果进行诊断。

Primary Pulmonary Sarcomatoid Carcinoma:CT Features and Differential Diagnosis

To evaluate the clinical manifestations, pathological characteristics and CT features of primary pulmonary sarcomatoid carcinoma and improve its diagnosis and differential diagnosis. Clinical manifestations, pathological characteristics and CT features of 8 patients with primary pulmonary sarcomatoid carcinoma were summarized. All patients underwent biopsy or surgery and pathological examination of the tumor. Clinical manifestations included cough, expectoration, dyspnea, chest distress and chest pain. Pathological examination showed eosinophilic giant cell or spindle cell carcinoma rich in cytoplasm. Immunohistochemistry revealed positive for Vinmentin, CK, and EMA. CT scan showed mass lesion in lung with unclear margin and heterogeneous density. Contrast enhanced CT showed heterogeneous enhancement of the mass. Enlargement of hilar and mediastinal lymph nodes were seen in all patients. Distant metastasis and local invasion were common. Primary pulmonary sarcomatoid carcinoma has no characteristic clinical and CT manifestations and is not easy to be differentiated from lung cancer and sarcoma of the lung. The diagnosis depends on pathological and immunohistochemistry exanmination.