肺癌與肺結核與影學診斷課件

1、肺癌與肺結核的影像學診斷1編輯版ppt肺癌與肺結核的影像學診斷1編輯版ppt肺癌分類Lung cancer, bronchogenic carcinoma病理分型：鱗、小、腺、大臨床分型：中央型、周圍型、縱隔型2編輯版ppt肺癌分類Lung cancer, bronchogenic Squamous cell Ca30-40%，generally central (70% hilar or perihilar in subsegmental or larger bronchi)strong association with cigarette smokingabout 15% bronchog

2、enic carcinomas are cavitary, and of these, nearly 60% are squamous cell lesions, wall typically thick and nodular 3編輯版pptSquamous cell Ca30-40%，generalintralumenal growth pattern- often resulting in distal atelectasis or post-obstructive pneumonitis (a non-infectious process). the lowest frequency

3、of distant metastases, spreads to involve local nodes by direct extensionthe most favorable prognosis Hypertrophic osteoarthropathy 4編輯版pptintralumenal growth pattern- oadenocarcinomaas common as squamous cell carcinoma (30-40%). generally peripheral (75%)uncommonly cavitate commonly metastasizes ea

4、rly to lymph nodes, the pleura, adrenal glands, CNS, and bone. 5編輯版pptadenocarcinomaas common as squSmall cell Ca15-20% of primary lung malignancies the strongest association with cigarette smokingthe most likely to produce ectopic hormones- most commonly resulting in Cushings syndrome (ACTH) or syn

5、drome of inappropriate antidiuretic hormone (SIADH)6編輯版pptSmall cell Ca15-20% of primarygenerally 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 cavitati

6、on is extremely rarethe worst prognosis, despite typically good response to initial chemotherapy 7編輯版pptgenerally central (85-90% withLarge Cell Ca only 5-10%strongly associated with cigarette smokingtypically peripheral and generally large (over 4 to 6 cm), with rapid growth, early metastases, and

7、a poor prognosis8編輯版pptLarge Cell Ca only 5-10%8編輯版pPancoast tumorapical 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 9編輯版pptPancoast tumorapical density (影像診斷目的

8、：明確診斷，TNM分期手段：X線平片、CT、MRI、PET等10編輯版ppt影像診斷目的：明確診斷，TNM分期10編輯版pptT1: 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).TUMOR11編輯版pptT1: A tum

9、or less than or equal12編輯版ppt12編輯版pptT2: A tumor with any of the following features:i) Larger than 3 cm in largest dimension13編輯版pptT2: A tumor with any of the foii) Associated with atelectasis or post-obstructive pneumonitis that extends to the hilar region, but does not involve the entire lung14編輯

10、版pptii) Associated with atelectasiiii) Invades the visceral pleura15編輯版pptiii) Invades the visceral pleuT3: A tumor of any size that directly invades any of the following: the chest wall (including superior sulcus tumors), diaphragm, mediastinal pleura, parietal pericardium; or tumor in the main bro

11、nchus 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.16編輯版pptT3: A tumor of any size that d17編輯版ppt17編輯版pptT4: A tumor of any size that invades any of the following: mediastinum, heart, g

12、reat 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.18編輯版pptT4: A tumor of any size that i19編輯版ppt19編輯版ppt 20編輯版ppt Regional Lymph Node Status (N

13、) N1: Ipsilateral peribronchial 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. 21編輯版pptRegional Lymph Node Status (N)N2: Ipsilateral mediastinal and subcarinal lymph nodal metastases

14、. Midline pre-vascular and retrotracheal nodes are considered ipsilateral 5, while nodes to the contralateral side of midline are considered N3 22編輯版pptN2: Ipsilateral mediastinal anN3: Contralateral mediastinal or contralateral hilar nodal metastases; also includes ipsilateral or contralateral scal

15、ene or supraclavicular nodes. Other cervical nodes are classified M1 23編輯版pptN3: Contralateral mediastinal Distant Metastasis (M)M0: No distant metastasis M1: Distant metastasis present; or separate tumor nodules in the ipsilateral nonprimary-tumor lobes of the lung. Separate tumor nodules in the co

16、ntralateral 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 24編輯版pptDistant Metastasis (M)24編輯版ppt25編輯版ppt25編輯版ppt原發(fā)肺結核原發(fā)綜合征26編輯版ppt原發(fā)肺結核原發(fā)綜合征26編輯版ppt支氣管淋巴結結核 tuberculosis of bronchial lymph nodes原發(fā)肺結核27編輯版ppt支氣管淋巴結結核原發(fā)肺結核27編輯版ppt肺浸潤及增殖infiltration and proliferation浸潤肺結核28編輯版ppt肺浸潤及增殖浸潤肺結核28編輯版ppt2、TB浸潤、空洞及支氣管播散infiltrative pulmonar