Orbital metastaz

Özet

Orbital metastaz, bilinen bir kanserin orbital yumuşak dokuya, ekstraoküler kaslara veya kemiklere yayılımıdır; bazen primer tümör tanısından önce ortaya çıkar. BT, özellikle litik/sklerotik kemik tutulumunu, kortikal yıkımı ve kitleye bağlı glob yer değiştirmesini hızla gösterir; yumuşak doku yayılımını haritalamak için MR daha ayrıntılıdır. Lezyon iyi sınırlı olabilir, ancak yaygın infiltrasyon, kas büyümesi veya kemik destrüksiyonu metastaz olasılığını artırır. Tek orbital kitleyi primer tümör sanmak ya da bilinen kanser öyküsü yok diye metastazı dışlamak sistemik hastalığın ilk bulgusunu kaçırabilir.

Faz ve pencere

Kontrastsız tanısal

Orbital ve kafa tabanı kemiklerinde litik, sklerotik veya permeatif değişiklik; ekstraoküler kas kalınlaşması, orbital yağda kitle ve glob yer değiştirmesi incelenir. Kontrastsız BT kalsifikasyon ve kemik paternini gösterir; yumuşak doku kitle sınırları için MR veya klinik bağlamda kontrastlı inceleme gerekebilir.

Kemik algoritması

Orbita duvarları ve komşu sfenoid kemikte kortikal kesinti, litik alan, skleroz ve kemik iliği yapısındaki asimetri değerlendirilir; sklerotik metastaz BT'de belirgin olabilir.

Önerilen pencereler: Yumuşak doku (G 400 / M 40), Kemik (G 1800 / M 400).

BT bulguları

• Orbital yağ içinde fokal kitle veya anatomik sınırları silen infiltratif yumuşak doku görülebilir.
• Ekstraoküler kasta fokal lezyon veya yaygın kalınlaşma metastatik kas infiltrasyonunu düşündürür; tümör paterni fokal veya yaygın infiltratif olabilir.
• Kemik metastazı litik, sklerotik veya karışık olabilir; litik lezyonlarda kortikal destrüksiyon ve permeatif sınırlar aranır.
• Meme kaynaklı desmoplastik metastaz orbital yağda çekinti ve enoftalmi yapabilir; diğer kitleler proptozisle globu öne itebilir.
• Orbital kitle globu kitlenin karşı yönüne iter; yaygın tutulumda kompartıman anatomisi bozulabilir.
• Birden çok orbital kompartımanın infiltrasyonu veya bilateral odaklar sekonder yayılım olasılığını artırır.
• Primer malignite öyküsü bilinen hastada yeni orbital kitle, özellikle kemik ya da kas tutulumu eşlik ediyorsa metastaz açısından dikkatle incelenir.

Normalde

Normal orbitada ekstraoküler kaslar simetrik kalınlıkta ve düzgün konturludur; orbital yağ planları açıktır, glob beklenen konumda, orbita kemik korteksi kesintisiz görünür. Aynı seviyede karşı kası ve orbital yağı karşılaştır; sonra kemik penceresinde litik boşluk, skleroz veya kortikal kaybı ara; metastazlar yumuşak doku, kas veya kemik dokusundan herhangi birinde veya kombinasyonunda saptanabilir.

Ayırıcı tanı

Primer orbital lenfoma

çoğunlukla homojen yumuşak doku infiltrasyonu yapar; belirgin kemik destrüksiyonu daha az tipiktir.

Orbital rabdomyosarkom

çocuklarda görülen önemli bir primer malign orbital tümördür ve metastatik kökenli değildir; hızla gelişen orbital kitlelerde ayırıcı tanıda yer alır.

Tiroid orbitopatisi

çoğu kez bilateral, kas karnı belirgin ve tendon nispeten korunmuş büyür; fokal yıkıcı kemik lezyonu beklenmez.

İdiyopatik orbital inflamasyon

kas, yağ veya lakrimal bezde inflamatuvar büyüme yapabilir; klinik ve MR'daki yayılım paterni metastazdan ayrım sağlar.

Tuzaklar

• Orbital metastaz kemik yıkımı olmadan yalnız kas veya yağ dokusunda kitle oluşturabilir; normal kemik penceresi metastazı dışlamaz.
• Meme metastazına bağlı fibrotik çekinti enoftalmi yapabilir; tüm orbital metastazların proptozis oluşturduğunu varsayma.
• Ekstraoküler kas metastazı fokal kitle veya yaygın infiltrasyon şeklinde olabilir; yalnızca yaygın kas büyümesi bekleme.
• Bilinen primer kanser yokluğu metastazı dışlamaz; orbital tutulum primer malignitenin ilk işareti olabilir.

Kendini dene

1. Akciğer kanseri öyküsü olan erişkinde tek taraflı ekstraoküler kas büyümesi, orbital yağ infiltrasyonu ve glob deviasyonu var. En olası tanı?

   • Orbital metastaz
   • Tiroid orbitopatisi
   • Optik yol gliomu
   • Kavernöz venöz malformasyon
   Cevabı göster

   Orbital metastaz. Kanser öyküsüyle birlikte fokal kas ve yağ infiltrasyonu metastazı destekler. Bilinen kanser öyküsüyle birlikte ekstraoküler kas ve orbital yumuşak doku tutulumu metastaz olasılığını artırır.

2. Meme kanseri olan hastada yeni enoftalmi ve orbital yağ çekintisi gelişmiş; kemik litik defekti yok. En uygun yorum?

   • Metastaz yine olasıdır
   • Metastaz dışlanmıştır
   • Rabdomyosarkom tipiktir
   • Normal yaşlanma bulgusudur
   Cevabı göster

   Metastaz yine olasıdır. Skirröz meme kanseri metastazları fibrotik çekinti nedeniyle enoftalmi ile prezente olabilir; kemik tutulumu bu prezentasyonda gerekli değildir. Bu nedenle negatif kemik bulgusu metastazı dışlamaz.

Kaynaklar

Bu sayfadaki 37 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 7 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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