肺纤毛黏液结节性乳头状肿瘤的高分辨CT影像表现

目的 探讨肺纤毛黏液结节性乳头状肿瘤(CMPT)的高分辨CT表现特点。方法 回顾分析2017年1月—2020年12月烟台山医院经手术病理证实的6例CMPT患者的临床、影像及病理学资料,其中男1例、女5例,年龄59～74(66.8±4.5)岁。6例患者均行肺低剂量CT及肺结节高分辨CT扫描。观察肿瘤的大小、位置、内部特征、病理特点以及肿瘤边缘距离最近脏层胸膜的距离。结果 6例CMPT患者肺部病灶均为孤立结节,肿瘤的最大径为4～11(7.7±2.4)mm。肿瘤位于左肺下叶3例、右肺下叶2例、右肺上叶1例,位于肺外带5例、叶间胸膜附近1例。肿瘤边缘距离邻近胸膜的最小距离为0～7 mm,平均3.7 mm。1例为实性结节,有分叶,密度不均匀,肿瘤内见斑片状低密度灶。5例表现为混合磨玻璃结节,其中1例瘤体边缘光整呈类圆形、密度均匀,4例形态不规则、瘤体边缘毛糙、病灶内可见斑片状低密度灶;2例肿瘤内见“空泡征”。病理检查显示,镜下肿瘤内均见大量黏液,并向相邻肺泡腔内不规则突出。结论 CMPT常表现为发生于周围肺的单发实性或磨玻璃结节,生长缓慢;肿瘤边缘多毛糙不规则且密度不均,而镜下肿瘤内大量黏液并向周围肺泡腔内突出可能是其病理基础。

High resolution CT manifestations of ciliated muconodular papillary tumor

Objective To investigate the high resolution computed tomography (HRCT) features of ciliated mucinous nodular papillary tumor (CMPT).Methods The data of clinical manifestation, pathological feature, and the medical imaging finding of six patients with CMPT confirmed by surgery and pathology in Yantai shan Hospital from January 2017 to December 2020 were collected and retrospectively analyzed. Among them one male and five females with a mean age of 59-74 (66.8±4.5) years. All six patients received low-dose CT and HRCT scans. The size and location of the tumor, the distance between the tumor margin, the internal characteristics and pathological characteristics, its nearest visceral pleura were observed.Results All lung lesions in the six CMPT patients were solitary nodules, with an average maximum diameter of 4-11 (7.7±2.4) mm. The tumor was located in the lower lobe of the left lung in three cases, the lower lobe of the right lung in two cases, and the upper lobe of the right lung in one case. The tumor occurred in the extrapulmonary zone and interlobar pleura in five cases and in one cases, respectively. The minimum distance between the tumor margin and the adjacent pleura was 0-7 mm, with an average of 3.7 mm. One of the six patients showed solid nodule with lobulated, uneven density, and patchy low-density lesions within the tumor. Five cases were ground glass nodules, and of which one case presented a quasiround edge smoothness with uniform density. The morphology of four cases was irregular, the margins of the tumors were rough, and patchy low-density foci can be seen in the lesions. The vacuolar sign was found in two tumors. Microscopically, the masses of mucous lakes were found in the tumors and protruding irregularly into the adjacent alveolar cavities.Conclusions CMPT is usually manifested as a single solid or ground glass nodule in the surrounding lungs with slow growth. The margin of the tumor is rough and irregular with uneven density. Therefore, the large amount of mucus in the tumor and protrusion into the surrounding alveolar space may be the pathological basis.