多层螺旋CT诊断肺原发性大细胞神经内分泌癌临床价值

Clinical value of MSCT in diagnosis of primary large cell neuroendocrine carcinoma of the lung

摘要:

目的 探讨肺原发性大细胞神经内分泌癌（PLCNEC）的多层螺旋CT（MSCT）特征，以提高PLCNEC临床术前的诊断率。方法 回顾性分析16例经手术或穿刺活检病理证实肺原发性PLCNEC患者的CT及临床病理资料，所有病例均行胸部平扫后增强扫描。结果 16例PLCNEC周围型14例（87.5%），中央型2例（12.5%），10例（62.5%）位于双肺上叶，1例（6.25%）位于右肺中叶，5例（31.25%）位于双肺下叶；肿瘤最大长径平均>4 cm；14例（87.5%）肿瘤形态不规则，12例（75%）呈分叶状，3例（18.75%）周围见毛刺，1例（6.25%）周围见磨玻璃影；10例（62.5%）肿瘤边界清晰；15例（93.75%）肿瘤密度不均匀，伴1例（6.25%）肿瘤内空洞形成，1例（6.25%）肿瘤内点状钙化，1例（6.25%）密度均匀；8例（50%）邻近胸膜增厚；10例（62.5%）纵隔及肺门多发肿大淋巴结；4例（25%）肺内见结节；1例（6.25%）出现肝脏低密度转移灶。增强扫描15例（93.75%）呈轻-中度强化，1例（6.25%）明显强化，15例（93.75%）均出现局灶性、弥漫性坏死。结论 当肺周围出现较大肿块、形态多不规则、边界清晰、有分叶、邻近胸膜受侵增厚、纵膈多发肿大淋巴结及远处转移，增强扫描呈轻-中度强化并伴有不同程度的坏死，具有一定的特征性。为临床术前诊断提供依据，但确诊仍需进一步组织病理学检查。

Abstract:

Objective To investigate the MSCT characteristics of primary large cell neuroendocrine carcinoma (LCNEC) of the lung in order to improve the preoperative diagnosis rate of LCNEC.Methods The CT and clinicopathological data of 16 patients with primary pulmonary LCNEC confirmed by operation or biopsy were retrospectively analyzed. All cases underwent enhanced chest scan after plain scan.Results Of 16 primary LCNEC cases, 14 cases (87.5%) were peripheral type, 2 cases (12.5%) were central type, 10 cases (62.5%) were located in the upper lobe of both lungs, 1 case (6.25%) was located in the middle lobe of the right lung, and 5 cases (31.25%) were located in the lower lobe of both lungs. The average maximum length of tumor was >4 cm. The tumors were irregular in shape in 14 cases (87.5%), lobulated in 12 cases (75%), burrs in 3 cases (18.75%), and ground glass shadows in 1 case (6.25%). The tumor boundaries were clear in 10 cases (62.5%). There were 15 cases (93.75%) with uneven tumor density, 1 case (6.25%) with cavity formation, 1 case (6.25%) with punctal calcification, 1 case (6.25%) with uniform tumor density. Adjacent pleural thickening occurred in 8 cases (50%). Ten cases (62.5%) had multiple enlarged lymph nodes in the mediastinum and hilum of the lung. Pulmonary nodules were found in 4 cases (25%). One case (6.25%) had low-density liver metastases. Fifteen cases (93.75%) showed mild to moderate enhancement, 1 case (6.25%) showed obvious enhancement, and 15 cases (93.75%) showed focal and diffuse necrosis.Conclusion When there were large masses around the lung, irregular shapes, clear borders, lobulated, thickened adjacent pleura, multiple enlarged mediastinum lymph nodes and distant metastases, the enhanced scan showed mild to moderate enhancement accompanied by varying degrees of necrosis, with certain characteristics. To provide a basis for preoperative clinical diagnosis, but further histopathological examination is needed for diagnosis.