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-  2017 

表现为肺部磨玻璃结节的浸润前病变和浸润性腺癌的 CT 及病理对比研究

DOI: doi:10.7507/1671-6205.201703010

Keywords: 肺部磨玻璃结节, CT 征象, 病理, 浸润前病变, 浸润性腺癌, 血管集束征

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Abstract:

目的 对肺部局灶性磨玻璃密度影(ground-glass opacity,GGO)患者 CT 影像和病理特征进行分析,以提高对 GGO 的认识。 方法 回顾性分析 30 例 GGO 患者,根据病理表现分为浸润前病变、微浸润性腺癌和浸润性腺癌,分析总结患者 GGO 的影像学表现。对 GGO 病灶的病理切片行 Masson 染色、Ⅳ型胶原染色和维多利亚蓝染色,对比分析各组患者病理表现的差异以及病理与影像学特征的关系。 结果 30 例 GGO 患者中,浸润前病变 13 例,微浸润性腺癌 3 例,浸润性腺癌 14 例。磨玻璃结节中浸润前病变、微浸润性腺癌和浸润性腺癌的结节直径依次增大,实性成分依次增多,分叶、毛刺、支气管充气征等依次更多见;在血管集束征的肺结节与供血血管关系方面,浸润性腺癌多为Ⅲ型,浸润前病变多为Ⅱ型。Ⅳ型胶原染色和维多利亚蓝染色提示浸润性腺癌肿瘤组织中网状纤维和胶原纤维呈不同程度的缺失,而 Masson 染色可见浸润性腺癌胶原纤维增生且肺浸润癌中央可见纤维瘢痕。进一步分析病理与影像特征,结果提示肿瘤组织中有明显纤维瘢痕的患者的肺结节与供血血管的关系多为Ⅲ型。 结论 对于持续存在的 GGO,病灶直径越大、实性成分越多,其恶性疾病可能性越大。在肿瘤逐步进展过程中,肿瘤细胞破坏肺泡壁周围网状纤维和胶原纤维,进一步浸润刺激成纤维细胞增生分泌胶原纤维,形成肿瘤组织中的纤维瘢痕,这可能为血管集束征形成的病理基础

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