胸腺原发神经内分泌肿瘤的CT诊断与鉴别诊断

目的探讨胸腺原发神经内分泌肿瘤的CT特点。方法选取经组织病理学及免疫组化确诊的13例胸腺原发神经内分泌肿瘤病例的临床及影像学资料。结果13例中男性10例,女性3例。5例不典型类癌,1例典型类癌,2例小细胞神经内分泌癌,5例神经内分泌癌未明确分型;1例伴双侧肾上腺皮质增生改变;胸腺神经内分泌肿瘤通常表现为较大肿块影(4.6~12.8 cm),形态多不规则(n=7),多数无包膜境界不清(n=8),密度多不均匀、肿瘤内坏死囊变明显(n=10),少见钙化(n=1),未见明显出血或分隔,增强后不均匀轻中度强化,3例伴胸腔及心包积液,侵犯纵隔内脂肪或心脏大血管(n=12),4例合并纵隔淋巴结肿大,3例合并远处转移。结论胸腺神经内分泌肿瘤多表现为大肿块,形态不规则,密度不均匀,不均匀强化和局部侵犯,坏死囊变常见,若合并库欣综合征多能明确诊断,CT检查有助于疾病分期,指导治疗决策。

CT diagnosis and differential diagnosis of thymic neuroendocrine tumor

Objective To investigate the CT features of primary thymic neuroendocrine tumors.Methods The clinical and imaging data of 13 patients confirmed thymic primary neuroendocrine tumor by histopathology and immunohistochemistry were retrospectively analyzed.Results Of the 13 patients,three were 3 females and 10 males.There were 5 cases of atypical carcinoids,1 case of typical carcinoid,2 cases of small cell neuroendocrine carcinoma,and 5 cases of neuroendocrine carcinoma without detailed definite classification furthermore.One case was associated with bilateral adrenal cortical hyperplasia.Thymic neuroendocrine tumors were generally characterized by large mass(4.6 cm to 12.8 cm),more irregular margin(n=7),most cases had no capsule and the boundary was obscure(n=8),with uneven density,obvious tumor necrosis or cystic degeneration(n=10),rare calcification(n=1),no significant hemorrhage or separation.The tumors showed uneven mild-moderate enhancement after contrast,3 cases presented with pleural and pericardial effusion,majority invaded mediastinal fat or heart,large blood vessels(n=12)and 4 cases had mediastinal lymph node enlargement,and 3 cases appeared distant metastasis.Conclusion Most primary thymic neuroendocrine tumors are large masses with irregular shape,uneven density,heterogeneous enhancement and local invasion,and necrotic cystic changes are common.If accompanied by Cushing syndrome,diagnosis can be made.CT examination is helpful for disease staging and guiding treatment decision.