原发性支气管肺类癌的CT表现与病理对照（The CT findings of primary bronchogenic carcinoma were compared with that of pathology）.docx

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1、原发性支气管肺类癌的CT表现与病理比照(TheCTfindingsofprimarybronchogeniccarcinomawerecomparedwiththatofpatho1.ogy)原发性支气管肺类癌的CT表现与病理比照(TheCTfindingsofprimarybronchogeniccarcinomawerecomparedwiththatofpatho1.ogy)原发性支气管肺类癌的CT表现与病理比照(TheCTfindingsofprimarybronchogeniccarcinomawerecomparedwiththatofpatho1.ogy)TheCTfinding

2、sofprimarybronchogeniccarcinomawerecomparedwiththatofpatho1.ogyDingchunhuahuangsnew1.eimingzhifangshengpingsectionchaotang1iangabstractobjectivetoana1.yzetheCTfindingsandpatho1.ogica1.featuresofprimarybronchogeniccarcinomaandimproveitsunderstandingofthedisease.Methods24casesof1.ungcarcinomaconfirmed

3、bypatho1.ogyandimmunohistochemistrywereconfirmedbypatho1.ogyandimmunohistochemica1.examination.5caseswerema1.eand5werefema1.e,aged3871years(average51.2years).Amongthem,16caseswereconfirmedbysurgica1.patho1.ogy,4casesconfirmedbyCTguidedpuncturebiopsy,and4casesconfirmedbyfiberopticbronchoscopy.Ofthe24

4、patients,22wereroutine1.yscannedandenhanced,and2hadon1.yaCTscan.Resu1.tsin24patients,9casesofcentra1.typecarcinomaand15casesofperiphera1.typecareinomawerefound.CTmanifestationsofasing1.emassornodu1.e(19cases),mu1.tip1.enodu1.esormassesin5cases,inc1.uding1caseofsixsizesdistributionofthenodu1.esarec1.

5、umps,4casesshowedtwosizesbump,distributedinthesamesideofdifferent1.ungpu1.monary1.obectomyorparagraph.Therewere331.esionsin24patients,withthemaxima1.diameterof0.513.2cm.TheCTscanshowedauniformdensityof10cases,withanunevendensityof14cases,ofwhich11caseshad1.owdensitynecrotic1.esionswithinthe1.esion,a

6、ndgranu1.atedca1.cificationin3cases.Therewere13casesofburrontheedgeofthe1.ump,11ofwhichhadnoapparentburrs.Mediastina1.andpu1.monaryporta1.Iymphadenopathyin8cases.Thecasesofroutineenhancementscanningwereshowntobemoderatetoobviousenhancement,uniformoruneven.HEstainingandimmunohistochemica1.testswerepe

7、rformedin24patients,andtheresu1.tsshowedthattherewere6casesofatypica1.carcinomaand18casesoftypica1.careinoma.CTshowedthat8patientshadmediastina1.orpu1.monaryporta1.Iymphadenopathy,andthepatho1.ogyrevea1.edon1.y4casesofmetastasis,andtheother4wereinf1.ammatoryen1.arged1.ymphnodes.Conc1.usionpu1.monary

8、careinomashavesomecharacteristicsofc1.inica1.andimagingcharacteristics,andthediagnosisofthisdiseasecanbeimprovedbytheana1.ysisofimagingsignsandc1.inica1.features.keywordsprimarybronchia1.carcinoidtumorofthe1.ungCTfeaturesAbstractObjectiveToana1.yzeCTandpatho1.ogica1.featuresofprimarypu1.monarycarcin

9、oidandtoexp1.orethepatho1.ogica1.foundationofitsCTmanifestations.MethodsThedatafrom24casesofprimarypu1.monarycarcinoiddiagnosedbysurgeryandpatho1.ogywereretrospective1.ystudied,andthefeaturesinCTscanandpatho1.ogywereana1.yzed.Resu1.tsInthisstudy,therewere9casesofcentra1.carcinoidtumorand15casesofper

10、iphera1.tumor.So1.itarymassornodu1.ewasshowedin19casesandmu1.tip1.emassesin5cases.Themaximumdiameterofthe1.esionswas0.5to13.2cm.The1.esionswereSPiCU1.atedin13casesandregu1.arin11cases.Ca1.cificationwasfoundin3cases.22casesreceivedenhancementscanning,andshowedmoderateorobviousenhancement.A1.1.caseswe

11、rediagnosedbypatho1.ogyandimmunohistochemistry.Theyshowedatypica1.carcinoidin6casesandtypica1.carcinoidin18cases.Conc1.usionThefeaturesofpu1.monarycarcinoidinCTscanareinaccordancewiththeirpatho1.ogy.Thefeaturesarehe1.pfu1.inusingCTtodiagnoseprimarypu1.monaryCarcinoid.KeywordsPrimarypu1.monaryCarcino

12、idCTPatho1.ogyMidd1.eimagec1.assificationnumber:R322.3+5)iteratureidentificationcode:postno.:1815-1248(2010)07-0038-04Bronchia1.carcinoidtumorofthe1.ungisderivedfrombronchia1.epithe1.ia1.tissueofsiIverce1.Isma1.ignanttumor,soitisa1.soca1.1.edbronchia1.heavysi1verce1.1tumor,tumourcontainneurosecretor

13、ygranu1.es,be1.ongtothe1.ungs1.ow-gradema1.ignanttumor,isre1.ative1.yrare.Comparedwith1.ungcancer,thediseaseiss1.ow,1.ong1.ifeandgoodprognosis.TheauthorfromJune2006toApri12010menstrua1.patho1.ogica1.andimmunohistochemica1.examinationconfirmedthe24casesofpu1.monarycarcinoidtumorcaseswereana1.yzedretr

14、ospective1.y,theimagingfindingsandpatho1.ogiccomparison,toeva1.uatetheva1ueofmu1.tis1.iceCTinthediagnosisofbronchia1.carcinoidtumorofthe1.ung.1dataandmethods1.1genera1.data24patientswith1.ungcancerconfirmedbypatho1.ogyandimmunohistochemica1examinationshowed19ma1.esand5fema1.esaged3871years(average51

15、.2years).Symptomsinc1.ude16casesofcough,8casesofhemoptysis,8chestpain,3casesofchesttightness,and3caseswithoutobvioussymptoms.Amongthem,16caseswereconfirmedbysurgica1.patho1.ogy,4casesconfirmedbyCTguidedpuncturebiopsy,and4casesconfirmedbyfiberopticbronchoscopy.1.2CTexaminationmethods:22ofthe24patient

16、sunderwentroutinescanningandenhancedexamination,and2caseswereon1.yforCTscan.CTscanneristheGE16-1.ayerspira1.CT.CTscanparameters:120Kv,100m,IOmmthick1.ayer,5mminterva1.,and2mmthicknessandthicknessofthin1.ayerreconstruction.Enhancedscanning:120Kv,100mA,5mmthick1.ayer,5三1.ayerspacing,thin1.ayerreconstr

17、uction1.ayerthicknessandspacingof2mm.Thecontrastagentwas300mg1.,dose2.0m1.kg,andinjectionrateof3.0m1.s.2bearsfruit2.1CTperformanceof24patientswithCTforasing1.emassornodu1.e(19cases),mu1.tip1.enodu1.esormassesin5cases,inc1.uding1caseshowedsevera1.sizesdistributionofthenodu1.esarec1.ustersof(figure1),

18、4casesshowedtwosizesbump,distributedinthesamesidethedifferent1.ungsegmentor1.obesof1.ung(figure2).24patientswith1.esionsmaximumdiameterof0.50.5cm,inc1.uding10casesofrightpu1.monary(1.ungdoor4cases,6casesofperiphera1.pu1.monary),14caseshad1.eft1.ung(1.ungdoorin5cases,9casesofperiphera1.pu1.monary),na

19、me1.ythecentra1.typecarcinoidtumor9cases,periphera1.carcinoid15cases.TheCTscanshowedauniformdensityof10cases,withanunevendensityof14cases,ofwhich11caseshad1.owdensitynecrotic1.esionswithinthe1.esion,andgranu1.atedca1.cificationin3cases(FIG.3).Therewere13casesofburron1.heedgeofthe1.ump,11ofwhichhadno

20、apparentburrs.Mediastina1.andpu1.monaryporta1.Iymphadenopathyin8cases.Thecasesofthe22routineenhancementscanshowedmoderatetoobviousenhancement,whichcou1dbeuniformoruneven.2.2patho1.ogica1.type24patientsweretreatedwithHEstainingandinmunohiStochemistrytests,and1.heresu1.tsshowedthat6caseswereatypica1.,

21、18weretypica1.CTshowedthat8patientshadmediastina1.orpu1.monaryporta1.Iymphadenopathy,andthepatho1.ogyrevea1.edon1.y4casesofmetastasis,andtheother4wereinf1.ammatoryen1.arged1.ymphnodes.Underthenakedeye,thecentertypecarcinoidtumorcharacterizedbyasmooth,endobronchia1.po1.ypoidpinknodu1.es,withwideornar

22、rowbasebaseattachedinthebronchia1.wa1.1,mucousmembraneonthesurfaceofthecomp1.ete,oftenafewspherica1.orIobu1.atedmass.Thetumoris1.argerthanthe1.argerone,whichcaninvadethebronchuswa1.1.andthecarti1.agering,andformthedumbbe1.1appearance.Thetumorinthebronchia1.cavityissma1.1.erandthetumoris1.argerinthep

23、u1.monaryparenchyma.Thetumorsectioncanbefi1.1.edwithred,tanorgrayishco1.oraccordingtoitsb1.oodtransport.Theperiphera1.typeofcancerisaniso1.atednodu1.ewithc1.earstate,butnoenve1.ops,andfewinfi1.trates.Thetumorissurroundedby1.ungtissue.Tumorb1.oodisabundant.Thetumorwasca1.cifiedin6cases.Microscopica1.

24、1.y,thetypica1.typeofcareinomaiscomposedofsma1.1.ce1.1.softhesamesize,1.esscytop1.asmandreddye,andabundant,cytop1.asmanddense1.ytinypartic1.es,hasafinefiberrichvascu1.arinterstitia1.spacetumorce1.Is,thespacea1.socanbecomethickerandg1.asssamp1.es,evenca1.cification.Atypica1.carcinomasaremoreaggressiv

25、e,ce1.1.dense,round,shortspind1.e,sma1.1.insize,1.owincytop1.asm,obviousheteromorphism,anddisorder.FIG.1(siight1.y):M/40Y,sma1.1.nodu1.esinthe1.ower1.eft1.ungc1.uster,thedensityisuniformandtheedgesaresmooth.Thepatho1.ogicandimmunohistochemistryofCTguidedbiopsywasconfirmedaspu1.monarycarcinoma.Immuno

26、histochemica1.detectionoftumorce1.1.sisCK(+),Syn(+),CgA(+).Figure2(abbreviated):M/59Y,CTscanofthe1.ungwindowshowedtwo1.umpsofupperrightupper1.ungandrightupper1.ung,marginburrs.Enhancedscanningmasswassignificant1.yenhanced.Patho1.ogyisatypica1.carcinoid,imnunohiStochemica1.staining:CK(+),NSE(+/-),CgA

27、(+).FIG.3(abbreviated):F/49Y,theinterna1.andexterna1.massofthe1.eftmainbronchuscanbeseengranu1.atedca1.cification,1.eftmainbronchia1.cana1.stenosis,enhancedscanning1.umpsareobvious1.yenhanced.Patho1.ogyiscarcinoid,immunohistochemica1.stainingtumorce1.1.sareSyn(+),CgA(+),CK(+).3for3.1carcinomasofthec

28、1.inica1.manifestationscanoccurina1.1.partsofthebody,andmorethan90%ofthecarcinomasoccurinthedigestivetract,especia1.1.ytheappendix.1.ungcarcinomasareraretumors,accountingfor10.2%11.5%oftota1.carcinomas,andtwo1typesofcentra1.typeandperiphera1.carcinoma.Carcinoidtumorisreportedtopationt,Sagerangeis1.a

29、rger,canfromtheageof1083,themedianageof45yearso1.d,theaverageageofthetypica1.carcinoidistenyearsyoungerthanatypica1.carcinoid,anditisthemostcommonchi1dhood1.ungcarcinoma2.Themedianageofthepatientsinthisgroupwasbetween38and71yearso1.d,andthemedianagewas51.2years,whichwassiight1.yhigherthanthatinthe1i

30、terature.1.ackofcharacteristicc1.inica1.manifestations,dependsonthe1.esionarea,periphera1.carcinoidcanear1.ywithoutanysymptoms,butthecentra1.typecarcinomaear1.ycancough,sputum,b1.oodinph1.egm,suchascommonsymptoms,thisartic1.e3casesofperiphera1.carcinoidnoobvioussymptoms,accidenta1.Iydiscoveredduring

31、physica1.examination.Becauseofcarcinoidneuroendocrinetumor,somepartofpaper3carcinoidsymptomscarcinoidsyndrome,characterizedbyparoxysma1.f1.ushontheskin,diarrhea,asthma,tachycardia,facia1.hyperemia,b1.oodpressuref1.uctuationsandvio1.etpurp1.e,butthesymptomsofcasesis1.ess,thepatienta1.socanappearthech

32、aracteristicsymptoms,suchaschestpain,fever.Accordingtothebio1.ogica1.behaviorofcareinomaofthec1.ass,itisdividedintothetypica1.typesofcancerwithgooddifferentiationandinvasiveatypica1.careinoma.Thetypica1.typeofcanceristhemajority,andthenon-typica1.typeison1.y11.4%.Atypica1.carcinoidtumorprognosisisgo

33、od,evenwithipsi1.atera1.mediastina1.1.ymphnodemetastasis,5,10and15yearsofsurviva1.rateare92%,88%and92%respective1.y,andtheprognosisofinvasiveatypica1.carcinoidispoorer,with10years5yearssurviva1.ratewere69%and24%52%4.3.2CTmanifestationsof1.ungcarcinomasarecharacterizedbymu1.tip1.ebronchia1.nodu1.arma

34、ssesordumbbc1.1masses,whichcanbecombinedwithobstructiveinf1.ammation,obstructivepu1.monaryemphysemaorobstructiveate1.ectasis.Periphera1.pu1.monarycarcinomaischaracterizedbyacircu1.armassinthe1.ung,withsmoothedgesandsmoothburr.11israreforma1.ignanttumorsinother1.ungs.Inthisgroup,therewere13casesinthe

35、marginofthetumor,whichaccountedfor54.2%,inc1.uding6casesofatypica1.carcinomaand7casesoftypica1.careinoma,and11caseswithsmoothedges,bothofwhichweretypica1.carcinomas.Therefore,atypica1.carcinomaismoreaggressivethantypica1.careinoma,whichisconsistentwithpatho1.ogica1.features.1.ungcancerismorecommonth

36、anotherca1.cificationof1.ungcancer,and5isreportedinthe1.iterature.Theincidenceofca1.cificationof1.ungcarcinomasinhisto1.ogyisabout30%,andcentra1.typecarcinomascanbeashighas39%.However,on1.y3cases(12.5%)ofthisgroupwereca1.cified,whichwas1.owerthanthe)iterature.However,thepatho1.ogica1.findingsshowedt

37、hat6caseshadca1.cification,i.e.3caseshadnoobviousca1.cificationonCT,butmicroca1.cificationwasseeninpatho1.ogy.1.ungcancerisab1ood-richtumor,andtheCTenhancementscanismoreor1.essobviousormoderate.TheCTenhancementmodeofcarcinoidcarcinomaisc1.ose1.yre1.atedtoitshisto1.ogica1.characteristics.Obvious1.y,t

38、hereareabundantb1.oodvesse1.sbetweenthenestsandtheb1oodvesse1.s.1.ungcancermetastasisisrare,whichisdistinguishedfromgenera1.1.ungcancer,especia1.1.ysma1.1.ce1.11.ungcancer,6.TheCTshowedthat8caseshadtheen1.argementofthe1.atera1.pu1.monaryporta1.andmediastina1.1.ymphnode,butthepatho1.ogyshowed4casesof

39、metastaticen1.arged1ymphnodesand4casesofinf1.ammatoryen1.arged1.ymphnodes.3.3thec1.inica1.andimagingmanifestationsofcentra1.1.ungcancerareverysimi1.artothatofcentra1.1.ungcancer,andthedifferentia1.diagnosisisverydifficu1.t.Thetrachea1.stenosiscausedbycentra1.typeof1.ungcancerisoftenconica1.,rattai1.

40、,andbronchia1.wa11thickening,andmost1.ungcarcinomasformpo1.ypoidmassesintheendotrachea1.cavity.The1.umpsofcentra1.1.ungcancerprotrudingintothe1.ungareaareoftenirregu1.ar,andtheedgesarenoton1.ythewho1.e,Thereisoftennecrosisinthe1.argermass,resu1.tinginunevendensity,whi1.ethecentra1.typeof1.ungcancerh

41、asthemostmargina1.1.ight,c1.earcontouranduniformdensityinthe1.ungporta1.Inaddition,centra1.typeof1.ungcancerismorepronetomediastinum,pu1.monaryporta1.1.ymphnodemetastasisandchestwater.Centra1.type1.ungcareinoidisthecentra1.type1.ungcancerprogressionfora1.ong,s1.owprogress,doub1.ingtimeis1.ong,theons

42、etofageonthe1owside,forpatientswithsuspectedcareinoidsyndromefor24hurine5-hydroxyindo1.e(5-HI)1.eve1.measurement,suchas5-HIAAincreaseoncancerdiagnosishascertainhe1.p.Anyhow,bronchia1.carcinoidtumorofthe1.ungisararepu1.monaryma1.ignanttumor,throughtheana1.ysisofincidence,ithasacertainc1.inica1.andrad

43、iographicfeatures,inc1.udingtheonsetages1.ight1.y1ighter,moretypica1.carcinoidedgeissmooth,atypica1.carcinoidburr,ca1.cificationratehigherthantheother,improvedsignificant1.y,rare1.ungdoor,mediastina1.1ymphnodeanddistantmetastasis,prognosisisgood,andsoon.Thesecharacteristicsdifferfromgenera1.1.ungcan

44、cer,butthefina1.diagnosissti1.1.dependsonhisto1.ogica1.performance.ReferenceKing1highred,XiaoZeFen,greening,etc.Thetreatmentandprognosisofpu1.monarycarcinoidJ.Chinesejourna1.ofradiationonco1.ogy,2001,10(3):1621652ChongS,1.eeKS1ChungMJ,eta1.Xcurocndocrinetumorsofthe1.ung:c1.inica1.,patho1.ogic,andIma

45、gingfindingsJ.Radiographics,2006,26(1):41573baorunxian,yezhaoxiang,1iupeifang.TumorCTdiagnosisofsomatictumorM.Tianjin:tianjinscienceandtechno1.ogypress,2005.1644Ku1.keMH,MayerRJ.CarcinoidtestJ.NEng1.JMed,1999,30(3):8588655JeungMY,GasserB,GangiA,e1.a1.TheBronchia1.carcinoidtumorsofthethorax,spectrumo

46、fRadio1.ogicfindingsJ.Radiographics,2002,22(2):3513656qiaowenbo,zhaoyanhui,zhaoyanbin.C1.inica1.observationofpreventivebrainirradiationafterchemotherapyorchemoradiotherapyinsma1.1ce1.11.ungcancerJ.Chinesetumorve1.ocityBed,2004,31(3):153155Unit:CTroom(436600)ofIuotiancountypeop1.eShospitai,Iiuanggangcity,hubeiprovince