原发性肺肉瘤样癌的临床病理特征及其影像表现

目的 探讨原发性肺肉瘤样癌各亚型的临床病理特征及影像表现.方法 回顾性分析15例经手术病理证实为原发性肺肉瘤样癌患者的临床病理资料及X线胸片和CT表现.术前14例行胸部CT检查,其中10例行CT增强扣描,9例行胸部X线平片检查.结果 15例中周围型肿瘤14例,中央型1例;肿瘤直径2.5～9.5 cm,病变位于右肺上叶5例、中叶3例、下叶4例、左肺上叶3例.X线胸片和CT均表现为肺内实质性肿块,3例肿瘤内可见偏心性不规则空洞,肿块边界光整6例、模糊2例、分叶4例、毛刺3例,另1例因中央型肿块伴阻塞性肺炎致边界不清.10例CT增强扫描患者均显示肿块周边厚薄不均的环形强化,肿块中央强化不明显或呈不均匀强化.7例侵及胸膜或胸壁组织,4例可见肺门和(或)纵隔淋巴结肿大,2例有远处转移.手术病理诊断为多形性癌8例,梭形细胞癌2例,巨细胞癌3例,肺母细胞瘤2例.结论 肺肉瘤样癌的X线胸片和CT表现无明显特异性,各亚型的病理组织学表现具有一定特征性,是确诊的依据.

Clinicopathology and imaging findings of primary pulmonary sarcomatoid carcinoma

Objective To investigate the clinical pathological features and imaging findings of primary pulmonary sarcomatoid carcinoma. Methods Fifteen patients with a pathologically verified primary pulmonary sarcomatoid carcinoma were reviewed retrospectively. Fourteen patients had CT examinations and I0 of them had contrast-enhanced CT scan. Nine patients had chest plain films. Results Of 15 patients, 14 were peripheral and 1 was central, diameters ranging from 2.5 cm to 9.5 cm. Five located in the upper, 3 in the middle and 4 in the lower lobe of the right lung. The other 3 located in the upper left lobe. All cases presented with a spheroid solid lung mass on chest plain film and CT examinations. Three had irregular eccentric cavities. Six were well demarcated, 2 were ill defined, 4 were lobulated and 3 were speculated. The central case had obstructive pneumonia and showed ill defined. Ten showed irregular peripheral heterogeneous contrast enhancement. The center part of the tumor showed no enhancement or inhomogeneous enhancement. Seven had thoracic wall or pleural invasion, 4 had hilar or mediastinal lymphopathy and 2 had metastasis. Histopathologically, 8 were pleomorphic carcinoma, 2 were spindle cell carcinoma, 3 were giant cell carcinoma and 3 were pulmonary blastomas. Conclusion The X-ray and CT findings of the primary pulmonary sarcomatoid carcinoma are not specific. The clinicopathologic features were the evidence of diagnosis.