CAJ | 학술논문

目的：探讨多层螺旋CT（MSCT）对原发性肺肉瘤样癌（pulmonary sarcomatoid carcinoma, PSC）的诊断价值。方法回顾性分析14例PSC患者的CT表现并与病理进行对照分析。结果13例表现为肺内肿块，1例表现为大片液化坏死，未见明显肿块。有明确肿块者中，中央型2例，周围型11例。位于右肺上叶7例，右肺中叶1例，右肺下叶1例，左肺上叶4例。肿块最大径3.3～12.7 cm，平均7.8 cm。肿块边缘呈分叶3例，细毛刺4例，棘突征4例；空泡征2例，胸膜凹陷征4例。肿块内部密度较均匀7例，不均匀6例，所有病例均未见钙化。8例增强扫描，增强后8例均呈薄壁或厚壁边缘环形强化，8例肿瘤内部均可见大片状均匀或不均匀弱强化区，胸膜侵犯9例，肺内或肺门、纵隔淋巴结转移7例，4例伴有胸腔积液。结论 PSC具有一定影像学特征，多发生在右肺上叶胸膜下较大肿块，常伴有胸膜侵犯，边缘少见分叶、毛刺，增强扫描肿块边缘薄壁或厚壁环形强化，中央大片状弱强化区域等征象是MSCT诊断PSC的重要征象，确诊仍需依靠组织病理学检查。
목적：탐토다층라선CT（MSCT）대원발성폐육류양암（pulmonary sarcomatoid carcinoma, PSC）적진단개치。방법회고성분석14례PSC환자적CT표현병여병리진행대조분석。결과13례표현위폐내종괴，1례표현위대편액화배사，미견명현종괴。유명학종괴자중，중앙형2례，주위형11례。위우우폐상협7례，우폐중협1례，우폐하협1례，좌폐상협4례。종괴최대경3.3～12.7 cm，평균7.8 cm。종괴변연정분협3례，세모자4례，극돌정4례；공포정2례，흉막요함정4례。종괴내부밀도교균균7례，불균균6례，소유병례균미견개화。8례증강소묘，증강후8례균정박벽혹후벽변연배형강화，8례종류내부균가견대편상균균혹불균균약강화구，흉막침범9례，폐내혹폐문、종격림파결전이7례，4례반유흉강적액。결론 PSC구유일정영상학특정，다발생재우폐상협흉막하교대종괴，상반유흉막침범，변연소견분협、모자，증강소묘종괴변연박벽혹후벽배형강화，중앙대편상약강화구역등정상시MSCT진단PSC적중요정상，학진잉수의고조직병이학검사。
Objective To evaluate the multi-slice spiral computed topography in diagnosis value of pulmonary sarcomatoid carcinoma.Methods CT and pathologicfi ndings of 14 cases of pulmonary sarcomatoid carcinoma were studied through retrospective research.Results13 cases presented with a spheroid solid lung mass. 1 case only showed necrosis. 2 cases were central and 11 cases were peripheral, 7 cases were located in the upper of the right lung, 1 in middle lobe of the right lung, 1 in inferior lobe of the right lung and 4 in the superior lobe of the left lung. Diameters ranging from 3.3 cm to 12.7 cm. The mean diameter of these lesions was 7.8 cm. Among the cases, 3 cases with lobulation, 4 cases with spiculation, 4 cases with spinous protuberance, 2 cases with vacuole and 4 cases with pleural indentation sign. The tumors showed homogeneous density in 7 cases and heterogeneous density in 6 cases with patchy low density. Among the 8 cases of enhanced scan, all lesions showed peripheral continuously enhancement with irregular heterogeneous ring nodular sharp, associated with the central uneven patchy strengthening and no enhancement necrotic areas. 9 lesions with adjacent pleural invasion. 7 cases with the lung, the hilus of the lung or mediastinal lymph node metastases. 4 cases with hydrothorax.Conclusion Site of tumor, diameter, periphery of tumor and weak enhancement in the central area and irregular peripheral heterogeneous enhancement are important characteristics for diagnosis pulmonary sarcomatoid carcinoma, but the fi nal diagnosis still depends on histopathological examination.