肺癌与肺结核.ppt

肺癌与肺结核的影像学诊断
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 Ca
30-40%,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 extension
the most favorable prognosis
Hypertrophic osteoarthropathy
adenocarcinoma
mon as squamous cell carcinoma (30-40%).
generally peripheral (75%)
monly cavitate
commonly metastasizes early to lymph nodes, the pleura, adrenal glands, CNS, and bone.
Small cell Ca
15-20% of primary lung malignancies
the strongest association with cigarette smoking
the most likely to produce ectopic hormones- monly 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 mon, 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 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
目的:明确诊断,TNM分期
手段:X线平片、CT、MRI、PET等