Dalak inflamatuvar miyofibroblastik tümörü

Özet

Dalak inflamatuvar miyofibroblastik tümörü (IMT), inflamatuvar hücreler içeren iğsi miyofibroblastik hücrelerden oluşan, dalakta çok seyrek görülen solid bir neoplazidir. WHO yumuşak doku tümörü sınıflamasında orta biyolojik davranışlı, nadiren metastaz yapabilen tümörler arasındadır. BT'de lezyon çoğunlukla hipoattenüe ve hipoenfaze bir kitle olarak izlenir; santral yıldızsı kalsifikasyon varlığı tanıyı destekleyebilir ancak kesin tanının yerini tutmaz. Görüntüleme özellikleri özgül olmadığından kesin tanı patolojiye dayanır. Komşu organ invazyonu veya ek hastalık bulgularını atlamak tanısal değerlendirmeyi eksik bırakabilir.

Faz ve pencere

Portal tanısal

Lezyon kontrastlı BT'de hipoattenüe ve hipoenfaze görünür; MR görüntülerinde ise yavaş ve gecikmiş kontrastlanma gösterir.

Kontrastsız

Kitle dalak dokusuna göre düşük veya benzer atenüasyonda olabilir; santral yıldızsı kalsifikasyon varsa kontrast öncesi görüntülerde daha net seçilir.

Önerilen pencereler: Batın (G 400 / M 50), Yumuşak doku (G 400 / M 40).

BT bulguları

• Genellikle soliter, iyi sınırlı, solid ve dalak parankimine göre hipoattenüan kitle
• Lezyon genellikle hipoattenüe ve hipoenfazedir; MR'da yavaş ve gecikmiş kontrastlanma gösterir.
• Santral yıldızsı kalsifikasyon eşlik edebilir ve IMT olasılığını artırır
• Lezyonun komşu organlarla ilişkisi ve invazyon varlığı imajing ile kesin ayrım yapılamadığı için histopatolojik değerlendirme gereklidir.
• Dalak hilusu ve üst abdominal lenf nodları eşlik eden yayılım bulguları açısından taranır
• BT görünümü malign splenik kitlelerle örtüştüğünden doku tanısı olmadan kesin sınıflama yapılamaz

Ölçütler ve sınıflamalar

WHO yumuşak doku tümörü sınıflamasında biyolojik davranış

IMT, intermediate (orta biyolojik davranışlı; nadiren metastaz yapabilen) neoplazi olarak sınıflanır; görüntüleme histopatolojik tanının yerini tutmaz.

Normalde

Normal dalak portal venöz fazda homojen kontrastlanır; fokal solid kitle, parankim konturunda kabarıklık veya santral kalsifikasyon görülmez. Lezyonun dalak parankimi ile olan atenüasyon farkı, sınırlarının düzgünlüğü ve boyutu değerlendirilir.

Ayırıcı tanı

Splenik lenfoma

malignite ayırıcısında lenfadenopati ve bilinen primer malignite varlığı belirleyici olup, lezyonun imajing özellikleri IMT ile örtüşebilmektedir.

Splenik hamartom

çoğu kez iyi sınırlıdır ve arteriyel fazda belirgin kontrastlanabilir; portal faz örüntüsü değişkendir.

Splenik anjiyosarkom

dalakta belirsiz sınırlı, merkezi nekrotik alanlar içeren kompleks kitleler oluşturur ve sıkça eşlik eden metastazlarla birlikte yüksek derecede agresif bir maligniteyi düşündürür.

Dalak metastazı

bilinen altta yatan malignite varlığı malign lezyon için önemli bir prediktördür; imajing özellikleri diğer malignitelere benzer.

Splenik tüberkülom

difüz mikronodüler seyir daha tipik olmakla birlikte soliter kütle de yapabilir; tanı için klinik bilgi ve doku örneği gerekir.

Tuzaklar

• Santral yıldızsı kalsifikasyon BT'de IMT tanısını güçlü şekilde destekler ancak diğer lezyonları kesin olarak dışlamaz.
• İyi sınırlı olması kitlenin benign olduğunu kanıtlamaz; dalak IMT'si görüntüde lenfoma ve diğer neoplazileri taklit edebilir.
• IMT'nin imajing özellikleri lenfoma ve metastaz gibi malignitelere benzediğinden, ön tanı yalnızca görüntülemeye dayanarak konulmamalıdır.

Kendini dene

1. BT'de dalakta solid hipoattenüan kitle ve santral yıldızsı kalsifikasyon görülüyor. En olası tanı hangisidir?

   • Dalak inflamatuvar miyofibroblastik tümörü
   • Splenik hamartom
   • Splenik lenfoma
   • Dalak metastazı
   Cevabı göster

   Dalak inflamatuvar miyofibroblastik tümörü. Santral yıldızsı kalsifikasyon BT'de IMT tanısını güçlü biçimde destekler; kesin tanı histopatolojik ve immünohistokimyasal değerlendirmeyle konur.

2. BT'de malignite kuşkusu yaratan solid bir dalak kitlesinde kesin tanıyı sağlayan yöntem hangisidir?

   • Lezyonun santral yıldızsı kalsifikasyon içermesi
   • Lezyonun portal venöz fazda hipoattenüe kalması
   • Cerrahi rezeksiyon sonrası patolojik inceleme
   • Korunmuş perisplenik yağ planının izlenmesi
   Cevabı göster

   Cerrahi rezeksiyon sonrası patolojik inceleme. Görüntüleme bulguları tanıya ipucu verebilir, ancak kesin tanı histopatolojik ve immünohistokimyasal değerlendirmeye dayanır.

Kaynaklar

Bu sayfadaki 35 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 18 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.