Primer tiroid lenfoması

Özet

Primer tiroid lenfoması sıklıkla Hashimoto tiroiditi zemininde gelişen, hızlı büyüyen boyun kitlesi ve bası bulgularıyla başvurabilen nadir bir ekstranodal lenfomadır. Kontrastlı BT, tiroid lenfomasının bez içindeki yayılımını, trakeaya kitle etkisini, servikal lenfadenopatiyi ve varsa üst mediastene uzanımını değerlendirmeye yardımcı olur. BT görünümü tek başına lenfomayı kesinleştirmez; doku örneklemesi gerekir. Homojen görünen büyük bir kitleyi benign guatr sanmak veya trakea darlığını raporlamamak klinik açıdan önemli obstrüksiyonu geciktirebilir.

Faz ve pencere

Venöz tanısal

Yumuşak doku kontrastlı boyun BT'de diffüz büyümüş bez veya fokal kitle çoğunlukla görece homojen, kasla benzer ya da düşük atenüasyonlu yumuşak doku şeklinde görünür; trakea lümeni, tiroid kapsülü dışı yayılım ve servikal nodlar değerlendirilir.

Kontrastsız

Tiroid içinde kasla karşılaştırılabilir düşük atenüasyonlu doku ve bezde diffüz genişleme seçilebilir; kontrastsız BT, iyotlu kontrast sonrası yayılım ve damar ilişkisini göstermez.

Önerilen pencereler: Yumuşak doku (G 400 / M 40).

BT bulguları

• Diffüz bez büyümesi — her iki lobu veya tüm tiroidi dolduran yumuşak doku, bez konturunu genişletir.
• Fokal lenfomatöz kitle — tek kitle veya çok odaklı nodüler yapı şeklinde bez içinde yer alabilir.
• Görece homojen düşük atenüasyon — kitle komşu kasla benzer ya da daha düşük dansiteli olup belirgin nekroz olmadan büyüyebilir.
• Trakeal bası — genişleyen bez hava kolonunu daraltır veya orta hattan yana iter; lümenin en dar noktası izlenir.
• Tiroid dışı yayılım — kitle çevre yağ planını silebilir ve boyun visseral kompartımanına taşabilir.
• Servikal lenfadenopati — santral veya lateral zincirde eşlik eden lenf nodları hastalık kapsamını artırır.
• Hashimoto zemini — bez parankimi heterojen/atrofik ya da nodüler olabilir; BT tek başına önceki otoimmün tiroiditi kanıtlamaz.

Normalde

Normal tiroid BT'de sağ ve sol lob ile isthmus trakeanın önünde ince, simetrik ve düzgün konturludur; trakea lümeni yuvarlak ya da hafif oval kalır. Normal bezle kıyaslarken lobların çevre kaslara oranla büyüklüğünü, bez içindeki homojen yumuşak doku hacmini ve trakea lümeninin daralma ya da yana itilmesini değerlendirin.

Ayırıcı tanı

Anaplastik tiroid karsinomu

genellikle büyük çapta, sınırları belirsiz ve heterojen görünür; trakea, özofagus veya damarlar gibi çevre yapılara invazyon yapma eğilimindedir.

Hashimoto tiroiditi

diffüz büyüme ve heterojen parankim olabilir; ayrı büyük kitle ve belirgin bası gelişmesi lenfoma için uyarıcıdır.

Diferansiye tiroid karsinomu

fokal ve düzensiz nodül, kistik ya da kalsifiye nodal metastazlar gösterebilir.

Metastatik lenfadenopati

tiroid dışı bilinen primer tümör ve bez dışında başlayan nodal kitlenin tiroidi basması tanıyı destekler.

Tuzaklar

• Homojen düşük atenüasyon lenfomaya özgü değildir; tiroidit ve diğer tümörler benzer görünür, kesin tanı için görüntüleme biyopsinin yerini tutmaz.
• Genişlemiş bezde yalnızca kitleyi ölçüp bırakmayın; trakeanın en dar segmentini, lümen şeklini ve torasik girişe uzanımı ayrıca tarif edin.
• Hashimoto tiroiditini lenfomanın eş anlamlısı saymayın; kronik tiroidit bir zemin olabilir, yeni hızlı büyüme ayrıca araştırılmalıdır.

Kendini dene

1. Hashimoto öyküsü olan hastada bez hızla büyümüş; BT'de homojen yumuşak doku trakeayı daraltıyor. En uygun olasılık nedir?

   • Primer tiroid lenfoması
   • Subakut tiroidit
   • Ektopik tiroid
   • Medüller tiroid karsinomu
   Cevabı göster

   Primer tiroid lenfoması. Hashimoto zemininde hızlı büyüyen ve görece homojen tiroid kitlesi primer lenfomayı düşündürür; trakeal bası kitle etkisini gösterir. BT görünümü tek başına kesin tanı koydurmaz ve diğer seçeneklerin tipik dağılımı bu görünümü daha az açıklar.

2. Diffüz tiroid büyümesi olan BT'de hangi ek özellik anaplastik karsinomu lenfomadan daha çok düşündürür?

   • Belirgin nekroz ve invazyon
   • Homojen bez atenüasyonu
   • Hashimoto öyküsü
   • Yaygın bez genişlemesi
   Cevabı göster

   Belirgin nekroz ve invazyon. Düzensiz nekroz ve çevre organlarda destrüktif invazyon anaplastik karsinom lehinedir. Homojen görünüm, Hashimoto zemini ve diffüz büyüme lenfomada da görülebilir.

Kaynaklar

Bu sayfadaki 34 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 2 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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