肺癌与肺结核肺癌与肺结核的影像学诊断的影像学诊断

肺癌分类

Lung cancer, bronchogenic carcinoma

病理分型：鳞、小、腺、大临床分型：中央型、周围型、纵隔型

Squamous cell Ca30-40%， generally central (70%

hilar or perihilar in subsegmental or larger bronchi)

strong association with cigarette smoking

about 15% bronchogenic carcinomas are cavitary, and of these, nearly 60% are squamous cell lesions, wall typically thick and nodular

intralumenal growth pattern- often resulting in distal atelectasis or post-obstructive pneumonitis (a non-infectious process). the lowest frequency of distant metastases, spreads to involve local nodes by direct extensionthe most favorable prognosis Hypertrophic osteoarthropathy

adenocarcinoma

as common as squamous cell carcinoma (30-40%).

generally peripheral (75%)uncommonly cavitate commonly metastasizes early to lym

ph nodes, the pleura, adrenal glands, CNS, and bone.

Small cell Ca15-20% of primary lung malignanci

es the strongest association with cigare

tte smoking the most likely to produce ectopic h

ormones- most commonly resulting in Cushings syndrome (ACTH) or syndrome of inappropriate antidiuretic hormone (SIADH)

generally central (85-90% within a lobar or mainstem bronchi) and has a tendency to invade longitudinally along the bronchial wall, in a submucosal and intramural fashion

Internal necrosis is common, but cavitation is extremely rare

the worst prognosis, despite typically good response to initial chemotherapy

Large Cell Ca

only 5-10% strongly associated with cigarette

smoking typically peripheral and generally

large (over 4 to 6 cm), with rapid growth, early metastases, and a poor prognosis

Pancoast tumor apical density (superior pulmonary sul

cus) destruction or adjacent rib or vertebr

a Horner's syndrome pain in arm usually bronchogenic Ca (squamous t

ype) also: mets, malignant neurogenic tum

or

影像诊断

目的：明确诊断， TNM分期手段： X线平片、 CT、MRI、 PET等

T1: A tumor less than or equal to 3 cm in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus (i.e., not in the main bronchus).

TUMOR

T2: A tumor with any of the following features:i) Larger than 3 cm in largest dimension

ii) Associated with atelectasis or post-obstructive pneumonitis that extends to the hilar region, but does not involve the entire lung

iii) Invades the visceral pleura

T3: A tumor of any size that directly invades any of the following: the chest wall (including superior sulcus tumors), diaphragm, mediastinal pleura, parietal pericardium; or tumor in the main bronchus less than 2 cm distal to the carina (but without involvement of the carina); or tumor associated with atelectasis or obstructive pneumonitis of the entire lung.

T4: A tumor of any size that invades any of the following: mediastinum, heart, great vessels, trachea, esophagus, vertebral body, carina; or any tumor with a malignant pleural or pericardial effusion; or with satellite tumor nodules within the ipsilateral primary-tumor lobe of the lung.

                                     

                                                  

          

Regional Lymph Node Status (N)

N1: Ipsilateral peribronchial or hilar nodal metastases; or intrapulmonary nodes involved by direct extension of the primary tumor. All N1 nodes lie distal to the mediastinal pleural reflection.

N2: Ipsilateral mediastinal and subcarinal lymph nodal metastases. Midline pre-vascular and retrotracheal nodes are considered ipsilateral [5], while nodes to the contralateral side of midline are considered N3

N3: Contralateral mediastinal or contralateral hilar nodal metastases; also includes ipsilateral or contralateral scalene or supraclavicular nodes. Other cervical nodes are classified M1

Distant Metastasis (M)M0: No distant metastasis M1: Distant metastasis present; or separate tumor nodules in the ipsilateral nonprimary-tumor lobes of the lung. Separate tumor nodules in the contralateral lung are considered M1 if they are of the same histologic cell type as the primary lesion. A contralateral lung tumor with a different cell type is considered a synchronous primary lesion and should be staged independently

原发肺结核

原发综合 征

支气管淋巴结结核 tuberculosis of bronchial lymph nodes

原发肺结核

肺浸润及增殖infiltration and proliferation

浸润肺结核

2、 TB浸润、空洞及支气管播散infiltrative pulmonary tuberculosis with cavity

浸润肺结核

结核球tuberculoma浸润肺结核

断层片tomography

急性粟粒性 TBMiliary TB

血行播散型肺结核

急性粟粒性肺结核