Bronchial Carcinoma

Neoplastic disease Carcinoma of the bronchus

Carcinoma of the bronchus is one of the most common primary malignant tumours. It has a clear association with cigarette smoking.

The majority of bronchial carcinomas arise in larger bronchi at, or close to, the hilum.  It is convenient to consider the radiological features of central and peripheral tumours separately.

Signs of a central tumor:

The tumour itself. may present as hilar mass (fig.2.106) and / or narrowing of a major bronchus. The narrowing may be irregular or smooth.

左上叶中央型腺癌，左上叶支气管狭窄 （左图），肿块已包饶左肺动脉（右图， 箭） (1)

The effect of obstruction by the tumour (Fig.2.107) is usually a combination of collapse and consolidation.

The collapse because air is absorbed beyond the obstructed bronchus and cannot be replaced , whereas consolidation is the consequence of retained secretions and secondary infection .

Signs of a peripheral tumour

A peripheral tumour (Fig. 2.108) usually present as a solitary pulmonary mass.

The signs of a peripheral primary carcinoma are :

A rounded shadow with an irregular border. Lobulation, notching and infiltrating edges are the common patterns. (fig.2.33,p40)

Cavitation within the mass: The walls of the cavity are classically thick and irregular, but thin-walled smooth cavities due to carcinoma do occur.

细支气管肺泡癌 (Bronchiolar carcinoma)  孤立肿块 (single tumor) ：  肺炎型： as if inflammatory infiltration.  弥漫型 (type of suffusion):Both sides of the lung have many scobinations and patchings which are showed inequality of size

CT 表现 对小泡征、含气支气管征、毛剌及胸 膜凹陷征等显示更为清楚。因含有较多 粘液，癌性浸润及实变常密度较低，其 中可见血管影，有一定特征性

Spread of bronchial carcinoma

 Evidence of spread on bronchial

carcinoma may be visible on plain chest radiography,  but CT and, in highly selected cases, MRI have made a major contribution to the staging of lung cancer.

 Both(CT and MRI) may show enlarged

mediastinal lymph node suggesting involvement by tumour or direct invasion of the mediastinum that is either not visible or is questionable on the plain chest film information, So that may save the patient unnecessary thoracotomy.

Hilar and mediastinal lymph node enlargement due to lymphatic spread of tumor

Only greatly enlarged lymph node can be recognized on plain chest radiograph.

CT, on the other hand, has the ability to show even mildly enlarged nodes, nodes that are not identifiable on plain film.

右肺上叶中央型肺癌并纵隔、肺 门淋巴结转移

肺癌胸膜转移 (pleural metastasis)

In practice, the role of CT is to decide which patients need preoperative lymph node biopsy, and to tell the surgeon which nodes to biopsy.

Pleural effusion in a patient with lung cancer is usually due to malignant involvement of the pleura.

lnvasion of the mediastinum

 On plain films, the signs are widening of

the mediastinal shadow and elevation of a hemideaphragm suggesting involvement of the phrenic nerve by tumour (Fig.2.107).  Mediastinal widening can be a difficult sign to evaluate, particularly in elder people with aortic unfolding.

CT and MRI are much more sensitive and accurate methods of assessing mediastinal invasion by tumour .

右 上 肺 肿 块 侵 犯 纵 隔

MRI 显示肿瘤已侵犯了主动脉 （箭）

Invasion of the chest wall (Fig.2.113). Destruction of a rib immediately adjacent to a pulmonary shadow is virtually diagnostic of bronchial carcinoma with chest wall invasion.

 Recognizing the rib destruction can be difficult sometimes.  It is important therefore to make a conscious effort to look at the ribs directly.  Oblique views may be helpful in detecting bone destruction.

CT and MRI can demonstrate rib and soft tissue invasion when the bone is not visibly eroded on plain films.

Rib metastases: Carcinoma of the lung frequently metastasizes to the ribs where it produces bone destruction.

Pulmonary metastases: Primary lung carcinoma sometimes metastasizes to other parts of the lungs. The rounded shadows that result are similar to secondary deposits from other primary tumours .

Metastatic neoplasms

Pulmonary metastases Typically, metastases are well defined , although irregular borders are occasionally seen. Usually, they are multiple and vary in size.

CT scanning can demonstrate metastases as small as 3-6mm.

Pleural metastases These usually give rise to pleural effusion. The individual pleural metastases are rarely seen.

Metastases to ribs  these are common with those primary

tumours that metastasize to bone, namely bronchus, breast, kidney, thyroid and prostate. .

纵隔原发性肿瘤 (Primary tumor of mediastinum)  前纵隔常见肿瘤 (The common tumors of the anterior mediastinum)  胸内甲状腺肿 (struma endothoracica) ：气管旁 close to the air tube ，密度高 high-density ，可有钙化 (calcif)  胸腺瘤 (thymoma) ： Usually located the root of the great vessels.  畸胎瘤 (teratoid tumor) ：其中有钙化 (calcification) ，脂肪 (fattiness)  中纵隔常见肿瘤  后纵隔常见肿瘤

struma endothoracica

thymoma

thymoma

thymoma

teratoid tumor

•中纵隔常见肿瘤 (The common tumor of middle mediastinum) ：

–恶性淋巴瘤 (Hodgkin's disease) ： The common manifestations of Hodgkin's disease are mediastial and hilar adenopathy and pleural effusion and involve many groups of lymph.

–支气管囊肿 (bronchial cysts) ： The edge of bronchial cysts is clear and density is equal of water.

•后纵隔 (posterior mediastinum) –神经源性肿瘤 (neurogenic tumour) ： It is clear association with the back bone and ribs.

The

end

谢 谢 ！