肺大细胞神经内分泌癌CT表现及临床特征

doi:10.3877/cma.j.issn.1674-6902.2022.02.007

目的

分析肺大细胞神经内分泌癌(LCNEC)的CT表现及临床特征，以提高对该病的认识及诊治水平。

方法

回顾性分析我院收治经病理证实的80例LCNEC患者的临床资料、CT征象并复习相关文献。

结果

临床症状最常见为咳嗽咳痰，约占71.25%，CT检查示肿瘤平均直径(58.23±33.58)mm，纵隔型5例，中央型23例，周围型52例；肿瘤出现钙化16例，分叶征78例，毛刺征63例，形态不规则72例，胸膜粘连71例，淋巴结肿大60例；肿瘤平扫CT值约(33.63±8.28)Hu，动脉期平均强化幅度约(17.42±9.30)Hu；34例首诊即发现单发或多处转移，其中骨转移16例，颅内转移14例，肾上腺转移7例，肺内转移6例，肝脏转移5例，脾脏转移2例。

结论

LCNEC好发于有长期大量吸烟史的老年男性，临床表现及实验室指标均缺乏特异性，确诊主要依靠组织学病理及免疫组织化学检查。其CT表现具有一定的特征性，对于重度吸烟史的老年男性，当CT发现肺内较大结节或不规则肿块并伴有分叶、边界清晰、强化不均及早期转移时应考虑到该病可能。其标准治疗方案存在很大争议，主张早期以手术治疗为主的综合治疗。早诊断、早治疗对于提高LCNEC患者生存率尤为重要。

关键词: 肺大细胞神经内分泌癌, 体层摄影术, X线计算机, 临床特征

Objective

To analyze the CT findings and clinical features of lung large cell neuroendocrine carcinoma (LCNEC) in order to improve the understanding, diagnosis and treatment of the disease.

Methods

The clinical data and CT signs of 80 LCNEC patients who were admitted to our hospital and pathologically confirmed were retrospectively reviewed, and the relevant literature was reviewed.

Results

The most common clinical symptoms were cough and expectoration, about 71.25%. CT showed that the average diameter of the tumor was (58.23±33.58)mm, including 5 cases of mediastinal type, 23 cases of central type and 52 cases of peripheral type; Calcification occurred in 16 cases, lobulation sign in 78 cases, burr sign in 63 cases, irregular shape in 72 cases, pleural adhesion in 71 cases and lymphadenopathy in 60 cases; The plain CT value of the tumor was about (33.63±8.28)Hu, and the average enhancement amplitude in arterial phase was about (17.42±9.30)Hu; Single or multiple metastases were found in 34 cases at the first diagnosis, including 16 cases of bone metastasis, 14 cases of intracranial metastasis, 7 cases of adrenal metastasis, 6 cases of intrapulmonary metastasis, 5 cases of liver metastasis and 2 cases of spleen metastasis.

Conclusion

LCNEC tends to occur in elderly men with a long history of massive smoking. The clinical manifestations and laboratory indexes are lack of specificity. The diagnosis mainly depends on histopathological and immunohistochemical examination. The CT findings have certain characteristics. For elderly men with a history of severe smoking, the possibility of the disease should be considered when CT finds large nodules or irregular masses in the lung with lobulation, clear boundary, uneven enhancement and early metastasis. The standard treatment scheme is controversial, but it still advocates the early comprehensive treatment based on surgical treatment. Therefore, early diagnosis and early treatment are particularly important to improve the survival rate of LCNEC patients.

Key words: Pulmonary large cell neuroendocrine carcinoma, Tomography, X-ray computed, Clinical characteristics

图1 右肺上叶周围型大细胞神经内分泌癌；注：A：CT肺窗示右肺上叶类圆性肿块，边缘浅分叶、可见毛刺征(箭头)；B：CT增强纵隔窗示右肺上叶肿块轻度不均匀强化，纵隔多发淋巴结肿大(箭头)

图2 左肺上叶中央型大细胞神经内分泌癌；注：A：CT肺窗示左肺上叶类圆性肿块，边缘浅分叶、周围少许阻塞性炎症；B：CT增强纵隔窗示左肺上叶肿块中度不均匀强化、肿块包绕左肺动脉(箭头)

图3 右侧纵隔型大细胞神经内分泌癌；注：A：CT平扫纵隔窗示右上纵隔不规则肿块、密度不均匀、局部见斑片状低密度坏死影(箭头)，右侧少量胸腔积液；B：CT增强纵隔窗示右上纵隔肿块轻-中度不均匀强化

图4 大细胞神经内分泌癌病理及免疫组化；注：A：镜下示(HE×200)癌细胞体积较大，胞浆丰富，核仁明显，核分裂象易见；B：免疫组织化学分析示CD56+

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CT findings and clinical features of pulmonary large cell neuroendocrine carcinoma

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CT findings and clinical features of pulmonary large cell neuroendocrine carcinoma