肺癌的不尋常放射學表徵

Unusual Radiographic Manifestations of Lung Cancers

許清寅(Chin-Yin Sheu) ； 藍功堯(Gong-Yau Lan) ； 周定遠(Ting-Ywan Chou) ； 黃倫奕(Lung-Yick Wong)

《中華放射線醫學雜誌》 13卷3期 (1988/09) Pp. 243-252

摘要

肺癌是一種常見的癌症，在一般常規胸部診斷上並不難，但有少數癌腫瘤卻因生長的位置特殊，形狀的怪異及並不相稱的發病史，造成初步診斷之困難，本文特收集胸腔X光討論會中五十二例經病理或細胞檢查證實為肺癌者，這些個案曾經使臨床胸腔科及放射科醫生在X光診斷上發生極大困擾，故將它列為肺癌在X光形象上不尋常的特殊病例，並依照這些個案在胸腔X光片上所顯示肺癌之位置，形狀，單一或多重病灶歸納為十種型式，如下：(1)縱膈腔型(mediastinal type)（8例）(2)肺葉間裂型(fissure-like pattern)（2例）(3)膿腫樣型(abscess-like pattern)（5例）(4)瀰漫性小結節型(diffuse nodular pattern)（7例）(5)肺大葉腫瘤(lobar tumor)（4例）(6)胸膜型(pleural pattern)（5例）(7)肺炎型(pneumonic type)（6例）(8)藏於心臟後方的腫瘤(retrocardiac tumor)（5例）(9)纖維結節型(Fibronodular pattern)（3例）(10)瘢痕癌(scar cancer)（7例）共52例。其中以膿腫型及肺炎型屬較高難度之診斷，蓋因這類病例並無強有力的X光證據，其混淆之病史乃導致診斷之失敗，故特提出檢討，俾使大家對這類較少數不尋常的肺癌提高診斷之警覺性。

關鍵字

肺癌 ； 不尋常表徵

並列摘要

Lung cancer is a kind of common cancer among being. It is not quite difficult to diagnose a lung cancer by routine conventional plain chest X-Ray. But, some kinds of unusual lung cancers, growing at special locations, with remarkable appearances and those unable to correlate with clinical presentations, can cause difficulties in initial diagnosis. This paper includes 52 cases of unusually manifested lung cancers, which has been presented at Chest Radiology Conferencee. All cases are already proved by pathology and tissue cytology.
Accurate radiographic diagnosis of these cases are not easy for physicians and radiologist. According to location, appearance and number of lesions, either single or multiple, the unusual manifested lung cancers are grouped into ten patterns : (1)Mediastinal type^8, (2) Fissure-like pattern^2, (3) Abscess-like pattern^5, (4) Diffuse nodular pattern^7, (5) Lobar tumor(superscript (4)), (6) Pleural pattern^5, (7) Pneumonic type^6, (8) Rethocardiac tumor^5, (9) Fibroinodular pattern^3, (10) Scar cancer^7, total(52).
Among them, abscess-like pattern and pneumonic type are very difficult to diagnose. As these are no strong radiographic evidence and sometimes presents with complicated clinical picture hency they can mislead us to the wrong impression.
The aim and object of this paper is to serve as a reminder for everyone to be alert on unuaual manifestation of lung cancers and arrive at a properly evaluated diagnosis.

並列關鍵字

lung cancers ； unusual manifestations