Yang X, Yan H, Liu H, Hu M, Xie Y, Soimakallio S
Department of Clinical Radiology, Kuopio University Hospital, Finland.
Acad Radiol. 1996 Apr;3(4):308-12. doi: 10.1016/s1076-6332(96)80245-5.
We evaluated pathologic correlations of pulmonary parenchymal manifestations surrounding small peripheral masses and their usefulness in differentiating small peripheral bronchogenic carcinomas from tuberculomas.
We evaluated 29 resected lobe specimens with 1.5- to 3.5-cm solitary pulmonary masses, including 24 carcinomas and five tuberculomas. These specimens were prospectively studied with preoperative chest radiographs, postoperative specimen radiographs, 10- to 15-microns-thick wholemount sections, and 5-microns-thick slices. A total of 100 chest X-rays and conventional tomography scans of 1- to 3-cm peripheral pulmonary masses, including 60 carcinomas and 40 tuberculomas, were retrospectively reviewed and analyzed.
The pulmonary parenchymal manifestations surrounding the masses presented as small infiltrates and nodular protrusions, thickened strands, and "double track" shadows, which extended from the proximal margin of five tuberculomas (100%, 5 of 5) and from the distal margin of 17 carcinomas (71%, 17 of 24). These pulmonary changes represented caseous material spreading from tuberculomas into the proximal bronchus and alveolar inflammatory exudation distal to the carcinomas. The proximal pulmonary manifestations were significantly more frequent in tuberculomas than in carcinomas (p < .01), whereas the distal pulmonary manifestations were more often found in carcinomas than in tuberculomas (p < .01).
The radiologic findings of the pulmonary parenchymal manifestations proximal or distal to the masses may be valuable radiologic signs for distinguishing between tuberculomas and small peripheral bronchogenic carcinomas, even though there is still considerable crossover between the two disease populations in the findings.
我们评估了小的周围型肿块周围肺实质表现的病理相关性及其在鉴别小的周围型支气管肺癌与结核瘤方面的作用。
我们评估了29个切除的肺叶标本，这些标本中有直径1.5至3.5厘米的孤立性肺肿块，其中包括24例癌和5例结核瘤。对这些标本进行了前瞻性研究，包括术前胸部X线片、术后标本X线片、10至15微米厚的整装切片以及5微米厚的切片。回顾性分析了总共100例1至3厘米周围型肺肿块的胸部X线片和传统体层摄影扫描，其中包括60例癌和40例结核瘤。
肿块周围的肺实质表现为小片状浸润和结节状突出、条索状增粗以及“双轨征”阴影，这些表现从5个结核瘤（5/5，100%）的近端边缘延伸，从17例癌（24/17，71%）的远端边缘延伸。这些肺部改变分别代表了结核瘤内干酪样物质向近端支气管的蔓延以及癌远端的肺泡炎性渗出。结核瘤近端肺部表现的发生率显著高于癌（p <.01），而癌远端肺部表现的发生率高于结核瘤（p <.01）。
肿块近端或远端肺实质表现的影像学发现可能是鉴别结核瘤和小的周围型支气管肺癌的有价值的影像学征象，尽管这两种疾病在这些表现上仍有相当程度的交叉。
