肺肉瘤样癌的影像和病理分析

目的:评价肺肉瘤样癌的影像和病理特点,提高对本病的认识。方法:回顾性分析经手术和病理证实的5例肺部肉瘤样癌,行影像与病理对照分析。5例均行胸部X线平片检查,其中3例行胸部增强前后CT扫描。结果:5例肺肉瘤样癌X线平片表现为边界模糊、密度不均之分叶状肿块。3例CT平扫表现为分叶及毛刺征3例、空洞1例、纵隔及肺门淋巴结转移3例、胸膜侵犯2例、阻塞性肺不张1例,阻塞性肺炎1例,肺内转移1例。3例CT增强扫描显示肺肉瘤样癌具肉瘤的强化特征,即肿块周缘厚薄不均的环形强化,而肿块中央强化不明显或不均匀低强化。病理显示5例患者肉瘤样组织均超过50%。结论:肺肉瘤样癌的常规X线及CT平扫具有典型肺癌表现,而增强CT扫描所示肿块强化方式类似肉瘤表现。故胸部CT增强扫描对肺肉瘤样癌的初步诊断具有一定的临床价值。

Radiological Analysis of Lung Sarcomatoid Carcimoma Correlated with Pathological Findings

Objective:To investigate the values of radiography and computed tomography (CT) in the diagnosis of sarcomatoid carcinoma (SC) of the lung correlated with the pathological findings.Methods:5 consecutive patients with SC of the lung proven by surgery and pathology,underwent radiographic examination in 5,pre- and post-contrast CT scan in 3.The images were reviewed retrospectively.Results:SC of the lung had the characteristics of both carcinoma and sarcoma of the lung.The plain X-ray films of the 5 cases exhibited an irregular lobulated mass with ill-defined margin and inhomogeneous density.Pre-contrast CT of 3 cases showed so much signs just like conventional lung cancer as follows:lobulation or spiculation in 3,cavity in 1,enlargement of lymph node of the hilum and mediastium in 3,pleura invasion in 2,atelectasis in 1,obstructive pneumonia in 1,and metastasis of the lung in 1.After administration of contrast medium,the 3 cases of SC of the lung had a heterogeneous ring enhancement.As to the pathological findings,all the 5 cases revealed sarcomatoid tissues for a percentage over 50%.Conclusion:The appearances of SC of the lung on the plain X-ray film and pre-contrast CT are similar to the typical findings of carcinoma of the lung.And contrast-enhanced CT seems to be useful in the diagnosis of SC of the lung for the enhancement features like sarcoma.