【摘要】：目的： 探討肺大細(xì)胞神經(jīng)內(nèi)分泌癌(lung large cell neuroendocrin carcinoma, LCNEC)的MSCT表現(xiàn)及其與病理結(jié)果的相關(guān)性,為臨床診斷LCNEC提供便利。 方法： 回顧性分析27例經(jīng)手術(shù)病理證實為LCNEC患者的MSCT表現(xiàn)與病理資料。所有患者術(shù)前均接受胸部CT平掃,其中20例接受胸部CT平掃+增強(qiáng)掃描,所有患者術(shù)后均進(jìn)行病理及免疫組化檢查。 結(jié)果： 27例患者中均表現(xiàn)為肺內(nèi)單發(fā)腫塊。腫塊最大徑為1.2～14.2cm([5.2±2.1]cm)。主要征象：周圍型26例(26/27,96.30%),僅1例(1/27,3.70%)為中央型；病灶位于左肺上葉6例(6/27,22.22%),左肺下葉4例(4/27,14.81%),右肺上葉8例(8/27,29.63%),右肺中葉3例(3/27,11.11%),右肺下葉6例(6/27,22.22%)；病灶形態(tài)為類圓形2例(2/27,7.41%),分葉征19例(19/27,70.37%),不規(guī)則形4例(4/27,14.81%)；腫塊邊緣光滑20例(20/27,74.07%),毛刺征7例(7/27,25.93%)；病灶密度均勻16例(16/27,59.26%),腫塊內(nèi)片狀壞死9例(9/27,33.33%)其中有3例有空洞或空腔,鈣化2例(2/27,7.41%)；胸膜牽拉征7例(7/27,25.93%)；伴肺內(nèi)阻塞性病變4例(4/27,14.81%)；14例(14/27,51.85%)伴同側(cè)肺門或縱隔淋巴結(jié)腫大,其中8例病理證實為淋巴結(jié)轉(zhuǎn)移。20例增強(qiáng)患者均呈不均勻強(qiáng)化。把增強(qiáng)后CT值的凈增劃分為三個等級：≤20HU為輕度強(qiáng)化,20～40HU為中度強(qiáng)化,≥40HU為重度強(qiáng)化。這20例不均勻強(qiáng)化患者中有4例為輕度強(qiáng)化,13例為中度強(qiáng)化,10例為重度強(qiáng)化。27例LCNEC患者中神經(jīng)特異性烯醇化酶(neurone specific enolase, NSE)呈陽性者16例(16/27,59.26%),嗜鉻顆粒蛋白A(chromogranin A, CgA)呈陽性者2例(2/27,7.41%),突觸素(synaptophysin, Syn)呈陽性者17例(17/27,62.96%),神經(jīng)細(xì)胞黏附分子CD56呈陽性者8例(8/27,29.63%,),27例患者中有10例進(jìn)行微管蛋白檢測均呈陽性；12例進(jìn)行血管內(nèi)皮生長因子(vascular endothelial growth factor, VEGF)檢測均呈陽性；2例患者進(jìn)行甲狀腺轉(zhuǎn)錄因子1(TTF-1)檢測,其中1例呈陽性；1例進(jìn)行細(xì)胞角質(zhì)蛋白7(cytokeratin, CK7)檢測呈陽性。 結(jié)論： LCNEC臨床表現(xiàn)無特異性,好發(fā)于中老年男性,大多數(shù)患者有吸煙史。影像學(xué)多表現(xiàn)為肺內(nèi)單發(fā)周圍型腫塊,邊緣光整,多伴分葉,其內(nèi)可見壞死,鈣化、空洞或空腔及含氣支氣管征少見,增強(qiáng)后病灶多呈不均勻強(qiáng)化。單純影像學(xué)不能診斷LCNEC,需結(jié)合病理學(xué)共同分析。病理上需同時滿足神經(jīng)內(nèi)分泌腫瘤的形態(tài)學(xué)特征和分化特征,至少有一種神經(jīng)內(nèi)分泌標(biāo)記物免疫組織化學(xué)染色呈陽性,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 鹵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，

本文編號：2372217