Background: Lung cancer presenting as cystic lesions was first described by Anderson and Pierce in 1954. Lung cancer presenting as cysts is a rare entity in clinical practice. Differential diagnosis is difficult in the benign-like cyst. This study investigated the clinical characteristics, diagnosis and treatment of lung cancer presenting as cysts.
Methods: We conducted a retrospective analysis of the clinical records of 24 patients who underwent surgery for a primary lung cancer presenting as cysts in our department between 2007 and 2013. We defined a 'Thin-walled cyst' as a cavitary lesion with a wall thickness of 4 mm or less along at least 75% of the circumference of the lesion. The whole group underwent post-operative follow-up.
Results: The incidence of cystic lung cancer was 0.49% (24/4,897) of surgical cases. The subjects' age ranged from 19 to 77 yr with a median age of 56.5 yr. Ten cases presented with respiratory symptoms while 14 showed abnormal shadows on a chest CT without symptoms. Histological analysis showed that 18 cases were of adenocarcinoma, three of squamous cell carcinoma, one of small cell carcinoma, one of adenosquamous carcinoma and one of large cell carcinoma. Three patients were dead, and the remaining 21 patients are alive and disease free at the end of follow-up.
Conclusions: Cystic lung cancer should be kept in mind during the differential diagnosis of focal benign cyst. Cystic lung cancer could achieve a good outcome if early diagnose can be obtained.
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。