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目的探讨WHO 2015年第4版肺大细胞癌(LCLC)的临床病理及其MDCT表现。方法回顾性分析19例经新标准确诊LCLC的临床病理资料及CT影像表现。结果 19例患者中位年龄68岁(47~81岁),18例为男性,1例为女性,长期重度吸烟史14例。病灶最长径中位数3 cm(1.7~9 cm)。1例为中央型,18例为周围型;14例位于肺上叶,5例位于肺下叶;病灶无或浅分叶征5例,深分叶4例,结节聚集10例。边缘光滑型14例,模糊型5例,其中伴毛刺4例,伴棘状突起3例,包含2例同时伴毛刺和棘状突起。CT平扫发现病灶内密度不均匀9例,密度均匀9例,散在点状钙化1例。10例行增强扫描,不均匀强化7例,其中伴环形强化1例;均匀强化3例。术后病理病灶发现坏死14例。肿瘤外改变包括:胸膜黏连伴增厚5例,肿瘤与胸膜呈宽基底或大面积黏合4例,胸膜凹陷征2例;病灶周围伴炎症11例;肺门纵隔淋巴结肿大2例。结论 LCLC的CT表现具有一定特征性,最终确诊必须依赖手术病理及免疫组织化学。
Objective To investigate the clinicopathologic and MDCT findings of WHO 2015 4th edition of pulmonary large cell carcinoma (LCLC). Methods The clinicopathological data and CT findings of 19 cases diagnosed by LCLC were retrospectively analyzed. Results The median age of the 19 patients was 68 years (47-81 years), 18 were male, 1 was female, and 14 were long-term heavy smoking. The longest median diameter of lesions 3 cm (1.7 ~ 9 cm). 1 case of central type, 18 cases of peripheral type; 14 cases were located in the upper lobe and 5 cases were located in the lower lobe of the lung. No lesions or superficial lobes were found in 5 cases, deep lobes in 4 cases and nodules were clustered in 10 cases. 14 cases with smooth margin, 5 cases with fuzzy type, including 4 cases with burr and 3 cases with spinous process, including 2 cases with burr and spine. In CT plain scan, there were 9 cases of uneven density in the lesion, 9 cases of even density and 1 case of spotted calcification. Ten cases underwent enhanced scanning, uneven enhancement in 7 cases, including ring enhancement in 1 case; uniform enhancement in 3 cases. Postoperative pathological lesions found in 14 cases of necrosis. The tumor changes include pleural adhesions with thickening in 5 cases, tumor and pleura was a wide base or large area adhesion in 4 cases, 2 cases of pleural indentation; lesions around with inflammation in 11 cases; hilar mediastinal lymph nodes in 2 cases. Conclusion The CT findings of LCLC have certain characteristics. The final diagnosis must rely on the pathology and immunohistochemistry.