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Sinonazal lenfoma

Sinonasal lymphoma

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Sinonazal lenfoma: yayımlanmış olgu görüntüsü, koronal kesit

4 adım

Görüntü: Kennedy K, Tremblay C, Zhang E ve ark., “Non-Hodgkins lymphoma of the nasal cavity: A case report.” 2023, Fig. 1. PMC10505587 · doi:10.1016/j.radcr.2023.08.073 · CC BY 4.0. Değişiklik: kırpıldı, yeniden boyutlandırıldı, odak işaretleri eklendi.

Özet

Sinonazal lenfoma, nazal kavite veya paranazal sinüs mukozasını kitle biçiminde infiltre edebilen ekstranodal lenfoid malignitedir. Kontrastsız BT sinüs opasifikasyonunu ve kemik etkisini gösterir; MR yumuşak doku sınırlarını ve komşu yayılımı değerlendirmeyi kolaylaştırır. Büyük yumuşak doku hacmine karşın kemik yıkımının görece sınırlı olması lenfoma olasılığını artırabilir, ancak özgül değildir. MR, sinonazal lenfomada intrakraniyal tümör uzanımını gösterebilir.

Faz ve pencere

Kontrastsız tanısal
Nazal kavite ya da sinüs lümeninde homojen veya hafif heterojen yumuşak doku yoğunluğu ve kemik penceresinde permeatif erozyon/remodeling değerlendirilir; kontrastsız ince kesit BT kemik etkisi için tanısaldır.
Kontrastlı tanısal
Sinonazal lenfomada görüntüleme bulguları özgül olmadığından kontrastlanma paterni tek başına tanı koydurmaz; kemik tutulumu BT, yumuşak doku yayılımı ise MR ile değerlendirilir. MR, kafa tabanı ve intrakraniyal yumuşak doku yayılımı için tamamlayıcıdır.

Önerilen pencereler G genişlik, M merkez; değerler Hounsfield birimi (HU)

  • Yumuşak dokuG 400 / M +40
  • KemikG 1800 / M +400

BT bulguları

  • Sinonazal lenfoma, nazal kavite veya sinüslerde yumuşak doku kitlesi şeklinde görülebilir; BT ve MR'da kitle homojenliği skuamöz hücreli karsinoma kıyasla daha yüksek olabilir.
  • Kitle hacmine kıyasla sınırlı kortikal yıkım veya permeatif kemik değişikliği.
  • Sinonazal lenfoma nazal kavite konkalarını tutabilir.
  • Sinonazal lenfoma nazolakrimal kanala ve inferomedial orbitaya uzanabilir.
  • Kontrastlanma ve nekroz paterni sinonazal lenfoma alt tipleri arasında değişebilir; görüntüleme bulguları alt tipleri güvenilir biçimde ayırt etmeye yetmeyebilir.
  • Sinonazal non-Hodgkin lenfomada bölgesel lenfadenopati olguların %7–19'unda bildirilmiştir.

Normalde

Karşı burun boşluğu ve sinüsleri kıyasla, ardından kitlenin orbital yağ ve servikal nodlarla ilişkisini yumuşak doku penceresinde 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 s0849; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Sinonazal skuamöz hücreli karsinomda yıkıcı büyüme paterni, sinonazal lenfomaya kıyasla daha sık görülür.
İnvaziv fungal sinüzitte doku nekrozu ve damar invazyonu görülebilir; invaziv rino-orbito-serebral mukormikozda retroantral yağ tutulumu sinüs dışı yayılım bulgularındandır.
Estesioneuroblastom, sinonazal malign kitlelerin ayırıcı tanısında yer alır.
Sinonazal melanom görüntülemede kitle oluşturabilir; kesin tanıda biyopsi ve histopatolojik inceleme gerekir.
Granülomatoz polianjiit (GPA), sinonazal lenfomayla endoskopik bulguları örtüşebilen ayırıcı tanılardandır.

Tuzaklar

  • Kemik korunmuş diye lenfomayı dışlama; küçük kemik perforasyonları veya permeatif hasar da görülebilir.
  • Sinonazal lenfoma eşlik eden inflamasyon veya nekrozla maskelenebilir; MR'da T2 ağırlıklı görüntüler tümörü normal mukozadan ya da sıvıdan ayırt etmeye yardımcı olabilir.
  • Sinonazal lenfoma nazolakrimal kanala ve orbitaya uzanabilir; bölgesel lenfadenopati de görülebildiğinden boyun lenf nodlarını değerlendir.
  • Ekstranodal NK/T hücreli lenfoma nazal tip, nekrozla birlikte kıkırdak ve kemikte belirgin yıkım yapabilir; bu nedenle tüm sinonazal lenfomalarda kemiğin korunduğu varsayılmamalıdır.

Kendini dene

  1. Nazal kaviteyi dolduran, BT ve MR’da skuamöz hücreli karsinoma kıyasla daha homojen görünen ve daha az sıklıkla yıkıcı büyüme paterni gösteren kitlede sinonazal lenfoma olasılığı düşünülmelidir. En olası tanı hangisidir?

    Cevabı göster

    Sinonazal lenfoma. Sinonazal lenfoma, skuamöz hücreli karsinoma kıyasla daha homojen görünebilir ve daha az sıklıkla belirgin yıkıcı kemik paterni gösterir. Bu özellikler özgül değildir; kesin tanı biyopsi ve immünohistokimya ile konur.

  2. Sinonazal lenfomada kesin tanı için hangi yaklaşım gerekir?

    Cevabı göster

    Biyopsi ve immünohistokimya. Sinonazal lenfomanın tanısı biyopsi ve immünohistokimya ile doğrulanır; görüntüleme ve laboratuvar incelemeleri tanı ve evrelemeye katkı sağlar.

İlgili konular

Kaynaklar

Bu sayfadaki 34 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 22 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.