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肺癌与肺结核 的影像学诊断 肺癌分类 wLung cancer, bronchogenic carcinoma w病理分型:鳞、小、腺、大 w临床分型:中央型、周围型、纵隔 型 Squamous cell Ca w30-40%,generally central (70% hilar or perihilar in subsegmental or larger bronchi) wstrong association with cigarette smoking wabout 15% bronchogenic carcinomas are cavitary, and of these, nearly 60% are squamous cell lesions, wall typically thick and nodular wintralumenal growth pattern- often resulting in distal atelectasis or post-obstructive pneumonitis (a non-infectious process). wthe lowest frequency of distant metastases, spreads to involve local nodes by direct extension wthe most favorable prognosis wHypertrophic osteoarthropathy adenocarcinoma was common as squamous cell carcinoma (30-40%). wgenerally peripheral (75%) wuncommonly cavitate wcommonly metastasizes early to lymph nodes, the pleura, adrenal glands, CNS, and bone. Small cell Ca w15-20% of primary lung malignancies wthe strongest association with cigarette smoking wthe most likely to produce ectopic hormones- most commonly resulting in Cushings syndrome (ACTH) or syndrome of inappropriate antidiuretic hormone (SIADH) wgenerally 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 wInternal necrosis is common, but cavitation is extremely rare wthe worst prognosis, despite typically good response to initial chemotherapy Large Cell Ca wonly 5-10% wstrongly associated with cigarette smoking wtypically peripheral and generally large (over 4 to 6 cm), with rapid growth, early metastases, and a poor prognosis Pancoast tumor w apical density (superior pulmonary sulcus) w destruction or adjacent rib or vertebra w Horners syndrome w pain in arm w usually bronchogenic Ca (squamous type) w also: mets, malignant neurogenic tumor 影像诊断 w 目的:明确诊断,TNM分期 w 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. 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