肺癌与肺结核影像诊断.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 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 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) 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 is common, 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 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 手段：X线平片、CT、MRI、PET等 * * 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 T1: A tumor less than or equal to 3 cm in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion m