修.翻译七年制呼吸影像肺肿瘤1

呼吸系统影像诊断学 Imaging diagnostics of the respiratory system 郑州大学第一附属医院放射科 the first affiliated hospital radiology department of Zhengzhou University 张焱 Zhang Yan,(六) 肺肿瘤 pulmonary tumours,分类：.原发性 Primary ：（1）良性 benign （少见 singularly ）（2）恶性malignant 支气管肺癌bronchiogenic cancer （98%）肺肉瘤sarcoma .继发性secondary （肺转移瘤metastasis）,1.原发性支气管肺癌（Primary bronchogenic carcinoma of lung）:近年来肺癌的发病率与死亡率急剧上升incidence and mortality of lung cancer sharp rised 吸烟smoking 、大气污染atmospheric pollution及工业致癌物质industrial carcinogen为主要的致病因素causative agent,（1）病理 pathology ：癌起源于支气管上皮bronchial epithelium ，腺体glandular organ或细支气管及肺泡上皮epithelium of the bronchiole or alveolus,肺癌组织学分型 histological type：小细胞肺癌small cell lung cancer; SCLC及非小细胞肺癌nonsmall-cell lung cancer; NSCLC 非小细胞肺癌nonsmall-cell lung cancer; NSCLC分为：鳞癌squamocellular cancer腺癌adenocarcinoma 腺鳞癌adenosquamous carcinoma 大细胞癌 large cell carcinoma,大体病理分型 macropathology ：中央型 central type ：周围型 peripheral：弥漫型 diffuse ：,按照肺癌的发生部位可以分为三型 position ：中心型 central type ：系指发生于肺段以上支气管的肺癌above the segmental bronchi 外围型 peripheral ：系指发生于肺段支气管以下的肺癌below the segmental bronchi 细支气管肺泡癌bronchioalveolar carcinoma ：系指发生于细支气管或肺泡上皮的肺癌epithelium of the bronchiole or alveolus,生长方式 growth pattern ：管内型intracanalicular type （息肉polypus 、菜花状cauliflowwer ）管壁型wall type （管腔狭窄或闭塞straitness or occlusion ）管外型extratubal type （肺内肿块intrapulmonary mass）,（2）临床clinic：咳嗽cough 、咳血emptysis 、胸痛chest pain 、气促polypnea 压迫症状pressure symptom ：上腔静脉综合征superior vena cava syndrome ，膈神经nervi phrenicus和喉返神经recurrent laryngeal nerve麻痹paralysis等肺外症状extrapulmonary symptom ：杵状指achropachy 、肺性肥大性骨关节病hypertrophic pulmonary arthropathy等,不同部位的肺癌可有以下几种生长方式 growth pattern ：管内型intracanalicular type ：癌瘤向管腔内生长，形成息肉样或菜花样肿块，逐渐引起支气管阻塞intracanalicular polypoid or cauliflower-like mass block bronchus 管壁型wall type ：癌瘤沿支气管壁浸润生长along bronchus ，可使管壁增厚thewall thickening ，造成支气管狭窄或阻塞straitness or occlusion 管外型extratubal type ：癌瘤穿透支气管壁向外生长，在肺内形成肿块penetrate the wall excentric growth ， intrapulmonary mass型多为中心型肺癌的生长方式growth pattern of the central lung cancer,肺段以下较小支气管的肺癌，很易侵入肺内形成肿块intrapulmonary mass is usual in the lung cancer below the segmental bronchi 细支气管或肺泡上皮的肺癌the cancer from epithelium of the bronchiole or alveolus 初期可沿肺泡壁生长，形成孤立结节状肿块initial stage ，grow along the wall of alveolus ，form a isolated node 晚期可经支气管及淋巴管播散，形成弥散性斑片状或粟粒状癌灶 advanced stage disseminated along bronchus and lymph vessel form diffuse carcinomatosis,（3）影像表现：中心型 central type ：,A.支气管改变bronchus ：支气管管壁增厚和管腔狭窄（正常支气管壁厚度均匀，约为1-3mm） the wall thickening and straitness B.肺门肿块mass in hilus pulmonis ，常伴有go with阻塞性肺气肿obstructive emphysema 、阻塞性肺炎obstructive pneumonia 、阻塞性肺不张obstructive atelectasis C.侵犯纵隔mediastinum encroachment D.纵隔及肺门淋巴结肿大lymphadenectasis in mediastinum and hilus pulmonis,右肺上叶不张atelectasis insuperior lobe of right lung,中央型肺癌（癌块、肺不张、横S征） central lung cancer,外围型肺癌 peripheral lung cancer ：肿瘤位于肺段以下到细支气管之间的支气管between the segmental bronchi and the bronchiole,主要征象 main character ：A.肿块征 mass：早期early stage直径diameter2cm，轮廓模糊weakened contours ，密度稍高之结节slightly high density lesion、球状或小片状影globosity or lamellar 密度有时不均、出现空泡征vacuole sign等the density is inhomogeneous 中晚期呈分叶状肿块，边缘有短毛刺，亦可有癌洞等middlelate stage the mass is lobulated, shallow needling and cavity 癌块倍增时间平均约3月average doubling time is about 3 months,B.转移征 同中央型metastatic is the same as central lung cancer C.阻塞征 在病灶周围，较中央型范围小obstruction is less-than central lung cancer D.胸膜受侵征（局限性增厚localized thickening，胸膜凹陷征pleural indentation sign等）pleura is encroached,发生于肺尖部的癌称肺上沟癌（pancoast tumor）apical 可侵蚀邻近肋骨及椎体并可压迫臂丛引起臂痛encroach rib and vertebrae ,press brachial plexus 也可压迫颈部交感神经而引起Horner综合征press cervical sympathetic nerve 表现为同侧眼睑下垂、瞳孔缩小homolateral ptosis and myosis,细支气管肺泡癌 bronchioalveolar carcinoma ：肿瘤位于细支气管或肺泡上皮 epithelium of the bronchiole or alveolus A.早期early stage ：为孤立的结节状或肺炎样浸润影isolated invasion lesion，内有含气的小透明区aerated transparent zone （空泡征vacuole sign ）B.晚期 later period ：一侧肺或两肺出现多数大小不等unilateral or bilateral multiply inequality of size 、境界不清ill-defined的结节或斑片状影nodular or patchy lesion，发展则融合成大片絮状影patchy shadow,周 围 型 肺 癌peripheral lung cancer （早期early stage ）,周围型肺癌peripheral lung cancer （中晚期middlelate stage ）,Age/Sex: 57/M Chief complaints: cough, sputum, and mild fever for 6 monthsSquamous cell lung cancer (with cystic lung to lung metastasis),周围型肺癌（空洞、胸膜凹陷征） peripheral lung cancer,肺上沟癌 Pancoast cancer,MRI显示肿瘤已侵犯了主动脉（箭）,肺上沟癌伴骨转移 Pancoast cancer with osseous metastasis,双肺细支气管肺泡癌bilateral bronchioalveolar carcinoma,2.肺转移性肿瘤（Metastatic tumors of lung）临床特点clinical feature：原发瘤经血行、淋巴或直接方式至肺hematogenous metastasis,lymphatic metastasis or direct metastasis 主要症状有咳嗽cough 、咳血emptysis 、气短polypnea和胸痛chest pain等,（2）影像学表现imaging ： 血行转移 hematogenous metastasis ：A.多见于两肺中、下肺野外带bilateral besides middle and lower field 常多发multiple ，少单发B.呈大小不等I nequality of size ，密度均匀homogeneous desity，边界清楚的棉球状致密影sharply marginated globular high density lesionC.少数呈粟粒状或片状模糊影，也可出现空洞或钙化few is miliary or patchy fuzzy image ,may have cavity or calcification,淋巴转移 lymphatic metastasis ：A.单侧或双侧肺门、纵隔淋巴结肿大unilateral or bilateral lymphadenectasis in mediastinum and hilu