肺癌与肺结核的影像学诊断hrv.pptx

《肺癌与肺结核的影像学诊断hrv.pptx》由会员分享，可在线阅读，更多相关《肺癌与肺结核的影像学诊断hrv.pptx（35页珍藏版）》请在淘文阁 - 分享文档赚钱的网站上搜索。

1、肺癌与肺结核的影像学诊断肺癌分类w Lung cancer,bronchogenic carcinomaw 病理分型：鳞、小、腺、大w 临床分型：中央型、周围型、纵隔型Squamous cell Caw 30-40%，generally central(70%hilar or perihilar in subsegmental or larger bronchi)w strong association with cigarette smokingw about 15%bronchogenic carcinomas are cavitary,and of these,nearly 60%are

2、 squamous cell lesions,wall typically thick and nodular wintralumenal growth pattern-often resulting in distal atelectasis or post-obstructive pneumonitis(a non-infectious process).wthe lowest frequency of distant metastases,spreads to involve local nodes by direct extensionwthe most favorable progn

3、osis wHypertrophic osteoarthropathyadenocarcinomaw as common as squamous cell carcinoma(30-40%).w generally peripheral(75%)w uncommonly cavitate w commonly metastasizes early to lymph nodes,the pleura,adrenal glands,CNS,and bone.Small cell Caw 15-20%of primary lung malignancies w the strongest assoc

4、iation with cigarette smokingw the most likely to produce ectopic hormones-most commonly resulting in Cushings syndrome(ACTH)or syndrome of inappropriate antidiuretic hormone(SIADH)w generally central(85-90%within a lobar or mainstem bronchi)and has a tendency to invade longitudinally along the bron

5、chial wall,in a submucosal and intramural fashion w Internal necrosis is common,but cavitation is extremely rarew the worst prognosis,despite typically good response to initial chemotherapy Large Cell Ca w only 5-10%w strongly associated with cigarette smokingw typically peripheral and generally lar

6、ge(over 4 to 6 cm),with rapid growth,early metastases,and a poor prognosisPancoast tumorw apical density(superior pulmonary sulcus)w destruction or adjacent rib or vertebra w Horners syndrome w pain in arm w usually bronchogenic Ca(squamous type)w also:mets,malignant neurogenic tumor 影像诊断w 目的：明确诊断，T

7、NM 分期w 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).TUMORT2:A tumor with any of the following features:i)Larger th

8、an 3 cm in largest dimensionii)Associated with atelectasis or post-obstructive pneumonitis that extends to the hilar region,but does not involve the entire lungiii)Invades the visceral pleuraT3:A tumor of any size that directly invades any of the following:the chest wall(including superior sulcus tu

9、mors),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 any of the following

10、: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:Ipsilateralperibronchialorhilarnodalmetastases;

11、orintrapulmonarynodesinvolvedbydirectextensionoftheprimarytumor.AllN1nodesliedistaltothemediastinalpleuralreflection.N2:Ipsilateralmediastinalandsubcarinallymphnodalmetastases.Midlinepre-vascularandretrotrachealnodesareconsideredipsilateral5,whilenodestothecontralateralsideofmidlineareconsideredN3N3

12、:Contralateralmediastinalorcontralateralhilarnodalmetastases;alsoincludesipsilateralorcontralateralscaleneorsupraclavicularnodes.OthercervicalnodesareclassifiedM1Distant Metastasis(M)M0:No distant metastasis M1:Distant metastasis present;or separate tumor nodules in the ipsilateral nonprimary-tumor

13、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 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