Kazerooni E A, Bhalla M, Shepard J A, McLoud T C
Department of Radiology, University of Michigan Hospitals, Ann Arbor 48109-0326.
AJR Am J Roentgenol. 1994 Aug;163(2):301-6. doi: 10.2214/ajr.163.2.8037019.
To our knowledge, the imaging features of pulmonary adenosquamous carcinoma, a form of bronchogenic carcinoma with a greater propensity for metastases at the time of diagnosis and a poorer prognosis than other forms of bronchogenic carcinoma, have not been reported. Accordingly, we studied the radiologic appearance of this tumor to describe the findings and discern if there are features that distinguish it from other bronchogenic carcinomas.
Clinical and radiologic features of 30 cases of adenosquamous carcinoma were reviewed. Chest radiographs were available in all cases and CT scans were available in 23. In cases without CT scans, planar tomograms were reviewed in five cases and MR images were reviewed in one. Tumors were defined by location, morphology, and TNM classification.
The tumors measured 0.6-6.5 cm in diameter (mean, 2.8 cm) on CT scans or chest radiographs. One tumor not seen even in retrospect on CT scans or chest radiographs was found at autopsy. Twenty-five tumors were solid and four were cavitary. Five tumors were central and 25 were peripheral, including one tumor of the superior sulcus of the lung and the tumor not seen at imaging. Tumor margins were poorly defined in 19 and spiculated in 10. Four large masses had heterogeneous attenuation on CT scans; one had punctate calcification. Fifty-three percent of tumors were peripheral nodules 1-3 cm in diameter. Results of fine-needle aspiration of 18 masses indicated malignant tumors in 16 cases, but adenosquamous carcinoma in only two. Evidence of previous lung injury, including tumor in or next to scar, pneumoconiosis, radiation fibrosis, and interstitial fibrosis, was found on CT scans, chest radiographs, and/or pathology in half the patients.
The radiologic findings of adenosquamous lung carcinoma are a spectrum, typically a peripheral solitary nodule, less commonly a central hilar mass or tumor of the superior sulcus. Scar or fibrosis within the lungs suggests that adenosquamous carcinoma, just as adenocarcinoma, may arise in scarred lung parenchyma.
据我们所知，肺腺鳞癌作为支气管源性癌的一种形式，在诊断时比其他形式的支气管源性癌更易发生转移且预后较差，其影像学特征尚未见报道。因此，我们研究了该肿瘤的放射学表现，以描述其影像学发现，并判断是否存在将其与其他支气管源性癌相鉴别的特征。
回顾了30例腺鳞癌的临床和放射学特征。所有病例均有胸部X线片，23例有CT扫描。在没有CT扫描的病例中，5例回顾了平面断层片，1例回顾了MR图像。根据肿瘤的位置、形态和TNM分类对肿瘤进行定义。
在CT扫描或胸部X线片上，肿瘤直径为0.6 - 6.5 cm（平均2.8 cm）。尸检发现1例肿瘤即使在回顾CT扫描或胸部X线片时也未显示。25个肿瘤为实性，4个为空洞性。5个肿瘤位于中央，25个位于周边，包括1个肺上沟肿瘤和影像学未显示的肿瘤。19个肿瘤边界不清，10个有毛刺。4个大肿块在CT扫描上呈不均匀密度；1个有斑点状钙化。53%的肿瘤为直径1 - 3 cm的周边结节。18个肿块的细针穿刺结果显示，16例为恶性肿瘤，但仅2例为腺鳞癌。在一半的患者中，CT扫描、胸部X线片和/或病理检查发现了既往肺损伤的证据，包括瘢痕内或瘢痕旁肿瘤、尘肺、放射性纤维化和间质性纤维化。
肺腺鳞癌的放射学表现具有多样性，通常为周边孤立结节，较少见中央肺门肿块或肺上沟肿瘤。肺内瘢痕或纤维化提示腺鳞癌可能与腺癌一样，起源于瘢痕化的肺实质。
