硬化性肺泡细胞瘤的MSCT表现及其相关病理分析(1)
[摘要]目的探討硬化性肺泡细胞瘤(PSP)的影像特征及相关病理表现，提高其诊断的准确性。方法回顾性分析经手术病理证实为PSP病人37例的多层螺旋CT(MSCT)表现，特别是其强化特征，并与病理学特征进行对照分析。结果本组37例中单发病灶36例，其中右肺15例(右肺上叶2例，右肺中叶5例，右肺下叶8例)，左肺21例(左肺上叶4例，左肺下叶17例);多发病灶1例(右肺上叶、中叶);中央型3例，周围型34例;圆形或类圆形30例，浅分叶7例;密度均匀28例，密度不均9例，其中钙化8例。增强扫描病灶轻中度强化7例，病理以实性成分、硬化成分为主;明显强化16例，病理以血管瘤样成分、乳头成分为主;增强扫描两期均强化均匀20例，病理示血管瘤样成分、乳头成分较多;动脉期强化不均、延迟期强化趋于均匀3例，病理证实多以实性区和硬化区为主且分布不均，血管瘤样区和乳头区相对较少。贴边血管征15例，晕征2例，晕征伴瘤周肺气肿1例。结论中老年女性单发圆形或类圆形软组织结节或包块，边界清，增强扫描呈两期均明显均匀强化或动脉期强化不均匀、延迟期强化趋于均匀，要考虑PSP。
[关键词]硬化性肺泡细胞瘤;肺;病理学，临床;体层摄影术，螺旋计算机
[中图分类号]R734.2;R814.42[文献标志码]A[文章编号] 2096-5532(2018)06-0691-04
MSCT FINDINGS AND PATHOLOGICAL ANALYSIS OF PULMONARY SCLEROSING PNEUMOCYTOMA BAO Shan， LI Ping， ZHANG Liang， YANG Lei， LOU He′nan， LIN Jizheng (Department of Radiology， The Affiliated Hospital of Qingdao University， Qingdao 266003， China)
[ABSTRACT]ObjectiveTo investigate the imaging findings and pathological manifestations of pulmonary sclerosing pneumocytoma (PSP)， and to improve diagnostic accuracy. MethodsA retrospective analysis was performed on the multislice spiral computed tomography (MSCT) data from 37 pathologically confirmed cases of PSP. The imaging findings (enhancement features) and pathological features of the lesions were analyzed. ResultsThere were 36 cases with a single lesion in the 37 patients， including 15 cases in the right lung (2 cases in the right upper lobe， 8 cases in the right lower lobe， and 5 cases in the right middle lobe) and 21 cases in the left lung (4 cases in the upper lobe and 17 cases in the lower lobe); there was one case with multiple lesions in the upper and middle lobes of the right lung. Three patients had central type PSP， and 34 had peripheral type PSP. Lesions were round or oval in 30 cases and were slightly lobulated in 7 cases. Homogeneous lesions were found in 28 cases， and inhomogeneous lesions were observed in 9 cases， among which 8 cases had scattered spotty calcification. Results from the contrast-enhanced CT scan demonstrated mild or moderate enhancement in 7 cases， with solid and sclerotic components as the main pathological features; significant enhancement was observed in 16 cases， with hemangioma-like and papillary components as the main pathological features. The contrast-enhanced CT scan showed homogeneous enhancement in both arterial and delayed phases in 20 cases， with hemangioma-like and papillary components as the main pathological features; inhomogeneous enhancement in the arterial phase and homogeneous enhancement in the delayed phase were observed in 3 cases， with uneven distribution of solid and sclerotic areas as the main pathological features， as well as relatively few hemangioma-like and papillary areas. There were 15 cases with welt vessel sign， 2 cases with halo sign， and 1 case with halo sign and peritumoral emphysema. ConclusionPSP should be considered in the middle-aged and elderly women with a single round or oval pulmonary nodule or mass with a clear margin. Also， PSP should be considered when contrast-enhanced CT scan demonstrates homogeneous enhancement in both phases， or inhomogeneous enhancement in the arterial phase and homogeneous enhancement in the delayed phase., 百拇医药(鲍山 李萍 张亮 杨蕾 娄和南 林吉征)
[关键词]硬化性肺泡细胞瘤;肺;病理学，临床;体层摄影术，螺旋计算机
[中图分类号]R734.2;R814.42[文献标志码]A[文章编号] 2096-5532(2018)06-0691-04
MSCT FINDINGS AND PATHOLOGICAL ANALYSIS OF PULMONARY SCLEROSING PNEUMOCYTOMA BAO Shan， LI Ping， ZHANG Liang， YANG Lei， LOU He′nan， LIN Jizheng (Department of Radiology， The Affiliated Hospital of Qingdao University， Qingdao 266003， China)
[ABSTRACT]ObjectiveTo investigate the imaging findings and pathological manifestations of pulmonary sclerosing pneumocytoma (PSP)， and to improve diagnostic accuracy. MethodsA retrospective analysis was performed on the multislice spiral computed tomography (MSCT) data from 37 pathologically confirmed cases of PSP. The imaging findings (enhancement features) and pathological features of the lesions were analyzed. ResultsThere were 36 cases with a single lesion in the 37 patients， including 15 cases in the right lung (2 cases in the right upper lobe， 8 cases in the right lower lobe， and 5 cases in the right middle lobe) and 21 cases in the left lung (4 cases in the upper lobe and 17 cases in the lower lobe); there was one case with multiple lesions in the upper and middle lobes of the right lung. Three patients had central type PSP， and 34 had peripheral type PSP. Lesions were round or oval in 30 cases and were slightly lobulated in 7 cases. Homogeneous lesions were found in 28 cases， and inhomogeneous lesions were observed in 9 cases， among which 8 cases had scattered spotty calcification. Results from the contrast-enhanced CT scan demonstrated mild or moderate enhancement in 7 cases， with solid and sclerotic components as the main pathological features; significant enhancement was observed in 16 cases， with hemangioma-like and papillary components as the main pathological features. The contrast-enhanced CT scan showed homogeneous enhancement in both arterial and delayed phases in 20 cases， with hemangioma-like and papillary components as the main pathological features; inhomogeneous enhancement in the arterial phase and homogeneous enhancement in the delayed phase were observed in 3 cases， with uneven distribution of solid and sclerotic areas as the main pathological features， as well as relatively few hemangioma-like and papillary areas. There were 15 cases with welt vessel sign， 2 cases with halo sign， and 1 case with halo sign and peritumoral emphysema. ConclusionPSP should be considered in the middle-aged and elderly women with a single round or oval pulmonary nodule or mass with a clear margin. Also， PSP should be considered when contrast-enhanced CT scan demonstrates homogeneous enhancement in both phases， or inhomogeneous enhancement in the arterial phase and homogeneous enhancement in the delayed phase., 百拇医药(鲍山 李萍 张亮 杨蕾 娄和南 林吉征)