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肺癌与肺结核的影像学诊断肺癌分类Lungcancer,bronchogeniccarcinoma病理分型:鳞、小、腺、大临床分型:中央型、周围型、纵隔型SquamouscellCa30-40%,generallycentral(70%hilarorperihilarinsubsegmentalorlargerbronchi)strongassociationwithcigarettesmokingabout15%bronchogeniccarcinomasarecavitary,andofthese,nearly60%aresquamouscelllesions,walltypicallythickandnodularintralumenalgrowthpattern-oftenresultingindistalatelectasisorpost-obstructivepneumonitis(anon-infectiousprocess).thelowestfrequencyofdistantmetastases,spreadstoinvolvelocalnodesbydirectextensionthemostfavorableprognosisHypertrophicosteoarthropathyadenocarcinomaascommonassquamouscellcarcinoma(30-40%).generallyperipheral(75%)uncommonlycavitatecommonlymetastasizesearlytolymphnodes,thepleura,adrenalglands,CNS,andbone.SmallcellCa15-20%ofprimarylungmalignanciesthestrongestassociationwithcigarettesmokingthemostlikelytoproduceectopichormones-mostcommonlyresultinginCushingssyndrome(ACTH)orsyndromeofinappropriateantidiuretichormone(SIADH)generallycentral(85-90%withinalobarormainstembronchi)andhasatendencytoinvadelongitudinallyalongthebronchialwall,inasubmucosalandintramuralfashionInternalnecrosisiscommon,butcavitationisextremelyraretheworstprognosis,despitetypicallygoodresponsetoinitialchemotherapyLargeCellCaonly5-10%stronglyassociatedwithcigarettesmokingtypicallyperipheralandgenerallylarge(over4to6cm),withrapidgrowth,earlymetastases,andapoorprognosisPancoasttumorapicaldensity(superiorpulmonarysulcus)destructionoradjacentriborvertebraHorner'ssyndromepaininarmusuallybronchogenicCa(squamoustype)also:mets,malignantneurogenictumor影像诊断目的:明确诊断,TNM分期手段:X线平片、CT、MRI、PET等T1:Atumorlessthanorequalto3cmingreatestdimension,surroundedbylungorvisceralpleura,withoutbronchoscopicevidenceofinvasionmoreproximalthanthelobarbronchus(i.e.,notinthemainbronchus).TUMORT2:Atumorwithanyofthefollowingfeatures:i)Largerthan3cminlargestdimensionii)Associatedwithatelectasisorpost-obstructivepneumonitisthatextendstothehilarregion,butdoesnotinvolvetheentirelungiii)InvadesthevisceralpleuraT3:Atumorofanysizethatdirectlyinvadesanyofthefollowing:thechestwall(includingsuperiorsulcustumors),diaphragm,mediastinalpleura,parietalpericardium;ortumorinthemainbronchuslessthan2cmdistaltothecarina(butwithoutinvolvementofthecarina);ortumorassociatedwithatelectasisorobstructivepneumonitisoftheentirelung.T4:Atumorofanysizethatinvadesanyofthefollowing:mediastinum,heart,greatvessels,trachea,esophagus,vertebralbody,carina;oranytumorwithamalignantpleuralorpericardialeffusion;orwithsatellitetumornoduleswithintheipsilateralprimary-tumorlobeofthelung.RegionalLymphNodeStatus(N)N1:Ipsilateralperibronchialorhilarnodalmetastases;orintrapulmonarynodesinvolvedbydirectextensionoftheprimarytumor.AllN1nodesliedistaltothemediastinalpleuralreflection.N2:Ipsilateralmediastinalandsubcarinallymphnodalmetastases.Midlinepre-vascularandretrotrachealnodesareconsideredipsilateral[5],whilenodestothecontralateralsideofmidlineareconsideredN3N3:Contralateralmediastinalorcontralateralhilarnodalmetastases;alsoincludesipsilateralorcontralateralscaleneorsupraclavicularnodes.OthercervicalnodesareclassifiedM1DistantMetastasis(M)M0:NodistantmetastasisM1:Distantmetastasispresent;orseparatetumornodulesintheipsilateralnonprimary-tumorlobesofthelung.SeparatetumornodulesinthecontralaterallungareconsideredM1iftheyareofthesamehistologiccelltypeastheprimarylesion.Acontralaterallungtumorwithadifferentcelltypeisconsideredasynchronousprimarylesionandshouldbestagedindependently原发肺结核原发综合征支气管淋巴结结核tuberculosisofbronchiallymphnodes原发肺结核肺浸润及增殖infiltrationandproliferation浸润肺结核2、TB浸润、空洞及支气管播散infiltrativepulmonarytuberculosiswithcavity浸润肺结核结核球tuberculoma浸润肺结核断层片tomography急性粟粒性TBMiliaryTB血行播散型肺结核急性粟粒性肺结核
本文标题:肺癌与肺结核的影像学诊断
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