肺癌与肺结核与影学诊断PPT课件.ppt

肺癌与肺结核的影像学诊断,.,1,肺癌分类,Lungcancer,bronchogeniccarcinoma病理分型：鳞、小、腺、大临床分型：中央型、周围型、纵隔型,.,2,SquamouscellCa,30-40%，generallycentral(70%hilarorperihilarinsubsegmentalorlargerbronchi)strongassociationwithcigarettesmokingabout15%bronchogeniccarcinomasarecavitary,andofthese,nearly60%aresquamouscelllesions,walltypicallythickandnodular,.,3,intralumenalgrowthpattern-oftenresultingindistalatelectasisorpost-obstructivepneumonitis(anon-infectiousprocess).thelowestfrequencyofdistantmetastases,spreadstoinvolvelocalnodesbydirectextensionthemostfavorableprognosisHypertrophicosteoarthropathy,.,4,adenocarcinoma,ascommonassquamouscellcarcinoma(30-40%).generallyperipheral(75%)uncommonlycavitatecommonlymetastasizesearlytolymphnodes,thepleura,adrenalglands,CNS,andbone.,.,5,SmallcellCa,15-20%ofprimarylungmalignanciesthestrongestassociationwithcigarettesmokingthemostlikelytoproduceectopichormones-mostcommonlyresultinginCushingssyndrome(ACTH)orsyndromeofinappropriateantidiuretichormone(SIADH),.,6,generallycentral(85-90%withinalobarormainstembronchi)andhasatendencytoinvadelongitudinallyalongthebronchialwall,inasubmucosalandintramuralfashionInternalnecrosisiscommon,butcavitationisextremelyraretheworstprognosis,despitetypicallygoodresponsetoinitialchemotherapy,.,7,LargeCellCa,only5-10%stronglyassociatedwithcigarettesmokingtypicallyperipheralandgenerallylarge(over4to6cm),withrapidgrowth,earlymetastases,andapoorprognosis,.,8,Pancoasttumor,apicaldensity(superiorpulmonarysulcus)destructionoradjacentriborvertebraHornerssyndromepaininarmusuallybronchogenicCa(squamoustype)also:mets,malignantneurogenictumor,.,9,影像诊断,目的：明确诊断，TNM分期手段：X线平片、CT、MRI、PET等,.,10,T1:Atumorlessthanorequalto3cmingreatestdimension,surroundedbylungorvisceralpleura,withoutbronchoscopicevidenceofinvasionmoreproximalthanthelobarbronchus(i.e.,notinthemainbronchus).,TUMOR,.,11,.,12,T2:Atumorwithanyofthefollowingfeatures:i)Largerthan3cminlargestdimension,.,13,ii)Associatedwithatelectasisorpost-obstructivepneumonitisthatextendstothehilarregion,butdoesnotinvolvetheentirelung,.,14,iii)Invadesthevisceralpleura,.,15,T3:Atumorofanysizethatdirectlyinvadesanyofthefollowing:thechestwall(includingsuperiorsulcustumors),diaphragm,mediastinalpleura,parietalpericardium;ortumorinthemainbronchuslessthan2cmdistaltothecarina(butwithoutinvolvementofthecarina);ortumorassociatedwithatelectasisorobstructivepneumonitisoftheentirelung.,.,16,.,17,T4:Atumorofanysizethatinvadesanyofthefollowing:mediastinum,heart,greatvessels,trachea,esophagus,vertebralbody,carina;oranytumorwithamalignantpleuralorpericardialeffusion;orwithsatellitetumornoduleswithintheipsilateralprimary-tumorlobeofthelung.,.,18,.,19,.,20,RegionalLymphNodeStatus(N),N1:Ipsilateralperibronchialorhilarnodalmetastases;orintrapulmonarynodesinvolvedbydirectextensionoftheprimarytumor.AllN1nodesliedistaltothemediastinalpleuralreflection.,.,21,N2:Ipsilateralmediastinalandsubcarinallymphnodalmetastases.Midlinepre-vascularandretrotrachealnodesareconsideredipsilateral5,whilenodestothecontralateralsideofmidlineareconsideredN3,.,22,N3:Contralateralmediastinalorcontralateralhilarnodalmetastases;alsoincludesipsilateralorcontralateralscaleneorsupraclavicularnodes.OthercervicalnodesareclassifiedM1,.,23,DistantMetastasis(M)M0:NodistantmetastasisM1:Distantmetastasispresent;orseparatetumornodulesintheipsilateralnonprimary-tumorlobesofthelung.SeparatetumornodulesinthecontralaterallungareconsideredM1iftheyareofthesamehistologiccelltypeastheprimarylesion.Acontralaterallungtumorwithadifferentcelltypeisconsideredasynchronousprimarylesionandshouldbestagedindependently,.,24,.,25,原发肺结核,原发综合征,.,26,支气管淋巴结结核tuberculosisofbronchiallymphnodes,原发肺结核,.,27,肺浸润及增殖infiltrationandpr