肺癌与肺结核与影学诊断课件.ppt

1、1编辑版ppt肺癌分类肺癌分类wLung cancer,bronchogenic carcinomaw病理分型：鳞、小、腺、大病理分型：鳞、小、腺、大w临床分型：中央型、周围型、纵隔临床分型：中央型、周围型、纵隔型型2编辑版pptSquamous cell Caw30-40%，generally central(70%hilar or perihilar in subsegmental or larger bronchi)wstrong association with cigarette smokingwabout 15%bronchogenic carcinomas are cavitar

2、y,and of these,nearly 60%are squamous cell lesions,wall typically thick and nodular 3编辑版pptwintralumenal 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

3、 extensionwthe most favorable prognosis wHypertrophic osteoarthropathy 4编辑版pptadenocarcinomawas common as squamous cell carcinoma(30-40%).wgenerally peripheral(75%)wuncommonly cavitate wcommonly metastasizes early to lymph nodes,the pleura,adrenal glands,CNS,and bone.5编辑版pptSmall cell Caw15-20%of pr

4、imary lung malignancies wthe strongest association with cigarette smokingwthe most likely to produce ectopic hormones-most commonly resulting in Cushings syndrome(ACTH)or syndrome of inappropriate antidiuretic hormone(SIADH)6编辑版pptwgenerally central(85-90%within a lobar or mainstem bronchi)and has a

5、 tendency to invade longitudinally along the bronchial wall,in a submucosal and intramural fashion wInternal necrosis is common,but cavitation is extremely rarewthe worst prognosis,despite typically good response to initial chemotherapy 7编辑版pptLarge Cell Ca wonly 5-10%wstrongly associated with cigar

6、ette smokingwtypically peripheral and generally large(over 4 to 6 cm),with rapid growth,early metastases,and a poor prognosis8编辑版pptPancoast 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 t

7、ype)w also:mets,malignant neurogenic tumor 9编辑版ppt影像诊断影像诊断w 目的：明确诊断，目的：明确诊断，TNM分期分期w 手段：手段：X线平片、线平片、CT、MRI、PET等等10编辑版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

8、.e.,not in the main bronchus).TUMOR11编辑版ppt12编辑版pptT2:A tumor with any of the following features:i)Larger than 3 cm in largest dimension13编辑版pptii)Associated with atelectasis or post-obstructive pneumonitis that extends to the hilar region,but does not involve the entire lung14编辑版pptiii)Invades the

9、visceral pleura15编辑版pptT3: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 tumo

10、r associated with atelectasis or obstructive pneumonitis of the entire lung.16编辑版ppt17编辑版pptT4: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

11、 tumor nodules within the ipsilateral primary-tumor lobe of the lung.18编辑版ppt19编辑版ppt 20编辑版pptRegional 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 pleur

12、al reflection.21编辑版pptN2: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 22编辑版pptN3:Contralateral mediastinal or contralateral hilar nodal metast

13、ases;also includes ipsilateral or contralateral scalene or supraclavicular nodes.Other cervical nodes are classified M1 23编辑版pptDistant 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 n

14、odules 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 24编辑版ppt25编辑版ppt原发肺结核原发肺结核原发综合原发综合征征26编辑版ppt支气管淋巴结

15、结核支气管淋巴结结核 tuberculosis of bronchial lymph nodes原发肺结核原发肺结核27编辑版ppt肺浸润及增殖肺浸润及增殖infiltration and proliferation浸润肺结核浸润肺结核28编辑版ppt2、TB浸润、空浸润、空洞及支气管播散洞及支气管播散infiltrative pulmonary tuberculosis with cavity 浸润肺结核浸润肺结核29编辑版ppt30编辑版ppt31编辑版ppt结核球结核球tuberculoma浸润肺结核浸润肺结核32编辑版ppt断层片断层片tomography33编辑版ppt急性粟粒性急性粟粒性TBMiliary TB血行播散型肺结核血行播散型肺结核34编辑版ppt急性粟粒性肺结核急性粟粒性肺结核35编辑版ppt