Akciğer dışı yüksek dereceli nöroendokrin karsinom BT bulguları

Özet

Ekstrapulmoner nöroendokrin karsinom, en sık gastrointestinal sistemde olmak üzere akciğer dışında gelişen, kötü diferansiye ve biyolojik olarak agresif bir malignitedir. BT'nin temel rolü primer tümörün yerini, komşu yapılara uzanımını ve sık görülen uzak yayılımı haritalamaktır. NEC'lerde bol nekroz ve uzak metastazlara eğilim görülebilir. Primer odağın ve metastazların eksik haritalanması hastalık yaygınlığının olduğundan düşük değerlendirilmesine neden olur.

Faz ve pencere

Portal tanısal: EP-NEC evrelemesinde toraks ve abdomen BT'si gerekir.

Önerilen pencereler: Batın (G 400 / M 50), Karaciğer (G 150 / M 30), Mediasten (G 350 / M 50), Yumuşak doku (G 400 / M 40).

BT bulguları

Gastrointestinal, genitoüriner veya jinekolojik bir organda solid, düzensiz sınırlı kitle; kontrastlanma heterojen olabilir.
Büyük tümör içinde kontrastlanmayan nekrotik alanlar ve canlı periferik solid bileşen.
Primer kitlenin komşu organ, mezenterik kök, damar veya serozal yüzeylere doğrudan uzanımı.
Primer drenaj alanında yuvarlaklaşmış veya kümelenmiş bölgesel lenf nodları.
Karaciğerde metastatik odaklar görülebilir.
Peritoneal/omental nodüller, asit veya mezenterik implantlar; yaygın hastalığı düşündürür.
Toraks BT'de pulmoner nodüller, mediastinal lenf nodları veya plevral odaklar eşlik edebilir.

Ölçütler ve sınıflamalar

WHO nöroendokrin neoplazm ayrımı: NEC kötü diferansiye küçük hücreli veya büyük hücreli karsinom morfolojisindedir ve yüksek derecelidir; NET G3 ise yüksek proliferasyon gösterebilen iyi diferansiye tümördür. Bu ayrım doku morfolojisi ve proliferasyon değerlendirmesiyle yapılır, BT ile güvenilir biçimde sınıflanmaz.

Normalde

NEC'lerde bol nekroz görülebilir.

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 s0119; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

GEP-NET G3, GEP-NEC'den ayırıcı tanıda zorlanabilir; az sayıda olguda benzer morfoloji ve immünfenotip görülebilir.
Adenokarsinom, NEC için ayırıcı tanıda yer alır.
Lenfoma, küçük bağırsak tümörlerinde ayırıcı tanıda yer alır; BT bulguları histolojiye yönelik şüphe oluşturabilir, ancak kesin tanı histopatolojiyle konur.
Gastrointestinal stromal tümör: bağırsak duvarından ekzofitik büyüyen, lümene göre dışa taşan solid kitle oluşturabilir.
Metastatik küçük hücreli akciğer karsinomu: toraksta primer kitle veya yaygın mediastinal nodlarla birlikteyse akciğer kökeni araştırılır.

Tuzaklar

NEC'lerde bol nekroz görülebilir; bu tümörler kötü diferansiye ve yüksek derecelidir.
EP-NEC'de primer kitle belirgin olmayabilir; evrelemede toraks ve abdomen BT'si gerekir.
Nekrotik merkez kontrastsız kistik lezyon gibi görünebilir; portal fazda periferik canlı tümör dokusunu ve organla bağlantısını takip et.

Kendini dene

GEP-NEN’lerde hangi iki grup, az sayıda olguda benzer immünfenotip ve morfoloji nedeniyle ayırıcı tanıda güçlük oluşturabilir?
Cevabı göster
GEP-NEC ile NET G3. GEP-NEC ile NET G3 ayrımı, az sayıda olguda benzer immünfenotip ve morfoloji nedeniyle güçleşebilir.
Portal fazda kitle merkezinin boyanmaması ve çevresinin solid kontrastlanması en iyi neyi açıklar?
Cevabı göster
Nekrozlu tümör. Canlı periferik tümörün kontrastlanıp merkezde kontrastlanmayan doku bırakması nekrozla uyumludur. NEC'lerde histolojik olarak nekroz görülebilir.

İlgili konular

Kaynaklar

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

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