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细支气管腺瘤的CT表现及病理分析初步探索

潘小环 何萍 陈淮

潘小环, 何萍, 陈淮. 细支气管腺瘤的CT表现及病理分析初步探索[J]. CT理论与应用研究, xxxx, x(x): 1-7. DOI: 10.15953/j.ctta.2022.247
引用本文: 潘小环, 何萍, 陈淮. 细支气管腺瘤的CT表现及病理分析初步探索[J]. CT理论与应用研究, xxxx, x(x): 1-7. DOI: 10.15953/j.ctta.2022.247
PAN X H, HE P, CHEN H. CT Findings and Preliminary Exploration of Pathological Analysis of Bronchiolar Adenoma[J]. CT Theory and Applications, xxxx, x(x): 1-7. DOI: 10.15953/j.ctta.2022.247. (in Chinese)
Citation: PAN X H, HE P, CHEN H. CT Findings and Preliminary Exploration of Pathological Analysis of Bronchiolar Adenoma[J]. CT Theory and Applications, xxxx, x(x): 1-7. DOI: 10.15953/j.ctta.2022.247. (in Chinese)

细支气管腺瘤的CT表现及病理分析初步探索

doi: 10.15953/j.ctta.2022.247
基金项目: 广东省自然科学基金-面上项目(2019A1515011390)。
详细信息
    作者简介:

    潘小环:女,广州医科大学附属第一医院放射科医师,E-mail:cirwen727@163.com

    通讯作者:

    女,广州医科大学附属第一医院病理科主任医师,E-mail:hp5567@163.com

CT Findings and Preliminary Exploration of Pathological Analysis of Bronchiolar Adenoma

  • 摘要: 目的:总结分析细支气管腺瘤的临床资料、CT征象、病理特征,探讨其对该病的诊断价值。方法:回顾性收集2020年1月至2020年12月术后经病理确诊为细支气管腺瘤的肺部结节18例,分析患者的临床资料、肺结节胸部CT征象及术后病理特征。结果:18例患者中16例无临床胸部症状,2例出现胸痛;年龄18~65岁,平均年龄51.8岁,中位年龄(25%~75%分位数)为52(49~59)岁,其中男性7例(39%),女性11例(61%)。胸部CT结节最大层面平均直径为11.1 mm,中位直径(25%~75%分位数)为8(6~15)mm,病灶距离胸膜位置≤10 mm者共15例。CT上表现为纯磨玻璃结节8例,部分实性结节7例,3例表现为单纯囊腔。表现为pGGN的细支气管腺瘤(8例)平均CT值为-690.7 HU,中位平均CT值(25%~75%分位数)为-717.5(-722~-681)HU。18例结节中边缘有毛刺征6例,结节周围出现胸膜牵拉征7例,结节内出现细支气管扩张5例。18例结节术后大体病理平均直径为9.1 mm,中位直径(25%~75% 分位数)为7(6~9)mm。免疫组化抗体CK7阳性18例、p40、p63、CK5/6、TTF-1阳性均为16例。结论:胸膜下10 mm左右结节术前CT诊断时不容忽视该病,免疫组化抗体CK7、p40等指标是诊断细支气管腺瘤的定性方法。

     

  • 图  1  细支气管腺瘤的CT图像

    (a)女,18岁,左肺下叶前内基底段胸膜下纯磨玻璃结节,直径约8 mm,边界清,密度均匀,形态规则。(b)女,51岁,右肺下叶背段纯磨玻璃结节,直径约8 mm,边界清,密度均匀,形态规则,内见小空泡。(c)女,58岁,左肺上叶前段胸膜下纯磨玻璃结节,直径约6 mm,边界清,密度均匀,形态规则。(d)男,57岁,右肺下叶外基底段胸膜下部分实性小结节,直径约9 mm,边界清,密度不均匀,形态不规则,少许毛刺征、胸膜牵拉征、内见小囊腔。(e)女,59岁,右肺下叶外基底段胸膜下单纯囊腔影,直径约20 mm,壁厚2 mm,边界清,形态规则,胸膜牵拉征。(f)男,53岁,左肺下叶外基底段胸膜下小囊腔影,直径约7 mm,壁厚2 mm,边界清,形态规则,可见胸膜牵拉征。

    Figure  1.  CT image of bronchiolar adenomas

    图  2  女,58岁患者的病理图

    (a)~(c)免疫组结果:TTF-1(+),CK7(+),p40/p63(基底细胞+),CK5/6(基底细胞+),Ki-67(热点区约3%+)。(a):HE染色,低倍放大。(b)和(c):分别为p40、CK5/6免疫组化显示基底细胞层。

    Figure  2.  Female, 58 years old Pathology of the patient

    表  1  细支气管腺瘤CT形态学特点

    Table  1.   CT morphological features of bronchiolar adenoma

    HRCT征象数值/例数P
        直径中位数/mm8
        结节位置      左上肺40.032
          左下肺6
          右上肺2
          右中肺0
          右下肺6
        距离胸膜位置      ≤10 mm15 <0.01
          >10 mm3
        结节性质      纯磨玻璃结节80.271
          部分实性结节7
          单纯囊腔结节3
        pGGN的平均CT值中位数/HU-717.5
        边缘      清晰13 0.018
          不清晰5
        密度      均匀70.318
          不均匀11
        形态      圆形/类圆形9 1
          不规则形9
        毛刺征60.094
        胸膜牵拉征70.318
        细支气管扩张50.018
    下载: 导出CSV

    表  2  细支气管腺瘤大体病理及免疫组化特点

    Table  2.   Gross pathological and immunohistochemical characteristics of bronchiolar adenoma

          大体病理及免疫组化数值(阳性)/例
                 大体病理中位数/mm 7
                 CK718
                 p4016
                 p6316
                 CK5/616
                 TTF-116
    下载: 导出CSV
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出版历程
  • 收稿日期:  2022-12-12
  • 修回日期:  2023-04-21
  • 录用日期:  2023-04-25
  • 网络出版日期:  2023-09-12

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