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目的探讨原发性肺胶样腺癌的CT表现及相关病理学基础,以提高对其认识水平。方法 13例经病理证实的原发性肺胶样腺癌纳入研究,其中男7例,女6例,年龄平均56岁(36~74岁)。13例均行CT平扫,11例行增强扫描,9例进行免疫组织化学分析,分析蛋白指标为CK7、CK20和TTF-1。结果 11例单发,其中周围型8例;9例病灶为类圆形结节/肿块影,3例形态不规则,1例为实变影。病灶边界均清楚。11例见分叶征。CT平扫囊实性密度7例,实性密度4例,混杂磨玻璃密度2例。增强扫描7例囊实性病灶实性成分无强化1例,轻度强化4例,轻至中度不均匀强化2例;4例实性密度病灶无强化2例,轻至中度不均匀强化2例;3例病灶周围见磨玻璃密度影。镜下见“黏液湖”形成,并见少量肿瘤细胞“漂浮”在湖中;免疫组织化学指标CK7、CK20和TTF-1阳性率分别为77.8%(7/9)、55.6%(5/9)和77.8%(7/9)。结论原发性肺胶样腺癌CT表现多样,典型者表现为周围型结节或肿块,病灶内多可见囊性成分,增强扫描轻度强化或无强化为主。分叶多见但无毛刺、棘状突起。结合CK7、CK20、TTF-1阳性有助于提示胶样腺癌。
Objective To explore the CT features of primary lung adenoid carcinomas and their related pathological basis in order to raise their level of cognition. Methods Thirteen cases of pathologically confirmed primary lung adenoid carcinomas were enrolled, including 7 males and 6 females, with an average age of 56 years (36-74 years). Thirteen patients underwent CT scan, 11 patients underwent enhanced scan, and 9 patients underwent immunohistochemical analysis. The protein indexes of CK7, CK20 and TTF-1 were analyzed. Results Eleven cases were solitary, including 8 cases of peripheral type. 9 cases were round nodules / masses, 3 cases were irregular in shape and 1 case was solidified. The boundary of the lesion is clear. 11 cases see the leaf sign. CT scan cyst density in 7 cases, 4 cases of solid density, mixed mill glass density in 2 cases. Among the 7 patients with contrast-enhanced cystic solid lesions, there was no enhancement in solid content in 1 case, mild enhancement in 4 cases, mild to moderate non-uniform enhancement in 2 cases, solid density in 4 cases without enhancement in 2 cases, mild to moderate inhomogeneous enhancement 2 cases; 3 lesions around the mill glass density. Microscopically, “mucus lake” was formed and a small amount of tumor cells “floating” was seen in the lake. The positive rates of immunohistochemistry CK7, CK20 and TTF-1 were 77.8% (7/9) and 55.6% (5/9) and 77.8% (7/9). Conclusions The CT findings of primary pulmonary adenoid carcinomas are diverse. Typical cases are peripheral nodules or masses, mostly cystic components in lesion, and mild or no enhancement mainly in enhanced scan. Leaves more common but no burr, spine-like processes. Combined with CK7, CK20, TTF-1 positive can help suggest that plastic adenocarcinoma.