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目的分析肺不典型腺瘤样增生(AAH)的影像表现,并与病理对照,旨在提高对 AAH影像表现的认识。方法回顾性分析由手术及病理证实的8例 AAH 的影像表现,所有患者均摄 X 线胸片并经高分辨率 CT(HRCT)及增强扫描,均为女性,中位年龄56岁。由影像科医师及病理科医师共同阅片,将影像学结果与病理学结果进行对照分析。结果胸部正侧位片3例未检出病变,5例参照 CT 可以辨别出小类结节或淡片影。CT 8例均见肺结节影,其中右肺上叶4例,右肺中叶1例,右肺下叶1例,左肺上叶2例。最大20.0 mm×18.1 mm,最小5.0 mm×4.1 mm。HRCT 均为非实性结节,密度不均匀,平均 CT 值最高为-362.7 HU,最低为-485.6 HU,平均为(-423.0±47.0)HU;4例可见空气支气管征、空泡。病变均为类圆形,边界较清晰,边缘有浅分叶者2例。未见毛刺征和胸膜牵拉征。镜下表现为结节边界清楚,与周围肺组织分界明显;肺泡间隔轻度增厚,上皮细胞沿肺泡间隔增生,细胞间排列紧密,但无重叠及挤压;核质比例轻度失调,有轻度异形性。结论有助于AAH 影像诊断的指标为:(1)偶尔发现的肺结节,无症状;(2)病变通常直径≤10 mm;(3)HRCT 表现为非实性结节,可有空泡或空气支气管征;(4)HRCT 无毛刺征和胸膜牵拉征等表现。最终确诊仍需组织学证据。
Objective To analyze the imaging manifestations of pulmonary atypical adenomatous hyperplasia (AAH) and compare them with the pathological findings to improve the understanding of AAH imaging. Methods Eight cases of AAH confirmed by surgery and pathology were retrospectively analyzed. All patients underwent X-ray and HRCT and enhanced scanning. All were female, with a median age of 56 years. By the imaging physicians and pathologists to read the film, the imaging results and pathological results were analyzed. Results There were no lesions detected in 3 cases of chest lateral radiographs and 5 cases of reference CT could identify small nodules or fainted radiographs. Pulmonary nodules were seen in 8 cases of CT, including 4 cases of the upper right lung, 1 case of the right middle lobe, 1 case of the right lower lobe and 2 cases of the left upper lobe. Maximum 20.0 mm × 18.1 mm, minimum 5.0 mm × 4.1 mm. HRCT were non-solid nodules with uneven density. The average CT value was -362.7 HU, the lowest was -485.6 HU, and the average was (-423.0 ± 47.0) HU. Four cases showed air bronchial signs and vacuoles. Lesions are round, border more clear edge of the shallow lobe in 2 cases. No burr sign and pleural traction sign. Microscopically, the nodules showed a clear boundary with obvious demarcation from the surrounding lung tissue. The alveolar septum slightly thickened, the epithelial cells proliferated along the alveolar septum, the cells arranged closely, but no overlap and extrusion; the proportion of the nuclear mass was mildly imbalanced, with Mild heterotropism. CONCLUSIONS The indicators that contribute to the diagnosis of AAH are: (1) occasional pulmonary nodules, asymptomatic; (2) usually diameter less than 10 mm; (3) HRCTs manifest as non-solid nodules and may have vacuoles Or bronchial air sign; (4) HRCT hairless signs and pleural traction signs and other performance. The final diagnosis still requires histological evidence.