肺淋巴上皮瘤样癌CT表现

目的 探讨肺淋巴上皮瘤样癌（LELC）的CT表现。方法 回顾性分析244例经病理证实的肺LELC的CT表现。结果 244例LELC中,中央型132例（132/244,54.10%）,周围型112例（112/244,45.90%）;肿瘤最大径1.2~13.1 cm,平均（5.42±2.64）cm;结节型49例（49/244,20.08%）,肿块型195例（195/244,79.92%）;169例（169/244,69.26%）边界清晰,183例（183/244,75.00%）见分叶征,104例（104/244,42.62%）病灶边缘见毛刺;184例（184/244,75.41%）病灶紧贴纵隔,111例（111/244,45.49%）见"类胸膜尾征"改变。CT平扫158例（158/244,64.75%）病灶密度均匀,增强后中度强化160例（160/223,71.75%）,145例（145/193,75.13%）呈渐进强化,108例（108/193,55.96%）动脉期病灶内见血管受侵变细和异常细小杂乱的血管影,81例（81/193,41.97%）动脉期病灶内见血管包埋征。185例（185/244,75.82%）见支气管包埋和/或闭塞。124例（124/244,50.82%）病灶周围见磨玻璃密度影,81例（81/244,33.20%）间质增厚,132例（132/244,54.10%）伴阻塞性肺炎或肺不张。167例（167/244,68.44%）肺门和/或纵隔淋巴结肿大。结论 右肺中叶、两肺下叶纵隔胸膜旁肿块,边界清、浅分叶,伴类胸膜尾征、增强动脉期血管包埋征、周围肺区磨玻璃密度影及网格增粗影和淋巴结肿大是肺LELC的相对特征性CT表现。

CT findings of pulmonary lymphoepithelioma-like carcinoma

Objective To investigate CT findings of pulmonary lymphoepithelioma-like carcinoma (LELC). Methods CT findings of 244 patients with pathologically proved pulmonary LELC were analyzed retrospectively. All patients underwent nonenhancement CT scan, 226 of them also underwent contrast-enhanced CT scan. Results Totally 132 (132/244, 54.10%) central tumors and 112 (112/244, 45.90%) peripheral tumors were identified. The maximum diameter of lesion was ranged from 1.2 cm to 13.1 cm, with average (5.42±2.64)cm. The lesions were characterized with 49 (49/244, 20.08%) nodules and 195 (195/244, 79.92%) masses. Totally 169 (169/244, 69.26%) tumors were found with well-defined borders, 183 (183/244, 75.00%) showed lobulations, and 104 (104/244, 42.62%) showed spiculation. The tumor located closely with the mediastinum in 184 cases (184/244, 75.41%), while pleural change of tail sign was observed in 111 cases (111/244, 45.49%). The tumor showed homogeneous density on nonenhancement CT in 158 cases (158/244, 64.75%), moderate enhancement in 160 cases (160/223, 71.75%), gradually enhancement in 145 cases (145/193, 75.13%), while 108 cases (108/193, 55.96%) showed abnormal small vessels and 81 cases (81/193, 41.97%) showed vascular encasements. Bronchial encasement and/or stenosis was found in 185 cases (185/244, 75.82%). Ground-glass opacity around the lesion was detected in 124 cases (124/244, 50.82%), when interstitial thickening was noticed in 81 cases (81/244, 33.20%) and obstructive pneumonia or pulmonary atelectasis was found in 132 cases (132/244, 54.10%). Hilar and/or mediastinal lymph node enlargement was found in 167 cases (167/244, 68.44%). Conclusion Most pulmonary LELC occurres in right middle lobe and bilateral lower lobe of lung, and appeares as well-defined and slight lobulated tumor with enlarged lymph nodes. Vascular encasements, closely associated with mediastinum, pleural change of tail sign, ground-glass opacity and interstitial thickening are comparative characteristics of pulmonary LELC.