原发性肺黏液腺癌的CT征像及病理基础（附32例报告）

目的:探讨原发性肺黏液腺癌（primary pulmonary mucinous adenocarcinoma，PPMA）的CT征象及病理基础。方法:回顾性分析经手术、气管镜或CT引导下穿刺活检病理证实的32例PPMA患者的临床、病理及影像资料，观察病变的形态、位置、病灶内及周边情况、增强表现及有无转移等征象。结果:32例PPMA均为单发病灶，中央型7例，周围型25例；其中位于两肺下叶20例，右肺中上叶6例，左肺上叶6例。CT表现为结节肿块型27例，肺炎型5例；增强后多呈轻度强化，中度强化2例；9例发生转移，其中肺门及纵隔淋巴结转移5例，肝转移1例，肺内转移3例合并骨转移者2例。结节肿块型PPMA可见分叶征11例、毛刺征5例、晕征9例、胸膜凹陷征4例、空洞或空泡征6例；32例肺黏液腺癌可见支气管充气征10例，血管造影征18例，此两种征象均出现在5例肺炎型PPMA中。结论:PPMA临床症状不典型，CT征象具有一定的特异性，各CT征像具有相应的病理基础，CT检查可以提高肺黏液腺癌的早期诊断率。

CT features and pathological basis of primary lung mucinous adenocarcinoma(A report of 32 cases)

Objective:To investigate the CT imaging features and Pathological basis of pulmonary primary mucinous adenocarcinoma(PPMA).Methods:Retrospective analysis clinical and imaging data of 32 patients with PPMA confirmed by surgery,bronchoscopy or CT guided biopsy.To observe the shape,location,intralesional and peripheral conditions,enhancement and metastasis of the tumors.Results:32 cases of PPMA were single lesions 7 cases of central type,25 cases of peripheral type.There were 20 cases located in the lower lobes of both lungs,6 cases in the middle and upper lobes of the right lung and 6 in the upper lobes of the left lung.There were 27 cases of nodular mass type and 5 cases of pneumonia type.In contrast-enhanced scan,mild enhancement was found in most cases,and moderate enhancement was found in 2 cases.Metastasis occurred in 9 cases,including hilar and mediastinal lymph node metastasis in 5 cases,liver metastasis in 1 case,intrapulmonary metastasis in 3 cases and bone metastasis in 2 cases.Nodular mass PPMA showed lobulation sign in 11 cases,burr sign in 5 cases,halo sign in 9 cases,pleural indentation sign in 4 cases,cavity or vacuole sign in 6 cases.Among 32 cases of lung mucinous adenocarcinoma,10 cases had bronchoinflatable sign and 18 cases had angiographic sign.Both signs appeared in 5 cases of pneumonic PPMA.Conclusion:The clinical symptoms of PPMA are not typical,the CT signs have certain specificity,and each CT sign has corresponding pathological basis.CT examination can improve the early diagnosis of lung mucinous adenocarcinoma.