Sklerozan anjiyomatoid nodüler transformasyon (SANT)

Özet

SANT, çoğunlukla erişkinlerde tesadüfen saptanan, dalak kırmızı pulpasından köken alan nadir benign vasküler-proliferatif bir lezyondur. BT'de soliter solid kitle ve kontrast sonrası periferden merkeze ilerleyen ışınsal dolum paterni tanıyı düşündürür; kesin tanı histopatolojiktir. Çok fazlı BT'de arteriyel fazda başlayan ve gecikmiş fazda merkez yönünde ilerleyen kontrastlanma SANT'ın karakteristik özelliğidir; bu bulgu ayırıcı tanıda değerlidir. Maligniteyle karışması gereksiz ileri girişimlere, görüntüleme bulgusunun tek başına kesin tanı kabul edilmesi ise gerçek tümörün gözden kaçmasına yol açabilir.

Faz ve pencere

Kontrastsız tanısal

SANT genellikle normal dalak parankimine göre hipodens, iyi sınırlı solid kitle olarak seçilir; santral yıldızsı fibrotik alan hipodens olabilir.

Arteriyel tanısal

Lezyon çevresinde ve periferden merkeze uzanan ince ışınsal damar alanlarında erken kontrastlanma görülebilir; merkez görece hipodens kalabilir.

Gecikmiş tanısal

Kontrastlanan periferik nodüller ile ışınsal septalar boyunca ilerleyici dolum ve fibrotik merkezde geç kontrastlanma görülebilir; spoke-wheel görünümü belirginleşebilir.

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

BT bulguları

• Soliter, yuvarlak veya lobüle, iyi sınırlı solid splenik kitle.
• Kontrastsız BT'de dalak parankimine göre düşük atenüasyon.
• Arteriyel fazda periferik ve ışınsal septal kontrastlanma.
• Gecikmiş fazda merkez yönünde ilerleyen dolum — spoke-wheel paterni.
• Santral stellat fibrotik skar; her olguda görünmesi beklenmez.
• Lezyon içinde kalsifikasyon bulunabilir ancak tipik veya zorunlu değildir.
• SANT tipik olarak soliter ve iyi sınırlıdır; çok odaklı hastalık, organ invazyonu veya uzak metastaz genellikle görülmez.

Normalde

Dalak parankimi kontrastsız görüntülerde homojen yumuşak doku atenüasyonundadır; kontrastlı çok fazlı BT'de portal venöz fazda homojenleşir. Kitleyi aynı fazdaki çevre parankimle kıyaslayın; periferik nodüllerin ve ışınsal septaların gecikmiş görüntülerde merkeze doğru dolup dolmadığını izleyin.

Ayırıcı tanı

Splenik lenfoma

çoklu hipoatenüasyonlu odaklar, diffüz infiltrasyon veya eşlik eden lenfadenopati lehinedir.

Dalak metastazı

bilinen primer tümör ve yaygın hastalık bağlamında değerlendirilmeli; ancak soliter dalak metastazı da görülebilir.

Splenik hamartom

erken belirgin heterojen kontrastlanma ve gecikmiş homojenleşme görülebilir.

İnflamatuvar psödotümör

fibrotik kitle görünümü örtüşebilir; BT tek başına güvenilir ayırım sağlamaz.

Dalak hemanjiyomu

progresif kontrastlanma bazen santral fibrotik skar ile görülebilir ve T2 ağırlıklı görüntülerde yüksek sinyal verir.

Tuzaklar

• Erken kontrast fazlarında dalak parankiminin doğal kontrastlanması lezyonun belirlenmesini zorlaştırabilir; SANT gecikmiş fazda çevre parankime izodens hâle gelebilir.
• Santral fibrotik skar nekrozla karışabilir; çevredeki ışınsal damar nodüllerinin kontrastlanması SANT lehinedir.
• Spoke-wheel paterni özgül histolojik kanıt değildir; görüntüleme SANT'ı kuvvetle düşündürse de maligniteyi tek başına dışlamaz.

Kendini dene

1. Tesadüfi soliter splenik kitlede arteriyel periferik nodüller gecikmiş fazda ışınsal biçimde merkeze doluyor. En olası tanı?

   • SANT
   • Hamartom
   • Lenfoma
   • Metastaz
   Cevabı göster

   SANT. Periferden merkeze ilerleyen spoke-wheel dolumu fibrotik SANT nodüllerini düşündürür. Hamartom daha çok diffüz erken kontrastlanıp homojenleşir; lenfoma çoğunlukla infiltratif/çok odaklıdır; metastazda bilinen primer ve başka odaklar aranır.

2. Bir splenik kitlede merkez hipodens, çevrede kontrastlanan alanlar var; hangi ek bulgu SANT lehine en çok katkı verir?

   • Gecikmiş ışınsal dolum
   • Daughter kistler
   • Hilus lenfadenopatisi
   • Kapsüler scalloping
   Cevabı göster

   Gecikmiş ışınsal dolum. Gecikmiş fazda merkez yönünde ilerleyen ışınsal dolum SANT'ın karakteristik vasküler-fibrotik örüntüsüdür. Daughter kistler hidatik hastalığı, hilus lenfadenopatisi lenfomayı; kapsüler scalloping peritoneal implantları destekleyebilir.

İlgili konular

• Dalak lenfoma tutulumu
• Dalak metastazları

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 9 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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