肺癌与肺结核

null肺癌与肺结核 的影像学诊断肺癌与肺结核 的影像学诊断肺癌分类肺癌分类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 CaSquamous cell Ca30-40%，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 nullintralumenal 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 adenocarcinomaadenocarcinomaas 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 CaSmall cell Ca15-20% 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)nullgenerally 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 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 prognosisPancoast tumorPancoast tumorapical density (superior pulmonary sulcus) destruction or adjacent rib or vertebra Horner's syndrome pain in arm usually bronchogenic Ca (squamous type) also: mets, malignant neurogenic tumor 影像诊断影像诊断目的：明确诊断，TNM分期 手段：X线平片、CT、MRI、PET等nullT1: 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). TUMORnullnullT2: A tumor with any of the following features: i) Larger than 3 cm in largest dimensionnullii) Associated with atelectasis or post-obstructive pneumonitis that extends to the hilar region, but does not involve the entire lungnulliii) Invades the visceral pleuranullT3: 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 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. nullnullT4: A tumor of any size that invades any of the following: 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. nullnullnullRegional Lymph Node Status (N) 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. nullN2: Ipsilateral mediastinal and subcarinal lymph nodal metastases. Midline pre-vascular and retrotracheal nodes are considered ipsilateral [5], while nodes to the contralateral side of midline are considered N3 nullN3: Contralateral mediastinal or contralateral hilar nodal metastases; also includes ipsilateral or contralateral scalene or supraclavicular nodes. Other cervical nodes are classified M1 nullDistant 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 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 nullnull原发肺结核原发综合征null支气管淋巴结结核 tuberculosis of bronchial lymph nodes原发肺结核null肺浸润及增殖 infiltration and proliferation浸润肺结核null2、TB浸润、空洞及支气管播散 infiltrative pulmonary tuberculosis with cavity 浸润肺结核nullnullnull结核球 tuberculoma浸润肺结核null断层片 tomographynull急性粟粒性TB Miliary TB血行播散型肺结核null急性粟粒性肺结核