Primer dalak anjiyosarkomu

Özet

Primer splenik anjiyosarkom, dalak damar endotelinden köken alan, nadir ve agresif bir malign tümördür. Karın ağrısı veya splenomegali ile ortaya çıkabilir; tümör içi kanama ve spontan rüptür hemoperitoneuma ve dolaşım bozulmasına yol açabilir. Kontrastlı BT kitle morfolojisini, kanamayı ve uzak yayılımı birlikte değerlendirir. Görüntüleme özellikleri özgül olmadığından heterojen vasküler kitle anjiyosarkomu düşündürebilir ancak tanı histopatolojiyle doğrulanır.

Faz ve pencere

Kontrastsız

Tümör içinde taze kanama varsa çevre parankimden daha yüksek atenüasyonlu odaklar; rüptürde perisplenik ve intraperitoneal yüksek atenüasyonlu kan görülebilir.

Arteriyel

Vasküler tümör bileşenleri yamalı veya heterojen kontrastlanabilir; taze kanama genellikle kontrastsız kesitte hiperdens olarak izlenir.

Portal

Portal venöz fazda sınırları belirsiz, heterojen kitle izlenir; tümör dokusu ile düşük yoğunluklu alanlar arasında kontrastlanma farkı belirginleşir. Karaciğer ve diğer organlardaki sekonder odaklar evreleme açısından aranır.

Önerilen pencereler: Batın (G 400 / M 50), Karaciğer (G 150 / M 30), Anjiyo (G 600 / M 150).

BT bulguları

• Dalak boyutunu artıran, parankimi yer yer değiştiren veya çok odaklı heterojen solid kitle.
• Kitle içinde nekroz, kistik görünümlü dejenerasyon ve kanama alanları; atenüasyon kontrastsız seride daha belirgin olabilir.
• Kontrastlanma homojen değildir; canlı tümör bileşenleri ile nekrotik bölgeler aynı lezyonda yan yana bulunur.
• Kapsül bütünlüğü kaybı ve perisplenik hematom rüptürü düşündürür.
• Dalak ve karaciğer çevresinde yüksek dansiteli serbest sıvı izlenmesi hemoperitoneumu düşündürür.
• Karaciğer metastazları sık görülen uzak yayılım örüntüsüdür; akciğer, kemik, lenf nodu ve diğer organlar da taranır.

Normalde

Anjiyosarkomda normal splenik parankim diffüz biçimde tümörle yer değiştirebilir; BT'de heterojen kitle ve nekrotik alanları bu parankimle karşılaştır. Dalak boyutundaki artışı ve parankimin tümörle diffüz yer değiştirmesini değerlendir.

Ayırıcı tanı

Splenik lenfoma

primer dalak maligniteleri arasında en sık görülen gruptur ve genellikle diffüz splenomegali ile seyrederek odaklardan ziyade organ büyümesine yol açar.

Metastaz

bilinen primer tümör ve diğer organlarda benzer lezyonlar tanıyı destekler.

Splenik hemanjiyom

vasküler yapısı nedeniyle anjiyosarkomla görüntüleme özellikleri açısından örtüşebilir; tanı kesinleştirilemeyince histopatoloji gerektirir.

Splenik hamartom

nadir görülen benign bir lezyondur; bulgu ve semptomları genellikle non-spesifik olup, hipersplenizm bulguları eşlik edebilir.

Enfarkt

kapsüle tabanı uzanan kama biçimli hipoperfüze alan kitle benzeri tümör dokusundan ayrılır.

Tuzaklar

• Kontrastsız kesitte tümör içi kanama, solid bileşenden ayrılmayabilir; aynı düzeyin kontrastlı serisiyle eşleştir.
• Tümör rüptürüne bağlı taze kanama alanları, kontrastsız BT kesitlerinde hiperatenuasyon olarak belirginleşir.
• Anjiyosarkomda heterojen kontrastlanma görülebileceğinden, bu görünümü tek başına tanı koydurucu kabul etme.
• Karaciğerdeki hipervasküler odakları bağımsız benign lezyon kabul etmeden önce dalak tümörü bağlamında metastaz açısından karşılaştır.
• Dalaktaki heterojen vasküler kitle görüntüleme ile anjiyosarkom olarak kesinleştirilemez; kanama ve yayılımı değerlendir, özgül tümör tanısını histopatolojiye bırak.

Kendini dene

1. Splenomegalik hastada heterojen, nekroz ve kanama içeren splenik kitle var. Bu özgül olmayan BT görünümünde hangi nadir agresif vasküler tümör ayırıcı tanıda akılda tutulmalıdır?

   • Splenik hamartom
   • Primer splenik anjiyosarkom
   • Splenik kist
   • Dalak enfarktı
   Cevabı göster

   Primer splenik anjiyosarkom. Primer splenik anjiyosarkom heterojen kitle, nekroz ve kanama ile görülebilir; ancak BT görünümü özgül değildir ve hemanjiyom, lenfoma gibi lezyonlarla örtüşür. Görüntüleme tümör şüphesini yükseltir, kesin tanıyı histopatoloji koyar.

2. Dalak kitlesi çevresinde kanama şüphesi olan hastada kontrastsız BT'de hiperatenuasyon ve intraperitoneal kanama bulguları izleniyor. Bu bulgular neyi düşündürür?

   • Aktif kanama
   • Kronik kalsifikasyon
   • Basit kist
   • Dalak enfarktı
   Cevabı göster

   Aktif kanama. Kontrastsız BT'de kanamaya bağlı hiperatenuasyon ve yoğun intraperitoneal sıvı, dalak rüptürüne bağlı kanamayı düşündürür.

İlgili konular

• Splenik arter anevrizması ve psödoanevrizması

Kaynaklar

Bu sayfadaki 38 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 14 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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