Apendiks adenokarsinomu ve nöroendokrin neoplazileri BT bulguları

Özet

Apendiks adenokarsinomu ve nöroendokrin neoplazileri, apandisit görünümüyle ya da tesadüfen saptanabilen farklı biyolojideki primer tümörlerdir. Portal venöz fazlı kontrastlı BT, özellikle apendiks tabanı kitlesi, apseyle karışan neoplastik kitle ve bölgesel/peritoneal yayılımın değerlendirilmesinde rol oynar. Nöroendokrin tümörler küçük ve distal yerleşimli olabileceğinden BT'de görünmeyebilir; görüntüleme normal olsa da histolojik tanıyı dışlamaz. Taban kitlesi veya müsinöz lezyonun obstrüksiyon, invazyon ya da rüptür bulguları atlanırsa hastalığın yayılımı eksik değerlendirilir.

Faz ve pencere

Portal tanısal: Kontrastlı BT apendiks tümörünü her zaman göstermeyebilir; peritoneal hastalık BT’de saptanabilir. Distal küçük nöroendokrin tümör kontrastlı BT'de seçilemeyebilir.

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

BT bulguları

Apendiks tabanı veya çekum ağzında fokal yumuşak doku kitlesi ve asimetrik duvar kalınlaşması.
Apendiks ağzının tümörle kapanmasına bağlı distal lümen genişlemesi; içerik sıvı veya müsinöz olabilir.
Apendiks çevresinde inflamasyonla birlikte apse ya da kitle; kalıcı/asimetrik komponent neoplaziyi akla getirir.
Apendiks kaynaklı büyük bir kitle çekum ve ileoçekal valvi tutabilir; terminal ileuma yapışıklık da görülebilir.
Adenokarsinomda nodal metastaz kötü prognozun bağımsız prediktörüdür ve sağ hemikolectomi ile elde edilen ileokolik lenf düğüllerinin durumu evreleme açısından belirleyicidir.
Müsinöz kitlede duvar düzensizliği, mural nodül, rüptür ve peritoneal/omental müsinöz implantlar.
Nöroendokrin tümörler çoğunlukla apendiksin distal üçte birinde yerleşir ve görüntülemede nadiren görülür; ileri hastalıkta karaciğer veya bölgesel lenf nodlarına yayılım görülebilir.

Ölçütler ve sınıflamalar

WHO Digestive System Tumours, 6. baskı (2026): Apendiks adenokarsinomu ve nöroendokrin neoplazileri ayrı histolojik gruplardır; nöroendokrin neoplaziler WHO sınıflamasında ayrı başlıkta değerlendirilir. BT, histolojik alt tipi veya derecesini değil görünür kitleyi ve yayılımı gösterir.
AJCC Cancer Staging Manual, Version 9 (2026 güncel listesi): AJCC evreleme kılavuzları, primer tümör boyutu, invazyon derinliği, bölgesel nod tutulumu ve uzak metastazı değerlendiren standart protokoller sunar. BT lokal yayılımı, bölgesel nodları ve uzak/peritoneal hastalığı değerlendirir; kesin histoloji ve patolojik evre görüntülemeden atanmaz.

Normalde

Apendiks, çekum ile ileum bileşkesine yakın çekumdan çıkan kaslı silindirik bir yapıdır. Apendiks tabanındaki kistik, sıvı dolu yapıyı ve apendiks lümenindeki genişlemeyi değerlendir. Küçük apendiks nöroendokrin tümörünün BT'de görünmemesi tümörü dışlamaz.

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

Akut apandisitte BT’de apendiks genişlemesi ve periappendiküler yağlı doku kirlenmesi görülebilir.
Apendiks mukoseli/LAMN: düzgün, müsinle dolu kistik-tübüler genişleme ön plandadır; invaziv yumuşak doku kitlesi şart değildir.
Çekum adenokarsinomu apendiks ağzını tıkayarak sekonder apandisite yol açabilir.
İnce bağırsak gastrointestinal stromal tümörleri dışa büyüyen kitleler şeklinde görülebilir.
Apendiks lenfoması, apendiks duvar kalınlaşması ve ileokolik lenfadenopatiyle görülebilir.

Tuzaklar

Küçük distal apendiks nöroendokrin tümörü BT'de saptanmayabilir; negatif BT'yi patolojinin yerine koyma.
Tümöre bağlı apandisit, sıradan inflamasyon gibi görünebilir; tabanda kalıcı yumuşak doku, lümen genişlemesi ve beklenmedik kitleyi özellikle ara.
Müsinöz neoplazide peritoneal yayılım, müsinöz asit ve omental kekleşme şeklinde görülebilir.
Çekum kaynaklı bir kitle apendiksi tıkayarak apandisite yol açabilir; çekum kitlesi ile apendiks arasındaki ilişkiyi değerlendirmek gerekir.

Kendini dene

BT’de çekumla devamlı apendiks tabanında asimetrik yumuşak doku kitlesi ve distal lümen genişlemesi var. En doğru çıkarım hangisidir?
Cevabı göster
Apendiks kaynaklı neoplazi kuşkusu. Taban kitlesi ve distal genişleme apendiks kaynaklı neoplazi kuşkusunu artırır; BT tek başına adenokarsinom histolojisini kanıtlamaz. Çekum duvarıyla kitlenin devamlılığı kaynak ayrımına yardım eder; epiploik apandajit ise kolon komşuluğundaki yağ dokusundan kaynaklanır.
Apendektomi sonrası BT normal; histolojide küçük distal nöroendokrin tümör bildiriliyor. BT'nin rolü nasıl yorumlanır?
Cevabı göster
Küçük tümörü dışlamaz. Küçük distal apendiks nöroendokrin tümörleri kesitsel görüntülemede görünmeyebilir; BT daha çok görünür primer kitleyi ve yayılımı değerlendirmeye yarar. Normal BT histolojik bulguyu geçersiz kılmaz.

Kaynaklar

Bu sayfadaki 44 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 16 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.