原发性肺黏液细胞癌的CT表现及鉴别诊断解析.pptVIP

原发性肺粘液腺癌CT表现及鉴别诊断 背景资料 原发性肺粘液腺癌属于肺腺癌的一种亚型，临床上不多见,发病年龄多为成人（20岁）。据报道该类型肺癌仅占肺腺癌的0.14％～0.25％。而且大多数病例在开始诊断不明确,极易被误诊为肺炎、肺结核及其他肺部弥漫性病变,因而未得到及时治疗 Histopathology 形态学表现为分化好的黏液性上皮性病灶,上皮细胞立方或柱状,核位于基底部,胞质透亮呈分泌状态,亦可增生呈2～3层,中度异型,部分核大深染,核分裂象罕见,组织形态类似卵巢交界性黏液性囊腺瘤或胃肠道黏液腺癌结构 。 典型的原发性黏液腺癌为相对细胞成分较少，可见大量的黏液湖及断裂的细胞残壁，稀疏的肿瘤细胞在病灶内沿肺泡壁呈线状分布。 Macroscopic appearances 肿瘤大体形态多表现为局限性结节或团块，边界清晰，有时病灶中央可见假囊性空隙；与黏液性支气管肺泡癌不同，后者边界往往模糊，而肺组织结构破坏不明显 大体形态及镜下表现 Radiology findings 据有限的病例报道认为：肺黏液腺癌多为位于肺外周的孤立团块，边界常常分界较明确，平扫CT值偏液性偏低密度影，可有轻度强化或强化不明显 病例1 Case 1 was a 75-year-old male smoker with a history of myocardial infarction and mild chronic bronchitis. When he visited our institute with mild chest pains, a routine chest roentgenogram revealed a solitary nodule in the right lung patients physicalexamination or serum laboratory data gave any remarkable findings. carcinoembryonic antigen (CEA) levels in the normal range. Both patients had mild obstructive ventilatory impairment (FEV1: 68 percent in case 1). 病例1－CR 病例1－CT 病例2 The patient was a 61-year-old male. An abnormal shadow in the left lung field of a chest X-ray was pointed out during a routine health check in November 1999. He received a fiberoptic bronchoscopy examination to assess the pulmonary nodule at a local hospital. No positive finding could be obtained. Through the follow-up, the nodule showed gradual enlargement. He was admitted for the first time in April 2000. Retrospectively, the abnormal shadow was seen on a chest X-ray in 1997. The shadow gradually enlarged year by year. 病例2－CT Differential diagnosis 肺黏液性囊腺瘤 黏液性细支气管肺泡癌 肺黏液性囊腺癌 黏液性肺转移癌等鉴别 诊断主要是依赖病理形态学特点及免疫组化,预后相对较好,不同于胃肠道黏液腺癌 Mucinous Cystadenoma of the Lung Mucinous bronchoalveolar carcinoma of lung －case1 Mucinous bronchoalveolar carcinoma of lung －case2 Mucinous bronchoalveolar carcinoma of lung －case3 Mucinous bronchoalveolar carcinoma of lung －case4 Prognosis 原发性肺黏液腺癌为低度恶性的肿瘤，预后相对较好,不同于胃肠道黏液腺癌 谢 谢 ！！ * * Low-pow