Kim Tae Hoon, Kim Sang Jin, Ryu Young Hoon, Lee Hyun Ju, Goo Jin Mo, Im Jung-Gi, Kim Hyung Joong, Lee Doo Yun, Cho Sang Ho, Choe Kyu Ok
Department of Radiology, Yongdong Severance Hospital, Yonsei University College of Medicine, 146-92 Dogok-Dong, Kangnam-Ku, Seoul 135-720, Korea.
Radiology. 2004 Aug;232(2):554-9. doi: 10.1148/radiol.2322031201. Epub 2004 Jun 23.
To retrospectively evaluate computed tomographic (CT) features of pleomorphic carcinoma of the lung and to compare these features with pathologic findings.
Ten patients (10 men, three women; mean age at diagnosis, 64.1 years; range, 43-75 years) with pleomorphic carcinoma treated from June 2000 to January 2003 were selected from two institutions. Two radiologists retrospectively reviewed CT features, which included size and location of tumor, presence of calcification, attenuation values and internal architecture of the mass, and invasion of pleura and chest wall. Attenuation values of the mass on CT scans were compared with pathologic findings in tumors in available gross specimens. Follow-up CT scans were not routinely obtained except in two patients with progressive pleural effusion and rapid growth of the tumor as seen on serial chest radiographs.
On unenhanced CT scans, attenuation of the tumor was similar to that of the surrounding muscle. Calcification within the tumor was visible in one patient. Invasion of chest wall was noted in two patients. Seven patients had pleural invasion. Tumors were located at the lung periphery in nine patients. On contrast material-enhanced CT scans, lesions with the longest diameter larger than 5 cm showed central low-attenuation areas with substantial enhancement in the tumor periphery; in comparison, lesions with the longest diameter smaller than 5 cm showed homogeneous enhancement. Size of two lesions with the longest diameter larger than 5 cm increased rapidly after a follow-up of shorter than 3 weeks. Low-attenuation areas on contrast-enhanced CT scans were found to correspond to areas of myxoid degeneration, necrosis, or hemorrhage in pathologic specimens.
Findings of this study suggest that pleomorphic carcinomas of the lung preferentially manifest as large peripheral lung neoplasms with a central low-attenuation area and frequently invade the pleura and chest wall.
回顾性评估肺多形性癌的计算机断层扫描（CT）特征，并将这些特征与病理结果进行比较。
从两家机构选取2000年6月至2003年1月期间接受治疗的10例肺多形性癌患者（10例男性，3例女性；诊断时平均年龄64.1岁；范围43 - 75岁）。两位放射科医生回顾性分析CT特征，包括肿瘤的大小和位置、钙化情况、肿块的衰减值和内部结构以及胸膜和胸壁的侵犯情况。将CT扫描上肿块的衰减值与可获得的大体标本中肿瘤的病理结果进行比较。除两名出现进行性胸腔积液且在系列胸部X线片上显示肿瘤快速生长的患者外，未常规进行随访CT扫描。
在未增强的CT扫描上，肿瘤的衰减与周围肌肉相似。1例患者可见肿瘤内钙化。2例患者发现胸壁侵犯。7例患者有胸膜侵犯。9例患者肿瘤位于肺周边。在对比剂增强CT扫描上，最长径大于5 cm的病变显示中央低衰减区，肿瘤周边有明显强化；相比之下，最长径小于5 cm的病变显示均匀强化。最长径大于5 cm的2个病变在随访短于3周后迅速增大。对比增强CT扫描上的低衰减区在病理标本中对应黏液样变性、坏死或出血区域。
本研究结果表明，肺多形性癌优先表现为周边较大的肺肿瘤，有中央低衰减区，且常侵犯胸膜和胸壁。
