作　　者： ; ; ;

机构地区： 湖北文理学院

出　　处： 《临床放射学杂志》 2019年第6期1038-1041,共4页

摘　　要： 目的探讨肺原发性大细胞神经内分泌癌(LCNEC)的CT与PET-CT表现及病理特点,以提高对该病的认识及诊断水平。方法回顾性分析经病理证实的10例肺原发性LCNEC患者的影像及临床病理资料,并复习相关文献。10例均行胸部CT平扫后增强扫描,其中2例行全身氟代脱氧葡萄糖(18F-FDG) PET-CT检查。结果CT扫描示10例肿瘤中央型及周围型各5例;9例形态不规则,呈分叶状,边缘见毛刺;7例边界清晰;7例密度不均匀,其中4例内见囊变坏死区,3例见点片状钙化;5例邻近胸膜增厚、粘连;5例纵隔多发肿大淋巴结;4例肺内见小结节;1例邻近肋骨骨质破坏;1例肝脏及双侧肾上腺区多发转移灶。18F-FDG PET-CT扫描示2例肺内肿块、同侧肺门及纵隔淋巴结呈明显高代谢,提示肺恶性占位伴同侧肺门及纵隔淋巴结转移。病理示肿瘤细胞异型性明显,体积较大,胞浆丰富,核为卵圆形及不规则形,核仁明显,核分裂象易见;免疫组织化学分析示9例Syn、CD56及CK呈阳性,7例Cg A、6例Ki-67、4例TTF-1、3例NSE及2例CEA呈阳性。结论肺原发性LCNEC的影像学表现具有一定的特征性,CT上病灶多呈不规则形、边界清晰、密度不均匀伴邻近胸膜增厚、粘连或纵隔淋巴结肿大;PET-CT上呈明显高代谢伴同侧肺门或纵隔淋巴结转移。但确诊仍需病理学及免疫组织化学检查。 Objective To investigate the CT,PET-CT imaging findings and pathological features of lung primary large cell neuroendocrine carcinoma(LCNEC),so as to improve the recognition and diagnostic accuracy.Methods The imaging and clinicopathologic data of ten patients with LCNEC confirmed by pathology were retrospectively analyzed and related literatures reviewed.Ten cases were all performed with plain and enhanced thoracic CT scan and two with whole body18 FFDG PET-CT examination.Results On CT,of the ten tumors,five were central type and the other were peripheral.Nine cases appeared irregularly shaped with lobular and spicular sign.Seven had clear boundary.Seven showed inhomogeneous density in which four with cystic degeneration and necrosis,and three with punctate calcifications.Five appeared to possess pleural indentation or mediastinal lymphadenopathy.Four showed small lung nodules.One had adjacent rib destruction or multiple metastases of liver and adrenals.On18 F-FDG PET-CT,two cases of lung tumors and ipsilateral hilar and mediastinal lymph nodes displayed significantly high metabolism,suggesting malignant lung tumors with ipsilateral hilar and mediastinal lymph nodes metastasis.The pathological findings showed large tumor cells with marked pleomorphism,abundant plasma,ovoid and irregular nucleus,obvious nucleoli,obvious mitotic figures.There were Nine cases with positive Syn,CD56 and CK on immunochemistry staining,seven with Cg A,six with Ki-67,four with TTF-1,three with NSE and two with CEA.Conclusion LCNEC of the lung has certain imaging characteristics with irregular shape,clear boundary,inhomogeneous density,pleural indentation or mediastinal lymphadenopathy on CT,significantly high metabolism,ipsilateral hilar or mediastinal lymph nodes metastasis on PET-CT.However,final diagnosis should be based on histopathology and immunohistochemistry examinations.

关 键 词： 肺 神经内分泌癌 体层摄影术 线计算机 病理

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