小细胞肺癌的临床CT病理特点及其征象分析

目的分析4 0例小细胞肺癌(SCLC)的CT表现及其与病理的关系,提高临床对该病的诊断准确性。方法选择我院2013年4月至2016年4月经病理证实的40例小细胞肺癌患者进行回顾性分析,总结其CT特征表现。结果中央型SCLC 35例,CT表现为肺门分叶状肿块或结节,增强扫描病灶以不均匀强化为主,内部不规则坏死16例、可见扩张血管14例,7例伴轻度阻塞性不张或炎症。纵膈及肺门淋巴结转移21例、远处转移8例。周围型SCLC 5例,病灶均为单发结节,边缘无明显毛刺,平扫CT值18-36HU,增强扫描2例为病灶均匀强化、3例不均匀强化。结论 SCLC患者的常规HE染色可见细胞较小,挤压变形、核浆比增大,CD56、Ki-67阳性率均可达100%。螺旋CT检查征象主要包括肺门区实性肿块,伴肺门、纵隔淋巴结转移,早期血行转移,支气管阻塞征象出现较晚,可据此提出诊断或疑诊,确诊仍须依靠病理活检。

Clinical CT Pathological Characteristics and Signs of Small Cell Lung Cancer

Objective To analyze the CT findings of 40 patients with small cell lung cancer and their relationship with pathology(SCLC), and to improve the diagnostic accuracy of the disease. Methods Retrospective analysis was conducted on 40 pathologically confirmed patients in our hospital between April 2013 and April 2016. The CT findings were summarized. Results There were 35 cases with central type SCLC, and CT showed hilar lobulated masses or nodules. Enhanced scan mainly showed inhomogeneous enhancement. There were 14 cases with internal irregular necrosis, 16 cases with dilated blood vessels, and 7 cases with mild obstructive atelectasis or inflammation. There was mediastinal and pulmonary hilar lymph node metastasis in 21 cases and distant metastasis in 8 cases. Five cases had peripheral SCLC and the lesions were solitary nodules, without obvious burr on edges. Plain scan CT value was 18-36HU. Enhanced scan showed homogeneous enhancement in 2 cases of lesions and inhomogeneous enhancement in 3 cases. Conclusion Routine HE staining of patients with SCLC showed that cells are smaller and were extruded and distorted, nuclear to cytoplasmic ratio increases, and the positive rates of CD56 and Ki-67 reach 100%. Spiral CT findings include solid masses in the hilar region, with hilar and mediastinal lymph node metastasis, early hematogenous metastasis, and bronchial obstruction sign appearing later, which can be used to put forward diagnosis or suspected diagnosis. Confirmed diagnosis must rely on biopsy.