1、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 smokingabout 15% bronchogenic carcinomas are cavitary, and of these, nearly 60% are
2、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 prog
3、nosis Hypertrophic osteoarthropathy,adenocarcinoma,as 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 Ca,15-20% of primary lung malignancies the strongest assoc
4、iation with cigarette smokingthe most likely to produce ectopic hormones- 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
5、bronchial wall, in a submucosal and intramural fashion Internal necrosis is common, but cavitation is extremely rarethe worst prognosis, despite typically good response to initial chemotherapy,Large Cell Ca,only 5-10%strongly associated with cigarette smokingtypically peripheral and generally large
6、(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 Horners 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
7、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 t
8、han 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
9、 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 an
10、y 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 peri
11、bronchial 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 considere
12、d 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
13、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
14、 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,
