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1、肺癌与肺结核 的影像学诊断,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 Ca,30-40%，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%
2、 are squamous cell lesions, wall typically thick and nodular,intralumenal 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 favorabl
3、e prognosis Hypertrophic osteoarthropathy,adenocarcinoma,as 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 Ca,15-20% of primary lung malignancies the stronges
4、t 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),generally central (85-90% within a lobar or mainstem bronchi) and has a tendency to invade longitudinally al
5、ong 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,only 5-10% strongly associated with cigarette smoking typically peripheral and gener
6、ally large (over 4 to 6 cm), with rapid growth, early metastases, and a poor prognosis,Pancoast tumor,apical 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,影像诊断,目的
7、：明确诊断，TNM分期 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).,TUMOR,T2: A tumor with any of the following features
8、: i) Larger than 3 cm in largest dimension,ii) Associated with atelectasis or post-obstructive pneumonitis that extends to the hilar region, but does not involve the entire lung,iii) Invades the visceral pleura,T3: A tumor of any size that directly invades any of the following: the chest wall (inclu
9、ding 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.,T4: A tumor of any size th
10、at 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.,Regional Lymph Node Status (N),N1: Ips
11、ilateral 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.,N2: Ipsilateral mediastinal and subcarinal lymph nodal metastases. Midline pre-vascular and retrotracheal nodes
12、are considered ipsilateral 5, while nodes to the contralateral side of midline are considered N3,N3: Contralateral mediastinal or contralateral hilar nodal metastases; also includes ipsilateral or contralateral scalene or supraclavicular nodes. Other cervical nodes are classified M1,Distant Metastas
13、is (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 lun
14、g 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TB Miliary TB,血行播散型肺结核,急性粟粒性肺结核,
