null肺癌与肺结核
的影像学诊断肺癌与肺结核
的影像学诊断肺癌分类肺癌分类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 CaSquamous 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 nullintralumenal 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 extension
the most favorable prognosis
Hypertrophic osteoarthropathy
adenocarcinomaadenocarcinomaas common as squamous cell carcinoma (30-40%).
generally peripheral (75%)
uncommonly cavitate
commonly metastasizes early to lymph nodes, the pleura, adrenal glands, CNS, and bone. Small cell CaSmall cell Ca15-20% of primary lung malignancies
the strongest association with cigarette smoking
the most likely to produce ectopic hormones- most commonly resulting in Cushings syndrome (ACTH) or syndrome of inappropriate antidiuretic hormone (SIADH)nullgenerally 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
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 prognosisPancoast tumorPancoast tumorapical density (superior pulmonary sulcus)
destruction or adjacent rib or vertebra
Horner's syndrome
pain in arm
usually bronchogenic Ca (squamous type)
also: mets, malignant neurogenic tumor 影像诊断影像诊断目的:明确诊断,TNM分期
手段:X线平片、CT、MRI、PET等nullT1: 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).
TUMORnullnullT2: A tumor with any of the following features:
i) Larger than 3 cm in largest dimensionnullii) Associated with atelectasis or post-obstructive pneumonitis that extends to the hilar region, but does not involve the entire lungnulliii) Invades the visceral pleuranullT3: 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.
nullnullT4: 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.
nullnullnullRegional 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.
nullN2: 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 nullN3: Contralateral mediastinal or contralateral hilar nodal metastases; also includes ipsilateral or contralateral scalene or supraclavicular nodes. Other cervical nodes are classified M1 nullDistant 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
nullnull原发肺结核原发综合征null支气管淋巴结结核
tuberculosis of bronchial lymph nodes原发肺结核null肺浸润及增殖
infiltration and proliferation浸润肺结核null2、TB浸润、空洞及支气管播散
infiltrative pulmonary tuberculosis with cavity 浸润肺结核nullnullnull结核球
tuberculoma浸润肺结核null断层片
tomographynull急性粟粒性TB
Miliary TB血行播散型肺结核null急性粟粒性肺结核