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中华肺部疾病杂志(电子版) ›› 2022, Vol. 15 ›› Issue (03) : 344 -348. doi: 10.3877/cma.j.issn.1674-6902.2022.03.012

论著

MSCT对原发性气管支气管腺样囊性癌的12例诊断及文献复习
葛晓东1, 龚明福1, 白奇之1, 赵刚1,(), 甘慧1, 戴书华1   
  1. 1. 400037 重庆,陆军(第三)军医大学第二附属医院放射科
  • 收稿日期:2022-02-11 出版日期:2022-06-25
  • 通信作者: 赵刚
  • 基金资助:
    陆军军医大学苗圃人才项目(2019R059)

Diagnosis of primary tracheobronchial adenoid cystic carcinoma by MSCT in 12 cases and literature review

Xiaodong Ge1, Mingfu Gong1, Qizhi Bai1, Gang Zhao1,(), Hui Gan1, Shuhua Dai1   

  1. 1. Department of Radiology, Xinqiao Hospital, Army Medical University, Chongqing 400037, China
  • Received:2022-02-11 Published:2022-06-25
  • Corresponding author: Gang Zhao
引用本文:

葛晓东, 龚明福, 白奇之, 赵刚, 甘慧, 戴书华. MSCT对原发性气管支气管腺样囊性癌的12例诊断及文献复习[J]. 中华肺部疾病杂志(电子版), 2022, 15(03): 344-348.

Xiaodong Ge, Mingfu Gong, Qizhi Bai, Gang Zhao, Hui Gan, Shuhua Dai. Diagnosis of primary tracheobronchial adenoid cystic carcinoma by MSCT in 12 cases and literature review[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2022, 15(03): 344-348.

目的

分析原发性气管支气管腺样囊性癌(tracheobronchial adenoid cystic carcinoma, TACC)的多层螺旋CT(multislice spiral computed tomography, MSCT)影像学征象、临床表现及文献复习,以提高TACC诊断率。

方法

回顾性分析我院2011年6月到2021年11月期间12例经病理确诊的气管支气管腺样囊性癌患者的临床资料及MSCT征象。

结果

12例气管支气管腺样囊性癌患者临床表现无特异性,以咳嗽、咳痰、呼吸困难及咯血最为常见。MSCT上气管支气管腺样囊性癌均为单发病例,6例位于气管,5例位于左主支气管,1位于右肺下叶支气管;9例为腔内外型,1例为弥漫浸润型;2例为周围结节型,肿瘤引起不同程度支气管狭窄,部分伴随阻塞性肺炎、肺不张;病变纵向浸润范围为21~60 mm,平均浸润长度为(37.7 ±11.8)mm,7例气管受侵范围>1/2环周;增强扫描呈轻-中度延迟强化;4例患者纵隔淋巴结肿大。

结论

气管支气管腺样囊性癌患者多见于中青年患者,沿气管支气管管壁浸润性生长,管壁不同程度增厚、呈结节状、息肉样凸向腔内,轻-中度延迟强化,MSCT征象具有一定特点,为其临床治疗提供依据。

Objective

To investigate the MSCT imaging and clinical manifestations of primary tracheobronchial adenoid cystic carcinoma, so as to improve the diagnosis rate of patients with this disease.

Methods

A retrospective analysis of the clinical data and MSCT signs of 12 patients with pathologically confirmed tracheobronchial adenoid cystic carcinoma in our hospital from June 2011 to November 2021.

Results

Among the 12 patients with adenoid cystic carcinoma, the onset was non-specific, and the most common clinical manifestations were cough, expectoration, hemoptysis and dyspnea. The tumors were all single on MSCT, and the lesions were located in the trachea in 6 cases, the left main bronchus in 5 cases, and the trachea in the right lower lobe in 1 case; 9 cases were intracavitary type and 1 case was diffuse infiltration type. 2 cases were peripheral nodular type. The lesions caused different degrees of bronchial stenosis, and some were accompanied by obstructive pneumonia and obstructive atelectasis. The longitudinal invasion ranged from 21 mm to 60mm, with an average infiltration length of (37.7±11.8)mm; The trachea was invaded more than 1/2 ring in 7 cases. Enhancement scan showed mild to moderate delayed enhancement. Mediastinal lymph nodes were enlarged in 4 patients.

Conclusion

Tracheobronchial adenoid cystic carcinoma is mostly seen in young and middle-aged patients. It grows infiltratively along the tracheobronchial wall, and the wall thickens to varying degrees, presenting nodular and poly-like protruding into the lumen, with mild to moderate delayed enhancement. MSCT signs have certain characteristics, which provide the basis for its clinical treatment.

图1 患者CT图像分析;注:38岁男性患者,间断咳嗽、咳痰1年,病理诊断腺样囊性癌;注:A:MSCT轴位平扫上胸段气管壁不规则增厚,大于1/2环周;B:冠状位增强,病灶呈腔内外型,宽基底向腔内外生长,气管壁不均匀增厚、沿管壁纵向浸润性生长,纵向浸润范围38 mm,管腔狭窄,轻度强化;C、D:Min IP、VR图显示病灶在气管内呈充盈缺损表现,气管管腔轻-中度狭窄
图2 患者CT图像分析;注:46岁男性患者,咳嗽、咯血1年,病理诊断腺样囊性癌;A:MSCT轴位平扫左主支气管壁后壁区见结节状软组织影,与降主动脉毗邻,病灶受侵范围小于1/2环周;B:冠状位增强,病灶呈腔内外型,左主支气管近段见结节影,向腔内外浸润性生长,纵向浸润范围21 mm,中度强化;C、D:Min IP、VR图显示病灶在左主支气管内呈充盈缺损表现,气管管腔重度狭窄
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