Large cell neuroendocrine carcinoma of the lung with a cystic appearance on computed tomography

[Thin-walled cystic lung cancer: an analysis of 24 cases and review of literatures]

背景与目的

英国学者Anderson和Pierce于1954年首先报道了表现为囊性病变的肺癌。作为少见的肺癌特殊表现类型，薄壁囊性肺癌在临床中经常被误诊。本研究旨在探讨薄壁空洞性肺癌的临床特点、影像学特点，诊断及治疗。

方法

自2007年3月-2013年12月，解放军总医院胸外科共收治4, 897例原发性肺癌患者，其中24例影像学表现为薄壁空洞型肺癌。我们将影像学上表现为囊性且75%以上囊壁厚度小于4 mm的肺癌定义为薄壁空洞性肺癌。回顾性总结24例病例的临床资料、病理结果及随访情况。

结果

薄壁空洞型肺癌在我科同期接受手术的肺癌中比例为0.49%（24/4, 897）。其中男性19例，女性5例，平均年龄56.5岁。14例无临床症状，于查体时发现。10例有呼吸道症状。24例患者中18例为腺癌（包括原位腺癌及微浸润腺癌），3例鳞癌，1例大细胞癌，1例小细胞癌，1例腺鳞癌。平均随访时间28个月，3例因肺癌死亡，其余21例未见复发。

结论

薄壁空洞型肺癌是肺癌少见的影像学表现类型，临床中应避免误诊。其具体形成机制并不明确，可能是肺癌形成的某一阶段。薄壁空洞型肺癌如能早期诊断，可获得较好预后。

Lung cancer presenting as thin-walled cysts: An analysis of 15 cases and review of literature

AIM

Lung cancer presenting as cysts is a rare entity in clinical practice. Differential diagnosis is difficult in the benign-like cyst.

METHODS

We conducted a retrospective analysis of the clinical records of 15 patients who underwent surgery for primary lung cancer presenting as cysts (wall thickness <5 mm) in our department between 2007 and 2012. The whole group underwent postoperative follow-up.

RESULTS

The subjects' age ranged from 18 to 80 years with a median age of 58.3 years. Eight cases presented with respiratory symptoms while seven showed abnormal shadows on a chest computed tomography without symptoms. Histological analysis showed that 10 cases were of adenocarcinoma, two of squamous cell carcinoma and one of large cell carcinoma. Two patients died at 13 and 26 months and the remaining 13 patients are alive and disease free at 3-38 months.

CONCLUSION

Cystic lung cancer should be considered in the differential diagnosis of focal benign cyst. Cystic lung cancer could achieve a good outcome if early diagnosis can be obtained.