CAJ | 학술논문

目的：探讨囊腔样肺腺癌的高分辨率CT（HRCT）表现及其与组织病理学特征的相关性，观察囊腔形成的病理基础。方法回顾性分析经手术病理证实的86例囊腔样肺腺癌HRCT和病理学检查结果，CT图像分析包括肿瘤和囊腔的影像学特征，病理切片分析包括病理亚型分级、肿瘤分化程度及囊腔形成的病理基础，并对影像学特征与组织病理学特征进行对照分析。结果 HRCT显示，肿瘤坏死17例（19．8％），囊腔中可见分隔40例（46．5％），囊腔中可见壁结节16例（18．6％），囊腔中厚壁和薄壁同时存在49例（57．0％）。63例患者的病理切片上可见囊腔，其中42例（66．7％）表现为肺泡结构被肿瘤细胞破坏。肿瘤密度类型（P＝0．030）、肿瘤坏死情况（P＝0．003）和薄壁所占比例（P＝0．014）在不同病理亚型分级中的差异有统计学意义，其中薄壁所占比例与病理亚型分级呈负相关（r＝-0．267，P＝0．015）。肿瘤边缘形态（P＝0．002）、肿瘤密度类型（P＝0．006）、肿瘤坏死情况（P＜0．001）、囊腔分隔情况（P＝0．016）和薄壁所占比例（P＝0．005）在肿瘤不同分化程度间的差异有统计学意义，其中薄壁所占比例与肿瘤分化程度呈正相关（ r＝0．266，P＝0．013）。结论 HRCT上，囊腔样肺腺癌的囊腔多表现为不同程度厚壁与薄壁混合存在，可伴分隔，壁结节和坏死少见，其HRCT表现与病理亚型分级和肿瘤分化程度有一定相关性。肿瘤细胞破坏肺泡结构可能是肺腺癌囊腔形成的主要病理基础。
목적：탐토낭강양폐선암적고분변솔CT（HRCT）표현급기여조직병이학특정적상관성，관찰낭강형성적병리기출。방법회고성분석경수술병리증실적86례낭강양폐선암HRCT화병이학검사결과，CT도상분석포괄종류화낭강적영상학특정，병리절편분석포괄병리아형분급、종류분화정도급낭강형성적병리기출，병대영상학특정여조직병이학특정진행대조분석。결과 HRCT현시，종류배사17례（19．8％），낭강중가견분격40례（46．5％），낭강중가견벽결절16례（18．6％），낭강중후벽화박벽동시존재49례（57．0％）。63례환자적병리절편상가견낭강，기중42례（66．7％）표현위폐포결구피종류세포파배。종류밀도류형（P＝0．030）、종류배사정황（P＝0．003）화박벽소점비례（P＝0．014）재불동병리아형분급중적차이유통계학의의，기중박벽소점비례여병리아형분급정부상관（r＝-0．267，P＝0．015）。종류변연형태（P＝0．002）、종류밀도류형（P＝0．006）、종류배사정황（P＜0．001）、낭강분격정황（P＝0．016）화박벽소점비례（P＝0．005）재종류불동분화정도간적차이유통계학의의，기중박벽소점비례여종류분화정도정정상관（ r＝0．266，P＝0．013）。결론 HRCT상，낭강양폐선암적낭강다표현위불동정도후벽여박벽혼합존재，가반분격，벽결절화배사소견，기HRCT표현여병리아형분급화종류분화정도유일정상관성。종류세포파배폐포결구가능시폐선암낭강형성적주요병리기출。
Objective To evaluate the high resolution CT ( HRCT ) features of cyst-like lung adenocarcinoma , explore the correlation between HRCT image features and histopathological characteristics , and observe the pathological basis of air-containing space .Methods HRCT and histopathologic findings of cyst-like lung adenocarcinoma in 86 patients were investigated retrospectively .The image features of both tumor and air-containing space were analyzed . All surgically resected specimens were reviewed . The pathological analysis included histologic subtype , differentiation degree , and the pathological basis of air-containing space formation .The correlation between HRCT image features and histopathologic grades was analyzed.Results On HRCT, intratumoral necrosis was detected in 17 cases (19.8%), air-containing space with septa in 40 cases (46.5%), wall nodule in the air-containing space in 16 cases (18.6%), mixed thick and thin walls of air-containing space in 49 cases (57.0%).Air-containing space and its wall were observed in 63 cases on histological specimens , among which destruction of the alveolar wall by tumor cells might be the pathological basis of air-containing space in 42 (66.7%) cases.Differences of tumor attenuation (P=0.030), intratumoral necrosis (P=0.003) and proportion of thin-wall in air-containing space (P=0.014) among different histopathologic grades were significant .The proportion of thin-wall in air-containing space was negatively correlated with histological grade (r=0.267,P=0.015).Differences of tumor contour (P=0.002), tumor attenuation (P=0.006), intratumoral necrosis (P<0.001), septa in air-containing space (P=0.016) and proportion of thin-wall in the air-containing space (P=0.005) among different differentiation degrees were significant .The proportion of thin-wall in air-containing space was positively correlated with differentiation degree (r=0.266,P=0.013).Conclusions On HRCT, cyst-like lung adenocarcinoma may manifest as an air-containing space with septa and mixed thin and thick walls , whereas wall nodule of air-containing space and intratumoral necrosis are not common .There is a certain correlation of HRCT manifestation with pathological subtype grading and tumor differentiation .Analysis of HRCT image features is helpful in prediction of the histopathologic grading and histological differentiation degree of the tumors .Destruction of the alveolar structure by tumor cells may be the main pathological basis of air-containing space formation in cyst-liked lung adenocarcinoma .