原发性肺黏液腺癌的CT影像诊断

陈武; 宋彪; 王彬; 李源; 宋奇隆; 王召华; 闵旭红

doi:10.16766/j.cnki.issn.1674-4152.003083

原发性肺黏液腺癌的CT影像诊断

doi: 10.16766/j.cnki.issn.1674-4152.003083

安徽省胸科医院影像科，安徽合肥 230000

基金项目:

中央财政支付临床重点专科建设项目 Z155080000004

详细信息

通讯作者:
闵旭红，E-mail：1160311840@qq.com

中图分类号: R734.2 R814.42
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出版历程
- 收稿日期: 2023-03-26
- 网络出版日期: 2023-08-28

CT imaging diagnosis of primary pulmonary mucinous adenocarcinoma

Medical Imaging Department of Anhui Chest Hospital, Hefei, Anhui 230000, China

摘要

摘要: 目的探讨原发性肺黏液腺癌的CT影像特征并进行总结，通过其影像特点早期诊断疾病，从而选择合适的治疗手段，以此来提高生存期。方法选取安徽省胸科医院2019年8月—2022年8月经病理证实的62例原发性肺黏液腺癌，回顾性分析其临床、影像特征及病理结果，对原发性肺黏液腺癌的结节/肿块型与实变型两种类型的影像特征作出对照，并通过影像表现结合病理及免疫组化特征进行总结。结果 62例患者发病年龄为14~80(60.5±10.5)岁，以咳白黏痰为主诉。影像结果示62例患者中结节/肿块型46例，其中纯磨玻璃结节2例(4.3%)，混杂磨玻璃结节22例(47.8%)，实性结节及肿块22例(47.8%)，发生于两肺下叶胸膜下(重力较大部位)31例(67.4%)，发生气道播散2例(4.3%)，其他常见征象有血管集束征、空泡/空洞征等。实变型16例，发生于两肺下叶胸膜下14例(87.5%)，发生气道播散9例(56.3%)，其他常见征象有空泡/空洞征、血管漂浮征、枯树枝征等。病理结果示：镜下可见丰富的黏液，内见散在异型细胞团，免疫组化示：CK7(+)43例，TTF-1(+)51例，Napsin-A(+)36例，Ki-67(≤50%)53例，CDX-2(+)18例。结论原发性肺黏液腺癌影像上大体分为结节/肿块型及实变型两类，以肺叶重力较大位置分布为主，增强后轻到中度强化，病理见散在异型细胞团周围充满黏液成分，免疫组化诊断常见CK7(+)和TTF-1(+)。
- 原发性肺黏液腺癌 /
- 干酪性肺炎 /
- 黏液湖
Abstract: Objective To investigate and summarize the CT imaging characteristics of primary pulmonary mucinous adenocarcinoma, diagnose the disease early through its imaging characteristics, and select appropriate treatment methods, so as to improve survival. Methods A total of 62 cases of pathologically confirmed primary pulmonary mucinous adenocarcinoma from August 2019 to August 2022 in Anhui Provincial Chest Hospital were selected, their clinical, imaging features and pathological results were retrospectively analyzed, and the imaging features of nodular/mass type and consolidation type of primary pulmonary mucinous adenocarcinoma were compared, and the imaging manifestations combined with pathological features were summarized. Results The age of onset of 62 patients was 14-80 years old, and the average age was (60.5±10.5) years. The main complaint was cough white phlegm. The imaging results showed that there were 46 cases of nodular/mass type in 62 patients, including 2 cases (4.3%) of pure ground-glass nodules, 22 cases (47.8%) of mixed ground-glass nodules, 22 cases (47.8%) of solid nodules and masses, 31 cases (67.4%) of subpleural (gravity-heavy parts) of the lower lobes of both lungs, 2 cases occurred in airway dissemination (4.3%), and other common signs included vascular cluster sign, vacuole/cavitation sign, etc. There were 16 cases of consolidation type, with 14 cases (87.5%) occurring under the pleura in the lower lobes of both lungs, 9 cases (56.3%) experiencing airway spread, and other common signs including vacuole/cavity sign, vascular floating sign, and dead tree branch sign. The pathological results showed that abundant mucus could be seen under the microscope, scattered in the heterotypic cell mass, and the immunohistochemistry showed: CK7(+) 43 cases, TTF-1(+) 51 cases, Napsin-A (+) 36 cases, Ki-67 (≤ 50%) 53 cases, and CDX-2 (+) 18 cases. Conclusion Primary pulmonary mucinous adenocarcinoma is generally divided into nodular/mass type and consolidation type, mainly distributed in the large position of gravity of lung lobes, light to moderate reinforcement after enhancement, pathological scattered around the heterotypic cell mass filled with mucus components, and immunohistochemical diagnosis commonly involves CK7(+) and TTF-1(+).
- Primary pulmonary mucinous adenocarcinoma /
- Caseous pneumonia /
- Mucus lake

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图 1 右肺下叶黏液腺癌影像学与病理

注：男性，14岁，A示右肺下叶类结节实性病灶内见空泡/空洞征；B、C示两肺多发播散病灶；D示MPR冠状位见右肺下叶病灶呈膨胀性生长；E为穿刺病理示异型细胞周围见黏液成分(HE染色，×200)。

Figure 1. Imaging and pathology of mucinous adenocarcinoma of the right lower lobe of the lung

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图 2 左肺下叶黏液腺癌影像学与病理

注：男性，55岁，A、B示横断位、矢状位见左肺下叶空洞型结节灶；C示最小密度投影示空洞壁较薄；D示CT引导下经皮肺穿刺活检；E为穿刺病理示肺黏液腺癌(HE染色，×200)。

Figure 2. Imaging and pathology of mucinous adenocarcinoma of the left lower lobe of the lung

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图 3 右肺上叶黏液腺癌影像学与病理

注：男性，50岁，A、B示右肺上叶近肺门结节灶，边缘分叶毛刺；C、D示测得实性部分平均CT值约40 HU；E为手术病理提示黏液腺癌(HE染色，×200)。

Figure 3. Imaging and pathology of mucinous adenocarcinoma in the upper lobe of the right lung

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图 4 肺黏液腺癌肺内播散影像学与病理

注：男性，70岁，A示两肺下叶实变影，并可见肺内播散灶；B示增强后动脉期左肺下叶实变病灶内见强化的血管漂浮影；C、D示最小密度投影见枯树枝征；E为穿刺病理示肺黏液腺癌(HE染色，×200)。

Figure 4. Imaging and pathology of intrapulmonary dissemination of pulmonary mucinous adenocarcinoma

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表 1 62例PPMA(结节/肿块型及实变型)的影像征象情况[例(%)]

Table 1. Image findings of 62 PPMA (nodule/mass type and solid type)[cases (%)]

影像特征	结节/肿块型	实变型
纯磨玻璃结节	2(4.3)
混杂磨玻璃结节	22(47.8)	7(43.8)
实性结节	22(47.8)	9(56.3)
分叶	32(69.6)
毛刺	17(36.9)
空泡/空洞征	21(45.7)	12(75.0)
血管集束征	29(63.0)
血管漂浮征		14(87.5)
枯树枝征	2(4.3)	11(68.8)
气道播散	2(4.3)	9(56.3)
胸膜增厚	34(73.9)	14(87.5)

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表 2 62例PPMA免疫组化阳性标记物结果[例(%)]

Table 2. Results of PPMA immunohistochemical positive markers in 62 cases [cases (%)]

免疫组化标记物	原发性肺黏液腺癌
CK7	43(69.4)
TTF-1	51(82.3)
Napsin-A	36(58.1)
Ki-67(≤50%)	53(85.5)
CDX-2	18(29.0)

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