Tükürük bezi lenfoması BT bulguları

Özet

Tükürük bezi lenfoması en çok Sjögren hastalığı zeminindeki parotis MALT lenfoması biçiminde görülür; daha seyrek olarak diğer B hücreli lenfomalar bezi tutabilir. Kontrastlı boyun BT, bez içindeki fokal ya da yaygın infiltrasyonu ve servikal lenf nodu dağılımını göstererek hastalık yükünü haritalar, ancak histolojik alt tipi tek başına belirleyemez. MALT lenfoması solid-kistik, çok odaklı veya yaygın görünüm alabilir; dolayısıyla tek bir görünüş tanıyı dışlamaz. Kaçırılması, özellikle Sjögren zemininde sistemik hastalık yayılımının ve biyopsi gerektiren fokal lezyonun fark edilmemesine yol açabilir.

Faz ve pencere

Venöz tanısal: Parotis lenfoması BT’de iyi sınırlı, homojen solid kitle şeklinde görülebilir; bazı hastalarda bilateral çoklu lenfadenopati eşlik edebilir.
Kontrastsız: Kitle ve bez asimetrisi seçilebilir; yumuşak doku sınırları, nekrotik alan ve eşlik eden nodal hastalık kontrastlı incelemeye göre daha sınırlı değerlendirilir.

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

BT bulguları

Parotis içinde tek, çok odaklı veya bez dokusuna yayılan solid kitle paterni
MALT lenfomasında solid ve kistik bileşenlerin birlikte bulunabilmesi; kistik odaklar kronik lenfoepitelyal değişikliklerle örtüşebilir
Tek taraflı fokal lezyonun Sjögren zeminindeki iki taraflı heterojen bez görünümü üzerine eklenmesi
Submandibular bezde benzer fokal infiltrasyon veya bez büyümesi
İpsilateral ve karşı taraf servikal zincirde birden çok nodal istasyonun tutulumu
Nekroz bulunmaması lenfomayla uyumlu olabilir; nekrozun varlığı lenfomayı tek başına dışlamaz
Bez dışı yumuşak dokuya uzanım ve komşu yağ planlarının silinmesi, yaygın hastalık yükünü gösterir

Normalde

Karşılaştırmada fokal nodülün bez parankiminden ayrılıp ayrılmadığını, bezin diffüz genişlemesini ve üst derin servikal zincirdeki lenf nodlarını iki taraflı izle.

Normal BT ile kıyasla

Aynı bölgenin, kaynak veri setinde patoloji içermediği belirtilen bir BT incelemesini kesit kesit kaydırın; organ sınırlarını açarak anatomiyi hasta görüntüsüyle karşılaştırın. Küçük rastlantısal bulgular tümüyle dışlanmamıştır.

Kaynak: TotalSegmentator v2.01 veri seti (Wasserthal ve ark., Radiology: Artificial Intelligence 2023), CC BY 4.0, vaka s0622; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Warthin tümörü: parotid bezlerde sık görülen benign bir neoplazmadır; yaşlı erkeklerde, sigara öyküsü ve obezite ile ilişkili bulunmuş olup bilateral veya çok odaklı oluşumlar rapor edilmiştir.
Pleomorfik adenom: tükürük bezlerinde en sık görülen benign tümördür; genellikle tek ve iyi sınırlı bir kütle olarak prezentanse olur, senkron çok odaklı oluşumlar nadirdir.
Nekrotik metastatik lenf nodlarında sınırları belirsiz nekrozla birlikte heterojen kontrastlanma görülebilir; değerlendirmede nodal dağılım da dikkate alınır.
Sjögren ilişkili lenfoepitelyal sialadenit: bilateral heterojen bez ve küçük kistik odaklar yapabilir; yeni belirgin fokal solid kitle lenfoma için örnekleme gereğini gündeme getirir.
IgG4 ilişkili sialadenit: baş ve boyun bölgesinde sık tutulum gösteren multi-sistemik fibro-enflamatuar bir hastalıktır; çoklu bez tutulumu ile malign lenfoma veya tümörlerle radyolojik olarak örtüşebilir.

Tuzaklar

MALT lenfomasını yalnızca homojen solid kitle diye aramak, solid-kistik veya yaygın glandüler paternleri gözden kaçırır; bezin tamamını ve her iki tarafı incele.
Nekroz yokluğunu lenfoma lehine kesin kanıt sayma; görüntü bulguları primer tükürük bezi tümörü ve inflamatuvar hastalıklarla örtüşür, kesin tanı doku örneklemesine dayanır.
Sjögren bezindeki yaygın heterojenite içinde yeni gelişen sınırlı solid odağı arka plan değişikliği olarak geçiştirme; önceki görüntülerle fokal değişimi karşılaştır.
Parotis içindeki tek bir kitlenin görüntüleme özellikleri lenfoma alt tipini güvenilir biçimde belirlemez; Sjögren ilişkili MALT lenfomasının tanısı histomorfolojik inceleme ve klonal analizle konur.

Kendini dene

Primer Sjögren sendromunda en sık hangi lenfoma tipi görülür?
Cevabı göster
MALT lenfoma. Primer Sjögren sendromunda gelişen lenfomalar çoğunlukla MALT tipindedir; bu lenfomalar en sık parotis bezlerinde ortaya çıkar.
Sjögren öyküsü olan hastada BT’de bilateral heterojen parotislerde çok sayıda küçük kistik odak ve belirgin solid kitle yok. Hangi süreç daha olasıdır?
Cevabı göster
Lenfoepitelyal sialadenit. Sjögren ilişkili lenfoepitelyal sialadenit bezlerde bilateral heterojenlik ve küçük kistik odaklar oluşturabilir. Metastatik nod ile pleomorfik adenom genellikle odaksal kitledir; lipom makroskopik yağ atenüasyonundadır.

İlgili konular

Kaynaklar

Bu sayfadaki 34 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 7 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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