Bronkopulmoner nöroendokrin tümör (karsinoid)

Özet

Bronş karsinoidi iyi diferansiye akciğer nöroendokrin tümörüdür; merkezi endobronşiyal kitle veya periferik pulmoner nodül biçiminde görülebilir. Kontrastlı toraks BT, bronşla ilişkiyi, tümörün damarlanmasını ve distal havalanma sonuçlarını birlikte gösterir. Tıkanma tekrarlayan atelektazi, hava hapsi ya da postobstrüktif enfeksiyonla başvurabilir. Belirgin kontrastlanan küçük endobronşiyal odağı yalnız mukus veya atelektazi sanmak tanının gecikmesine yol açar.

Faz ve pencere

Venöz tanısal

Venöz faz toraks BT’de endobronşiyal yuvarlak/oval yumuşak doku odağı genellikle belirgin ve homojen kontrastlanır; bronşla devamlılığı ve distal atelektazi aynı incelemede izlenir.

Önerilen pencereler: Mediasten (G 350 / M 50), Akciğer (G 1500 / M -600).

BT bulguları

• Ana, lober veya segmental bronş lümeninde düzgün sınırlı, yuvarlak ya da oval endobronşiyal yumuşak doku nodülü.
• İntravenöz kontrast sonrası belirgin, çoğu kez homojen kontrastlanma; kontrastlanma mukus tıkacından ayrımda yardımcıdır.
• Santral kitlenin bronşu daraltması veya kesmesiyle aynı lobda atelektazi ve hacim kaybı.
• Distal bronşlarda mukus birikimi, postobstrüktif konsolidasyon ya da tekrarlayan enfeksiyonla uyumlu opasite.
• Periferik karsinoid bronş lümeniyle doğrudan ilişki göstermeyen, düzgün sınırlı solid pulmoner nodül olarak izlenebilir.

Ölçütler ve sınıflamalar

WHO akciğer karsinoid sınıflaması

Tipik karsinoid düşük proliferasyon aktivitesi ve tümör nekrozu bulunmamasıyla tanımlanır. Atipik karsinoid, bronkopulmoner nöroendokrin tümörlerin tipik karsinoidden ayrı sınıflanan alt tipidir. Tipik ve atipik karsinoid ayrımı histopatolojiktir; FDG-PET/BT’de SUVmax bu iki alt tipi güvenilir biçimde ayırt etmemiştir.

Normalde

Şüpheli bronş düzeyinde MDCT ile fokal nodüler lezyonu ve hava yolu duvarını değerlendir.

Ayırıcı tanı

Endobronşiyal hamartom

düşük kontrastlanma ve düşük FDG tutulumu gösterir; klasik radyografik bulgu patlama benzeri kalsifikasyondur.

Mukus tıkacı ve lümen içi gölgeler çok kesitli BT’de endobronşiyal tümörlerle ilişkili bulgular arasında yer alabilir.

Endobronşiyal metastaz

bilinen primer malignite ve birden fazla hava yolu odağı ayırıcı tanıyı destekler.

Vasküler lezyonlar

bronkoskopi sırasında nabız atımı varsa biyopsi yapılmamalıdır; BT anjiyografi ile damarsal süreklilik ve köken araştırılır.

Tuzaklar

• Tam tıkalı bronş distalindeki atelektazi endobronşiyal tümörü gizleyebilir; kontrastlanan fokal kitleyi bronş girişinde, çökmüş parankimden ayrı ara.
• Mukus tıkacı ve lümen içi gölgeler çok kesitli BT’de endobronşiyal tümörlerle ilişkili bulgular arasında yer alabilir; bu nedenle lümen içeriği kitle şüphesinde dikkatle değerlendirilmelidir.
• Karsinoidlerin tipik ve atipik alt tipleri görüntüde güvenilir biçimde ayrılamaz; nekroz ya da metastaz yokluğu tipik histolojiyi kanıtlamaz.

Kendini dene

1. BT'de sağ intermediate bronşta hiperatenüe endobronşiyal lezyon ve kısmi bronş obstrüksiyonu görülüyor. Bu bulgularla en olası tanı nedir?

   • Mukus tıkacı
   • Bronş karsinoidi
   • Bronşiyal anevrizma
   • Endobronşiyal lipom
   Cevabı göster

   Bronş karsinoidi. Bronş karsinoidi merkezi hava yollarında ortaya çıkabilir ve bronş obstrüksiyonuna yol açabilir. Endobronşiyal lezyonlarda BT görünümü tek başına histolojik tanıyı kesinleştirmeyebilir; kaynak olguda hamartokondrom az kontrastlanan endolüminal doku olarak bildirilmiştir.

2. Histopatolojide tipik bronş karsinoidi tanısı kondu. Bu tümör için kaynakta hangi histolojik özellikler tanı ölçütü olarak belirtilmiştir?

   • Kontrastlanma yoğunluğuyla
   • Kalsifikasyon biçimiyle
   • Histolojik mitoz ve nekrozla
   • Atelektazi varlığıyla
   Cevabı göster

   Histolojik mitoz ve nekrozla. Kaynakta tipik karsinoid için düşük proliferasyon aktivitesi ve tümör nekrozu bulunmaması belirtilmiştir. Bu kaynak, kontrastlanma, kalsifikasyon veya atelektazinin alt tipi belirlediğini göstermemektedir.

İlgili konular

• Akciğer dışı yüksek dereceli nöroendokrin karsinom
• Nöroendokrin tümör karaciğer metastazları

Kaynaklar

Bu sayfadaki 35 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 19 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.