原发性肺肉瘤样癌的CT影像学特征

目的探讨原发性肺肉瘤样癌的CT影像征象及临床表现，提高对该疾病的认识。 方法回顾性分析2011年1月至2020年9月我院15例经病理证实的原发性肺肉瘤样癌的临床资料及CT影像征象。 结果15例原发性肺肉瘤样癌患者中，多见于50岁以上有吸烟史的中老年男性，临床表现以咳嗽、咳痰及痰中带血多见。CT上肺内肿瘤均单发，病变位于右肺9例、左肺6例，双肺上叶居多；瘤体最大径范围12 mm～159 mm，平均值63 mm；中央型及周围型例数分别是6例、9例；形态类圆形7例、类椭圆形3例、不规则形4例、楔形1例；病灶边缘光整较清晰6例、分叶10例及毛刺3例；CT平扫密度较均匀者6例、不均匀者9例，其中伴钙化3例、不规则形虫蚀样空洞1例；CT增强扫描本组病例12例，其中较均匀强化1例、不均匀强化11例；病灶周边区动脉期呈环形强化、静脉期实性部分呈不同程度进行性强化，病灶中央区常呈片状轻度强化及强化不明显9例或不均匀斑片状及分隔样强化2例。肺部血管受侵5例；支气管狭窄伴阻塞性炎症9例、阻塞性肺不张2例；胸膜受侵11例，肺门淋巴结肿大5例，纵膈淋巴结肿大5例；肺内外转移5例。 结论原发性肺肉瘤样癌多发生于长期大量吸烟男性患者，以双肺上叶、周围型较多，瘤体较大、密度多不均匀，易侵犯邻近胸膜，常伴纵膈及肺门淋巴结肿大，CT增强有一定特征性表现，但确诊仍需依赖病理学检查。

CT imaging features and clinical manifestations of primary pulmonary sarcomatoid carcinoma

Objective To investigate the CT imaging features and clinical manifestations of primary pulmonary sarcomatoid carcinoma,and to improve the understanding of the disease.Methods The clinical data and CT imaging features of 15 cases of primary pulmonary sarcomatoid carcinoma confirmed by pathology in our institute from January 2011 to September 2020 were retrospectively analyzed.Results Among 15 patients with primary pulmonary sarcomatoid carcinoma,it was more common in middle-aged and elderly men over 50 years of age with a history of smoking.The clinical manifestations were cough,expectoration and blood in sputum.Each of the cases was single tumor,with 9 cases of lesions located in the right lung and 6 cases in the left lung.The upper lobes of both lungs were mostly;the maximum diameter of the tumors ranged from 12mm to 159mm,with an average of 63mm;the number of central and peripheral types were 6 cases,9 cases,respectively;7 cases of round shape,3 cases of oval shape,4 cases of irregular shape,1 case of wedge shape;6 lesions of relatively clear edge,10 cases of lobes and 3 cases of burrs;6 cases of uniform density and 9 cases of heterogeneity,including 3 cases with calcification and 1 case with irregular worm-like cavities;CT enhanced scan of 12 cases in this group,including 1 case with more uniform enhancement and 11 cases with heterogeneity enhancement;in arterial phase,peripheral area of the lesion showed ring-shaped enhancement,and performed partly showed different degrees of progressive enhancement in venous phase;the central area of the lesion often showed lightly enhancement and no significantly enhancement 9 cases or uneven patchy and divided enhancement 2 cases.5 cases of pulmonary vascular invasion;bronchial stenosis with obstructive inflammation 9 cases,obstructive atelectasis 2 cases;11 cases of pleural invasion,5 cases of pulmonary hilar lymphadenopathy,5 cases of mediastinal lymphadenopathy;internal and external lung metastases 5 cases.Conclusion Primary pulmonary sarcomatoid carcinoma mostly occurs in male patients with long-term heavy smoking.The upper lobes and peripheral types of both lungs are more common,the tumors are larger,and the density is heterogeneity.It is easy to invade the adjacent pleura,often with mediastinum and pulmonary hilar lymphadenopathy,CT enhancement has certain characteristic features,but the diagnosis still needs to rely on pathological examination.