原发性肺淋巴上皮瘤样癌CT表现(附11例报告及文献复习)

目的探讨原发性肺淋巴上皮瘤样癌(LELC)CT表现。方法回顾性分析11例经病理证实为原发性肺LELC患者的临床及影像资料,并复习文献。所有患者术前均行胸部CT平扫及增强扫描。结果中央型6例,周围型5例,最大径约1.4～7.9cm,平均(4.5±1.8)cm。4例呈圆形或类圆形,7例呈分叶状;9例肿瘤轮廓光滑,边界清晰;1例肿瘤边缘可见毛刺,1例见胸膜牵拉凹陷征。平扫8例肿瘤为均匀等密度,3例见斑片状低密度区,均未见空洞形成,增强后肿瘤呈均匀或不均匀强化,5例出现斑片状坏死,4例伴"包绕血管征"。5例见肺门、纵隔、隆突下淋巴结肿大,肝转移2例,1例ECT骨扫描证实有骨转移。结论原发性肺淋巴上皮瘤样癌CT表现具有一定特点,诊断需要与其他肺部肿瘤鉴别,确诊依靠病理学检查。     

原发性肺淋巴上皮瘤样癌CT特征及PET-CT表现

目的探讨原发性肺淋巴上皮瘤样癌的CT特征及PET-CT表现。方法回顾性分析经手术和病理证实的2例肺淋巴上皮瘤样癌CT及PET-CT资料。结果 2例均为肺内单发病灶,最大径2. 0～3. 4cm,中央型及周围型各1例,2例均位于右肺上叶,肿块呈分叶征1例,出现支气管充气征1例,伴阻塞性肺炎1例,伴有纵隔淋巴结肿大2例。增强扫描,2例均出现均匀强化,PET-CT提示均为恶性,氟脱氧葡萄糖(FDG)最大摄取值(SUVmax)为10. 3～12. 2。结论PET-CT能够明确肺LELC是原发还是转移,最终诊断仍需依靠病理及免疫组化。     

肺原发性淋巴上皮样癌的MSCT表现及病理分析

目的探讨肺原发性淋巴上皮样癌(LELC)的MSCT表现并分析其病理学基础。方法回顾性分析15例经病理证实为肺原发性LELC的临床、病理及影像资料。所有患者术前均行胸部CT平扫,其中10例行增强扫描。结果中央型10例,周围型5例,最大径约2.2~10.2 cm,平均(4.8±2.3)cm。CT表现:边界清晰12例(80%),呈浅分叶状11例(73.3%),血管纠集征2例(13.3%),肿块内片状坏死者4例(26.7%),阻塞性肺炎6例(40%)。增强扫描大部分肿块不均匀强化(8/10,80%),并且"包绕血管征"(6/10,60%)在不均匀强化肿块中更多见。9例(60%)见肺门或纵隔、隆突下淋巴结肿大,其中6例经病理证实为淋巴结转移,PET-CT证实2例发生肝、骨等远处转移。EBER阳性率为100%(4/4)。结论肺原发性LELC多表现为体积较大、中央型、浅分叶的肿块,增强扫描不均匀强化并可见"包绕血管征"。本病CT表现缺乏特征性,确诊依靠病理学检查。     

原发性肺肉瘤样癌的病理亚型及其CT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CT表现,以提高对本病的认识.方法 回顾性分析14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CT表现.所有病例术前均行CT检查,其中10例行CT增强扫描.结果 14例中周围型13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2例、下叶4例,左肺上叶3例.14例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7例,梭形细胞癌2例,巨细胞癌3例,肺母细胞瘤2例.结论 原发性肺肉瘤样癌的CT表现有一定特征,最终诊断有赖于组织病理及免疫组织化学检查.     

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.     

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.     

原发性肺淋巴上皮瘤样癌的影像表现及病理特征

【摘要】目的：探讨原发性肺淋巴上皮瘤样癌（LELC）的影像表现及病理特征。方法：回顾性分析2006年1月至2017年7月18例经手术病理证实的肺LELC的影像及病理资料。其中男6例,女12例;年龄26～73岁,中位年龄52岁,均接受CT检查。结果：18例患者共检出19个瘤灶,右肺13例共14个瘤灶（1例右下肺有2个瘤灶）,左肺4例4个瘤灶;18个瘤灶均位于双肺中下叶,单发为主,1例肺部未见瘤灶,仅见纵隔淋巴结肿大并融合。平扫病灶无论大小,均呈密度较均匀的实性结节或肿块,边界多清晰,部分可见分叶和毛刺征,无钙化和空洞;增强扫描病变处血管包埋或推移,静脉期呈实性不均匀强化,实质内可见斑片状、小片状低密度区,位于病灶中心、边缘或间杂分布。病理示该肿瘤为多形性上皮源性,肿瘤细胞呈片状、多角形,体积较大,界限欠清,周围间质伴较多淋巴细胞和浆细胞浸润;免疫组织化学染色EBER、CK、CK5/6、P63(+)支持诊断。结论：原发性肺LELC影像表现有一定特征性,病理免疫组化可以明确诊断。     

肝脏原发性血管肉瘤的CT表现(附3例报告及文献复习)

目的探讨肝脏原发性血管肉瘤的CT诊断特点及鉴别诊断。资料与方法对经手术病理证实的3例肝脏原发性血管肉瘤的CT表现进行回顾性分析,并结合文献分析肝脏原发性血管肉瘤的CT表现特点。结果 2例表现为巨块型,并周缘见子病灶,1例表现为弥漫多结节型,平扫均表现为不规则低密度区,无明显边界,增强扫描动脉期病灶内呈轻度不均匀强化,门静脉期可见不规则条状及斑片状强化,延迟期病灶呈向中心充填式强化;肝内外胆管均未见扩张,1例伴双肺转移瘤。结论肝脏原发性血管肉瘤的CT表现具有一定特点,结合临床病史及体征,不难与肝血管瘤、肝癌及肝转移癌鉴别。     

脾脏原发性淋巴瘤的CT、MRI表现

目的 探讨脾脏原发性淋巴瘤(PSL)的CT、MRI表现。方法 选取并分析经手术病理证实的17例PSL的临床和CT、MRI表现，探讨其影像学特征。结果 17例PSL均为非霍奇金淋巴瘤，其中弥漫浸润型4例，表现为巨脾合并脾梗死；粟粒结节型2例，表现为脾脏多发小结节，最大直径<1.0 cm;多发结节型8例，表现为脾脏多个大小不等结节，直径从5.0～10.0 cm不等，增强后部分呈环形强化，部分轻度强化；孤立肿块型3例，表现为脾脏单发巨大肿块，直径>10.0 cm,增强后不均匀强化。结论 PSL的CT、MRI表现具有一定的特征，影像学检查对PSL的分期有一定帮助。     

肺错构瘤的CT诊断(附14例分析)

目的：评价CT在诊断肺错构瘤中的价值。方法：回顾性分析14例经手术病理证实的肺错构瘤的CT表现。结果：中央型2例，表现为叶支气管内软组织密度肿物，伴阻塞性肺炎或肺不张；周围型12例，表现为圆形或椭圆形肿块，病灶平均直径2.3cm，多数边缘光滑，病灶内有钙化6例，含有脂肪4例，形成空洞1例。结论：CT在肺错构瘤的诊断中有重要作用，诊断时应强调对病灶边缘及内部结构等征象进行综合分析。     

Computed tomography characteristics of primary pulmonary lymphoepithelioma-like carcinoma in 41 patients

Purpose

To assess the computed tomography (CT) findings of primary pulmonary lymphoepithelioma-like carcinoma (LELC).

Materials and methods

Clinical information and CT findings of 41 patients with pulmonary LELC were reviewed. CT images of 2 or 5 mm thickness were obtained with a pre-treatment CT and were jointly evaluated by two radiologists.

Results

Thirty central tumors and 11 peripheral tumors with diameters ranging from 1.0 to 8.7 cm (mean, 4.1 ± 1.9 cm) were identified. Central tumors appeared to be larger than peripheral tumors (P = 0.017). Tumors occurred more frequently in right middle lobe (31.7%) and left lower lobe (29.3%). CT findings of patients with early stage were similar to those observed in patients with advanced stage except that lymphadenopathy was significantly more common in patients with advanced stage. CT findings of pulmonary LELC consisted of well defined border (63.4%), lobulation (78.0%), vascular or bronchial encasement (43.9%), obstructive pneumonia (41.5%), pleural effusion (12.2%) and calcification (4.9%). On contrast-enhanced CT scans, inhomogeneously enhanced tumors were significantly larger than homogeneously enhanced tumors (P < 0.001). Lymphadenopathy was seen in 28 patients, and lymph nodes with homogeneous enhancement were observed in 24/28 patients. Enlarged lymph nodes were more frequently occurred in peribronchial or hilar nodes (53.7%), subcrinal nodes (39.0%), right lower paratracheal nodes (31.7%) and right upper paratracheal nodes (22.0%).

Conclusion

Pulmonary LELC usually appeared as a large, central, well defined and lobulated tumor with vascular or bronchial encasement and obstructive pneumonia. Calcification was rare in pulmonary LELC. Lymphadenopathy was common, usually with homogeneous enhancement.     

Computed tomography characteristics of advanced primary pulmonary lymphoepithelioma-like carcinoma

Our objectives were to document CT features of advanced primary pulmonary lymphoepithelioma-like carcinoma (LELC) and to determine features that may assist differentiation from other non-small cell lung cancers (NSCLC). Imaging and clinical data of all patients with biopsy-proven pulmonary LELC (n=12) were retrieved from a database of all NSCLC patients over a 2-year period. Twenty-five controls were recruited from other inoperable non-LELC NSCLC patients from the database. Pre-treatment CT scans of the thorax of both study and control patients were reviewed for lobe involved; tumour site, borders and size; and pleural, vascular or pulmonary involvement. Presence of lymphangitis carcinomatosis was noted. Lymph node metastasis was characterised as ipsilateral or contralateral enlarged (>1 cm) mediastinal or hilar nodes, or as peribronchovascular nodal spread. Differences between the two groups were tested using Mann-Whitney rank-sum test. The LELC tumours were significantly larger (45.67 vs 17.71 cm²) than controls and were closely associated with the mediastinum. There were more LELC tumours with well-defined borders (p<0.001) and fewer with spiculated borders (p<0001) than non-LELC tumours. There was increased peribronchovascular nodal spread (p=0.01) and vascular encasement (p=0.02) in LELC compared with non-LELC tumours. Advanced primary pulmonary LELC has distinct radiological features, and can appear as well-defined tumour closely associated with the mediastinum, with peribronchovascular spread and vascular encasement. Electronic Publication     

腮腺良恶性肿瘤的CT鉴别诊断

目的:探讨CT对腮腺良恶性肿瘤的鉴别诊断价值.方法:回顾性分析20例经手术病理证实的腮腺肿瘤的CT表现,其中良性肿瘤16例,恶性肿瘤4例.结果:本组中CT术前诊断符合率为90%.良性肿瘤的主要CT表现为边界清楚15例(94%),平均大小为8 cm3;位于浅叶10例(63%),深叶1例(6%),5例同时累及深、浅叶;钙化1例(6%),囊变3例(19%),头颈部淋巴结增大2例(13%).恶性肿瘤中边界清楚1例(1/4),平均大小为13 cm3;1例(1/4)位于浅叶,2例(2/4)位于深叶,1例同时累及深、浅叶;头颈部淋巴结增大3例(3/4).结论:腮腺肿瘤的CT表现有一定特征性,CT对良恶性腮腺肿瘤的鉴别诊断有一定价值.     

硬化性肺泡细胞瘤的CT表现与病理对照研究

目的：分析硬化性肺泡细胞瘤(PSP)的 CT 和病理表现,提高对此病的认识。方法回顾性分析经手术病理证实的12例 PSP(13个病灶)的临床及 CT 资料,12例均行 CT 平扫,9例行增强扫描。结果11例为单发孤立病灶,1例呈多发病灶,病灶最大长径1.10~8.03 cm,平均(3.53±0.78)cm。13个病灶中,左肺3个(23.1%,上叶1个,下叶2个),右肺10个(76.9%,上叶2个,中叶2个,下叶6个);双下肺8个(61.5%),中上肺5个(38.5%);肺门中心型4个(30.8%),周围型9个(69.2%);病灶形状呈卵圆形及类圆形8个(61.5%),不规则形1个(7.7%),浅分叶4个(30.8%);边缘光滑10个(76.9%),边缘毛刺3个(23.1%);增强后7个见血管贴边征(53.8%),空气新月征6个(46.2%),晕征6个(46.2%),尾征6个(46.2%);3个(23.1%)病灶内有散在点样或斑点样钙化,余病变 CT 平扫密度均匀,CT 值28~47 HU,平均35 HU;9例(10个病灶)增强扫描后,2个轻度强化,5个明显均匀强化,3个不均匀强化。增强后 CT 值60~110 HU,平均77.2 HU,最大强化净值为75 HU。结论青中年女性3 cm 左右单发圆形或卵圆形软组织密度样肺结节或肿块,边缘光滑,增强后明显均匀性强化,同时伴有血管贴边征、空气新月征及晕征、尾征时,要考虑到 PSP 的诊断。     

Lymphoepithelioma-like carcinoma of the lung: radiologic features of an uncommon primary pulmonary neoplasm

OBJECTIVE: The purpose of this study was to review the chest radiographic, CT, and MRI appearances of primary pulmonary lymphoepithelioma-like carcinoma (LELC). CONCLUSION: Primary pulmonary LELC is histopathologically identical to nasopharyngeal carcinoma. The radiographic, CT, and MRI features of primary pulmonary LELC are nonspecific, often resembling those of bronchogenic carcinoma. Primary pulmonary LELC usually presents as a poorly circumscribed, enhancing, peripheral solitary pulmonary nodule on CT; necrosis may be present and is considered a poor prognostic sign. MRI shows isointense to low-intensity signal on T1-weighted images and mildly increased signal on T2-weighted images; enhancement of abnormal tissue is typical. Most patients present with early-stage disease. Primary pulmonary LELC should be suspected in selected patients and requires differentiation from bronchogenic carcinoma and metastatic nasopharyngeal carcinoma.     

肝胰原发性恶性纤维组织细胞瘤的CT诊断

目的:探讨肝胰原发性恶性纤维组织细胞瘤(MFH)的CT表现。方法:回顾性分析经手术和病理证实的4例肝MFH和1例胰MFH的CT表现。病理分型:1例为黏液型,4例为多形性型。5例均采用CT平扫和双期增强扫描,其中2例进行了延迟扫描。结果:5例肿瘤最大径6.8~22.5cm,其中位于肝右叶1例,肝左叶3例,胰尾部1例。CT平扫:1例表现为巨大囊性结构为主的肿块,有包膜,边界清楚;4例表现为不规则形低密度肿块,边界不清。增强扫描:动脉期示肿瘤实质呈轻度~明显强化,2例肿瘤内可见细小血管;静脉期肿瘤呈中度~明显强化,肿瘤内坏死区和肿瘤实质显示清晰,边界清楚;延迟期2例示病灶密度稍低于肝实质。5例中合并肝内转移1例,肝内胆管轻度扩张2例,侵犯膈肌2例,腹膜后淋巴结转移1例。术前CT诊断为恶性肿瘤4例,良性病变1例。结论:肝胰MFH的主要CT表现为肿瘤内坏死显著,局部浸润性强,其CT表现与病理所见有很好的一致性。     

原发性肺肉瘤的CT表现及鉴别诊断

目的 探讨原发性肺肉瘤(PPS)的CT特征表现.方法 回顾分析5例PPS患者的CT表现和临床病史、病理资料,结合相关文献进行分析总结.结果 肿块较大,最大径约9.8 cm,平均为6.3 cm.1例呈鹿角状,1例类圆形,3例不规则团块状;5例患者均未见毛刺征象;2例伴有纵隔淋巴结肿大;5例患者中病灶内均未见钙化;1例伴有同侧肺动脉侵犯形成肺动脉瘤征象,1例伴有同侧下肺动脉栓塞;5例增强后病灶均轻度强化;2例伴有同侧胸腔积液征象.5例患者周围骨质均未见骨质破坏征象.结论 PPS的CT表现具有相对特异性,确诊需要依靠病理检查.     

腮腺淋巴结结核的CT表现

目的 分析腮腺淋巴结结核的CT表现,以期提高对该病的诊断正确性.方法 回顾性分析经手术病理和实验室检查诊断的腮腺淋巴结结核9例,术前均经CT平扫及增强扫描,复习CT扫描结果 并与手术病理对照.结果 9例中发生于左侧7例,右侧2例.8例位于腮腺浅叶,1例累及腮腺深叶.病灶呈肿块型8例,数目1～4个,直径2.7～5.3 cm.浸润型1例,直径3.4 cm.CT平扫病灶5例密度均匀,边缘光整,4例病灶内旱斑片状低密度影,其中2例边缘模糊.增强扫描病灶呈中等度均匀强化3例,环形强化4例,不均匀强化1例,花边状强化1例.病灶向周围浸润6例.同侧颈部出现增大淋巴结2例.结论 腮腺淋巴结结核的CT表现多样化,与其病理改变密切相关,认识腮腺淋巴结结核的特征性CT表现有助于鉴别诊断,确诊仍依靠病理及实验室检查.