【作者】 谢尚煌；

【导师】 刘源；

【作者基本信息】 汕头大学 ， 医学诊断专门化， 2011， 硕士

【摘要】 背景与目的肺癌是世界上发病率和死亡率最高的恶性肿瘤之一,细支气管肺泡癌(bronchioloalveolar carcinoma, BAC)属肺腺癌的一种特殊类型。1960年Liebow首次用BAC命名一种发生在肺的外周、边界清楚、不破坏肺泡间隔的腺癌。国外学者研究发现,近半个世纪以来,细支气管肺泡癌的发病率迅速增长,占肺癌的比例从1955年5.0%上升到1990年24.0%,几乎与肺鳞癌相等,并占女性肺癌的30%~50%。在国内,BAC约占肺癌的20%,男性较多见,发病年龄在40~60岁。由于BAC患者临床上特征性大量白色泡沫痰并不多见,如果有亦多见于晚期,且BAC在不同个体之间的临床、病理及影像学表现复杂,故临床上不易及时诊断,容易造成误诊,延误治疗时机。本文回顾性分析细支气管肺泡细胞癌(BAC)的临床特点、胸部CT的影像学征象及病理学基础,其目的在于提高BAC影像诊断的准确率,减少误诊。材料与方法搜集2005-2010年经汕头大学医学院第一附属医院检查并最终得到病理诊断的23例细支气管肺泡癌的CT表现进行回顾性分析,寻找其相对特征性的表现,探讨各型病变的影像特征及其对应的病理关系。结果23例确诊BAC病例均行CT平扫及2mm薄层重建,男:女=10:13,平均发病年龄55岁,中位发病年龄60岁,最大发病年龄70岁,最小发病年龄24岁。其中5例吸烟。8例患者有咳白色泡沫样痰。CT诊断正确率69.6%(16/23),误诊者超过一半57.1%(4/7)被误诊为结核。根据CT征象将BAC分为3型:孤立结节型10例,占43.5%(10/23),其中增强扫描3例;炎症实变型8例,占34.8%(8/23);及多发结节型5例,占21.7%(5/23)。其中孤立结节型中80.0%(8/10)分布于肺野外带,支气管充气征/空泡征90%(9/10),瘤周或瘤内磨玻璃密度征70%(7/10),分叶征60.0%(6/10),毛刺征90%(8/10),胸膜凹陷征50.0%(5/10),3例增强病例均见血管集束征,血管包埋征66.7%(2/3)。8例炎症实变型见枯树枝征100%(8/8),磨玻璃密度征75%(6/8),蜂窝征62.5%(5/8),腺泡样结节50%(4/8),病变发生在下肺为主,占75.0%(6/8)。多发结节型中3例见支气管充气征/空泡征,3例见磨玻璃密度征,4例见毛刺征。结论细支气管肺泡癌的影像表现复杂多样,掌握各型BAC的典型影像学表现,有助于本病的的正确诊断。更多还原

【Abstract】 Background and ObjectiveLung cancer is one of the highest morbidity and mortality rates of malignant tumors in the word. Bronchioloalveolar carcinoma (BAC) is a special type of lung cancer. In 1960, Liebow named a special kind of adenocarcinoma with BAC which occurred in the peripheral lung with clear boundary, and does not destroy the alveolar septum for the first time. The foreign study found that the incidence of BAC growth rapidly nearly half a century, accounting for the proportion of lung cancer increased from 5.0% in 1955 to 24.0% in 1990, almost equal to squamous cell carcinoma of lung, and is about 30% to 50% of lung cancer in female. In China, BAC accounted for about 20% of lung cancer. Most of them are between 40 and 60 years old. Because the BAC patients’clinical characteristics with large number of white foam sputum are rare, if so, are more common in the late. And between different individuals, the clinical manifestations, pathology and imaging are complex. It is difficult to diagnose in clinical timely and easily lead to Misdiagnosed, delaying treatment opportunity. We will review the Clinical features, chest CT and thin slice CT features, and pathologic signs of the cases. The purpose is to improve the diagnostic accuracy and reduce misdiagnosis.Materials and Methods23 cases which have complete clinical data and confirmed by pathology are collected in our study. These cases are all from The First Affiliated Hospital of Shantou University Medical College between 2005-2010. We analyze their CT and thin slice CT features to find the relative characteristic imaging. Discuss the imaging features of various types of BAC and their corresponding pathological features.ResultsAll the 23 finally diagnosed as BAC cases have plain scanning and 2mm thin slice reconstruction. male:female=10:13, average age 55 years, median age 60 years, maximum age 70 years, minimum age 24 years. There are 5 smokers. Eight of them have typical white foam sputum. The CT diagnostic accuracy rate is 69.6% (16/23), more than half (57.1%, 4/7) of the misdiagnosed cases are diagnosed as tuberculosis. According to the CT signs; BAC could be classified into three types: solitary nodule (n=10) 43.5% (10/23), in which there are 3 enhanced scanning cases, inflammatory consolidation (n=8) 34.8% (8/23), and multiple nodules (n=5) 21.7% (5/23). 80.0% (8/10) of the solitary BAC cases are peripheral distribution, aerated bronchus sign or bubble-like attenuation are found in 9 cases, the peritumoral or intratumoral ground-glass opacity (GGO) are found in 7, lobulated sign in 6, marginal spiculated sign in 9, and hollowed pleura in 5. Vessel embedding sign are found in 2 of the 3 enhanced cases, vessel convergence sign in 3. Air bronchus can be found in all the 8 consolidated BAC cases. GGO sign are found in 6, honeycomb-like sign in 5. gland alveolar nodules in 4. In most of the cases(6/8), the signs are found in lower lungs. In multiple BAC cases, aerated bronchus sign or bubble-like attenuation are found in 3 cases, GGO sign are found in 3, and spiculated sign are found in 4.ConclusionThe imaging features of BAC are complicated, more exact diagnoses can be made through deep and careful analysis on the imaging features of the manifestation of each type.更多还原