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目的 研究周围型肺癌 (peripherallungcancer ,PLC)瘤—肺界面影像不对称分布的病理基础。方法 将病理证实的 2 5例周围型肺癌及 16例肺良性结节的病灶肺叶术后标本行Heitsman法固定 48～ 72h后HRCT扫描 ,再将标本制成含病灶肺全叶切片及病灶组织切片进行对照研究 ,观察瘤—肺界面HRCT表现的病理基础。结果 术后标本HRCT、大体病理切片的变化完全吻合。PLC近端边缘模糊 4例 (16% ) ,细毛刺 3例 (12 % ) ,远端分别为 18例 (72 % )、19例 (76% ) ,呈明显不对称分布 (Ρ <0 .0 1)。肺良性结节近端病灶边缘出现上述改变者各 3例 ,远端分别为 2例、3例 ,两者之间分布无差异 (Ρ >0 .0 5 )。远端瘤—肺界面显示不对称分布组织病理学主要表现为慢性阻塞性肺炎、肺间质纤维组织增生、淋巴管炎及癌细胞浸润。癌灶与支气管间的关系为支 (细 )气管腔完全阻塞 9例 ,管腔偏心性狭窄 >5 0 % 12例 ,管腔无明显变化但出现毛刺等变化 3例。良性病灶附近支 (细 )气管主要表现为受压、移位、绕行 ,管腔无明显狭窄或截断。病灶周边组织学变化主要为变性的纤维组织包膜及受病灶压迫萎陷的肺泡组织。结论 周围型肺癌界面影像改变不对称分布的病理基础是癌灶所致的支气管阻塞及导致癌结节远端与肺交界面的淋巴管回流障碍、?
Objective To study the pathological basis of asymmetric distribution of tumor-lung interface in peripheral lung cancer (PLC). Methods Twenty-five cases of peripheral lung cancer confirmed by pathology and 16 cases of benign pulmonary nodules were fixed with Heitsman for 48-72 hours and then HRCT scans were performed. A controlled study was performed to observe the pathological basis of HRCT findings at the tumor-lung interface. Results The postoperative specimens HRCT, gross pathological changes completely consistent. There were 4 cases (16%) in the proximal margin of fuzzy control (PLC), 3 cases (12%) of fine burr and 18 cases (72%) and 19 cases (76% 1). There were 3 cases of these changes in the margin of the benign pulmonary nodules, 2 cases in the distal end and 3 cases in the benign nodules. There was no difference between them (P> 0.05). Distal tumor - lung interface showed asymmetric distribution Histopathology is mainly manifested as chronic obstructive pulmonary disease, interstitial lung fibrosis, lymphangitis and cancer cell infiltration. The relationship between foci and bronchial bronchus branch (fine) tracheal cavity completely obstruction in 9 cases, lumen eccentric stenosis> 50% 12 cases, no significant change in the lumen but there are burr changes in 3 cases. Near the benign lesion branch (thin) trachea mainly for compression, displacement, bypass, no obvious narrow or truncated lumen. Histological changes around the lesion are mainly denatured fibrous tissue envelopes and collapsed collapsed alveolar tissue. Conclusions The pathological basis of the asymmetric distribution of the peripheral lung cancer interface changes is the bronchial obstruction caused by the foci and the lymphatic drainage disorder resulting in the junction of the distal end of the nodule and the lung.