肺大细胞神经内分泌癌MSCT表现与病理对照研究
发布时间：2018-12-11 08:20
【摘要】：目的： 探讨肺大细胞神经内分泌癌(lung large cell neuroendocrin carcinoma, LCNEC)的MSCT表现及其与病理结果的相关性,为临床诊断LCNEC提供便利。 方法： 回顾性分析27例经手术病理证实为LCNEC患者的MSCT表现与病理资料。所有患者术前均接受胸部CT平扫,其中20例接受胸部CT平扫+增强扫描,所有患者术后均进行病理及免疫组化检查。 结果： 27例患者中均表现为肺内单发肿块。肿块最大径为1.2～14.2cm([5.2±2.1]cm)。主要征象：周围型26例(26/27,96.30%),仅1例(1/27,3.70%)为中央型；病灶位于左肺上叶6例(6/27,22.22%),左肺下叶4例(4/27,14.81%),右肺上叶8例(8/27,29.63%),右肺中叶3例(3/27,11.11%),右肺下叶6例(6/27,22.22%)；病灶形态为类圆形2例(2/27,7.41%),分叶征19例(19/27,70.37%),不规则形4例(4/27,14.81%)；肿块边缘光滑20例(20/27,74.07%),毛刺征7例(7/27,25.93%)；病灶密度均匀16例(16/27,59.26%),肿块内片状坏死9例(9/27,33.33%)其中有3例有空洞或空腔,钙化2例(2/27,7.41%)；胸膜牵拉征7例(7/27,25.93%)；伴肺内阻塞性病变4例(4/27,14.81%)；14例(14/27,51.85%)伴同侧肺门或纵隔淋巴结肿大,其中8例病理证实为淋巴结转移。20例增强患者均呈不均匀强化。把增强后CT值的净增划分为三个等级：≤20HU为轻度强化,20～40HU为中度强化,≥40HU为重度强化。这20例不均匀强化患者中有4例为轻度强化,13例为中度强化,10例为重度强化。27例LCNEC患者中神经特异性烯醇化酶(neurone specific enolase, NSE)呈阳性者16例(16/27,59.26%),嗜铬颗粒蛋白A(chromogranin A, CgA)呈阳性者2例(2/27,7.41%),突触素(synaptophysin, Syn)呈阳性者17例(17/27,62.96%),神经细胞黏附分子CD56呈阳性者8例(8/27,29.63%,),27例患者中有10例进行微管蛋白检测均呈阳性；12例进行血管内皮生长因子(vascular endothelial growth factor, VEGF)检测均呈阳性；2例患者进行甲状腺转录因子1(TTF-1)检测,其中1例呈阳性；1例进行细胞角质蛋白7(cytokeratin, CK7)检测呈阳性。 结论： LCNEC临床表现无特异性,好发于中老年男性,大多数患者有吸烟史。影像学多表现为肺内单发周围型肿块,边缘光整,多伴分叶,其内可见坏死,钙化、空洞或空腔及含气支气管征少见,增强后病灶多呈不均匀强化。单纯影像学不能诊断LCNEC,需结合病理学共同分析。病理上需同时满足神经内分泌肿瘤的形态学特征和分化特征,至少有一种神经内分泌标记物免疫组织化学染色呈阳性,包括NSE、CgA、Syn以及CD56等。
[Abstract]:Objective: to investigate the MSCT findings of large cell neuroendocrine carcinoma (lung large cell neuroendocrin carcinoma, LCNEC) and its correlation with pathological results in order to provide convenience for clinical diagnosis of LCNEC. Methods: the MSCT findings and pathological data of 27 patients with LCNEC proved by operation and pathology were analyzed retrospectively. All the patients received plain CT scan before operation, 20 cases received plain enhanced CT scan, and all the patients underwent pathological and immunohistochemical examination after operation. Results: all the 27 patients showed solitary pulmonary mass. The maximum diameter of mass was 1.2~14.2cm ([5.2 卤2.1] cm). The main signs were: peripheral type 26 cases (26 / 2796.30%), only 1 case (1 / 273.70%) was central type; The lesions were located in the upper lobe of the left lung in 6 cases (6 / 2722.22%), in the lower lobe of the left lung in 4 cases (4 / 2714.81%), in the upper lobe of the right lung in 8 cases (8 / 2729.63%), in the middle lobe of the right lung in 3 cases (3 / 27 / 11.11%). The lower lobe of the right lung was found in 6 cases (6 / 2722. 22%); The lesions were round in 2 cases (2 / 277.41%), lobulated in 19 cases (19 / 2770.37%) and irregular in 4 cases (14 / 27 14. 81%). The margin of the tumor was smooth in 20 cases (74.07% of 20 / 27) and the burr sign in 7 cases (7 / 2725.93%). The density of lesions was homogeneous in 16 cases (16 / 2759.26%), flake necrosis in 9 cases (9 / 2733.33%), calcification in 2 cases (2 / 277.41%), pleural traction sign in 7 cases (7 / 27 / 25. 93%), calcification in 2 cases (2 / 277.41%) and pleural traction sign in 7 cases (7 / 27 / 25. 93%). There were 4 cases (14 / 2751.85%) with pulmonary obstructive disease and 14 cases (14 / 2751.85%) with ipsilateral hilar or mediastinal lymphadenopathy, of which 8 cases were confirmed by pathology as lymph node metastasis. The net increase of CT value after enhancement was divided into three grades: 鈮，
本文编号：2372217
[Abstract]:Objective: to investigate the MSCT findings of large cell neuroendocrine carcinoma (lung large cell neuroendocrin carcinoma, LCNEC) and its correlation with pathological results in order to provide convenience for clinical diagnosis of LCNEC. Methods: the MSCT findings and pathological data of 27 patients with LCNEC proved by operation and pathology were analyzed retrospectively. All the patients received plain CT scan before operation, 20 cases received plain enhanced CT scan, and all the patients underwent pathological and immunohistochemical examination after operation. Results: all the 27 patients showed solitary pulmonary mass. The maximum diameter of mass was 1.2~14.2cm ([5.2 卤2.1] cm). The main signs were: peripheral type 26 cases (26 / 2796.30%), only 1 case (1 / 273.70%) was central type; The lesions were located in the upper lobe of the left lung in 6 cases (6 / 2722.22%), in the lower lobe of the left lung in 4 cases (4 / 2714.81%), in the upper lobe of the right lung in 8 cases (8 / 2729.63%), in the middle lobe of the right lung in 3 cases (3 / 27 / 11.11%). The lower lobe of the right lung was found in 6 cases (6 / 2722. 22%); The lesions were round in 2 cases (2 / 277.41%), lobulated in 19 cases (19 / 2770.37%) and irregular in 4 cases (14 / 27 14. 81%). The margin of the tumor was smooth in 20 cases (74.07% of 20 / 27) and the burr sign in 7 cases (7 / 2725.93%). The density of lesions was homogeneous in 16 cases (16 / 2759.26%), flake necrosis in 9 cases (9 / 2733.33%), calcification in 2 cases (2 / 277.41%), pleural traction sign in 7 cases (7 / 27 / 25. 93%), calcification in 2 cases (2 / 277.41%) and pleural traction sign in 7 cases (7 / 27 / 25. 93%). There were 4 cases (14 / 2751.85%) with pulmonary obstructive disease and 14 cases (14 / 2751.85%) with ipsilateral hilar or mediastinal lymphadenopathy, of which 8 cases were confirmed by pathology as lymph node metastasis. The net increase of CT value after enhancement was divided into three grades: 鈮，
本文编号：2372217
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