Gastrik nöroendokrin tümör

Özet

Gastrik nöroendokrin tümörler (gNET), biyolojik davranışı ve görüntüleme gereksinimi farklı olan iyi diferansiye tümörleri kapsar. Klinik-etyolojik sınıflamada Tip I kronik atrofik gastrit ve hipergastrinemiyle, Tip II gastrinoma ile ilişkili Zollinger–Ellison sendromu ve sıklıkla MEN1 ile, Tip III ise sporadik tümörlerle ilişkilidir; sunulan kaynaklar WHO 6. baskıda Tip IV ve Tip V’in eklendiğini doğrulamamaktadır. Bu tipler histolojik derece sınıflamasından ayrıdır: iyi diferansiye NET’ler G1–G3 olarak derecelendirilir, kötü diferansiye nöroendokrin karsinomlar (NEC) ayrı bir gruptur. Abdominal BT, Tip I ve II gNET’lerde 2 cm’den büyük lezyonlar ve tüm Tip III lezyonlar için evrelemede önerilir. Kontrastlı incelemede tümör ve karaciğer metastazı arteriyel fazda belirginleşebilir; Tip III tümörde nodal veya karaciğer yayılımı daha sık görülebilir.

Faz ve pencere

Arteriyel tanısal

Triphasik BT’de arteriyel fazda hiperenhansmanlı gastrik lezyon ve karaciğer metastatik depozitleri görülebilir; gNET tanısı endoskopik biyopsiyle doğrulanır.

Portal tanısal

Portal venöz fazda gastrik lezyonda kalıcı kontrastlanma ve karaciğer tutulumu görülebilir.

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

BT bulguları

• Tip I örüntüsünde korpus/fundusta çok sayıda küçük polipoid duvar odağı ve eşlik eden atrofik gastrit görünümü
• Tip II örüntüsünde çoklu küçük tümör odakları normal veya hipertrofik mide mukozasıyla birlikte görülebilir ve gastrinoma/Zollinger–Ellison sendromu, sıklıkla MEN1 ile ilişkilidir.
• Tip III gNET genellikle tek ve 1 cm’den büyük bir lezyon olarak görülür.
• Submukozal veya intramural başlangıçlı odağın çevre mide duvarıyla kıyaslandığında belirgin arteriyel kontrastlanması
• Derin submukoza invazyonu, retroperitoneal lenfadenopati ve vasküler tutulum (splenokaval tromboz gibi) değerlendirilir.
• Tip III gNET’lerde bölgesel lenf nodu metastazları görülebilir.
• Triphasik BT’de arteriyel fazda hiperenhansmanlı gastrik lezyonla birlikte karaciğer metastatik depozitleri görülebilir.
• Tip III lezyonlarda karaciğer, dalak ve retroperitoneal nodlara yönelik metastaz risk yüksektir; ileri evre hastalık bulguları değerlendirilir.
• Literatürde Tip IV olarak adlandırılan ve parietal hücre hipertrofisi/hiperplazisi ile karakterize varyantlar bildirilmektedir; bu varyantların BT ile tanısal ayırımı patoloji ve klinik bağlama bağlıdır.

Ölçütler ve sınıflamalar

İyi diferansiye gastrik NET tipleri

İyi diferansiye gastrik NET’lerin klinik-etyolojik tipleri: Tip I kronik atrofik gastrit/hipergastrinemiyle, Tip II gastrinoma ile ilişkili Zollinger–Ellison sendromu/MEN1 bağlamıyla, Tip III sporadik tümörlerle ilişkilidir. WHO sınıflamasında iyi diferansiye NET’ler G1–G3 derecelerine ayrılır; Tip IV olarak parietal hücre hipertrofisi ve hiperplazisi ile seyreden ve hipoplaziye yol açan varyantlar literatürde yer alır. Klinik tip sınıflaması histolojik sınıflamadan ayrıdır: iyi diferansiye NET’ler G1–G3 derecelerinde olabilir; kötü diferansiye NEC ayrı sınıflanır. BT, gNET’in histolojik derecesini tek başına belirlemez; dereceleme histopatolojik incelemeyle yapılır.

Normalde

Arteriyel fazda hiperenhansmanlı gastrik lezyonla birlikte karaciğer metastatik depozitleri görülebilir. Portal venöz fazda gastrik lezyonda kalıcı kontrastlanma ve karaciğer tutulumu görülebilir.

Ayırıcı tanı

Gastrik GİST

sıklıkla dışa büyüyen duvar kitlesidir; gNET daha mukozal/submukozal odak ve tip III'te ülserli duvar kitlesi şeklinde görülebilir.

Glomus tümörü antrumda iyi sınırlı, belirgin ve kalıcı kontrastlanan bir kitle oluşturabilir; gNET’ten klinik tip ve eşlik eden çoklu odaklar ayırt edicidir.

Gastrik adenokarsinom ve gNET’in görüntüleme bulguları örtüşebilir; kesin tanı için histopatolojik inceleme gerekir.

Tuzaklar

• Küçük tip I odaklar BT'de görünmeyebilir; negatif BT'yi endoskopik hastalığın yokluğu şeklinde yorumlama.
• Triphasik BT’de arteriyel fazda hiperenhansmanlı gastrik lezyon ve karaciğer metastatik depozitleri görülebilir.
• Çoklu küçük polipoid odaklar Tip I ve Tip II gNET’lerde görülebilir; tip ayrımında atrofik gastrit, gastrin ve mide asidi durumu ile gastrinoma/Zollinger–Ellison sendromu ve MEN1 bağlamı değerlendirilmelidir.
• Antrumdaki yoğun kontrastlanan nodülün otomatik olarak gNET kabul edilmemesi gerekir; glomus tümörü gibi diğer alt epitelyal lezyonlar da belirgin arteriyel kontrastlanma gösterebilir.

Kendini dene

1. Atrofik gastrit zemininde korpusta çok sayıda küçük kontrastlanan polipoid odak var. En olası gNET tipi hangisidir?

   • Tip I gastrik NET
   • Tip II gastrik NET
   • Tip III gastrik NET
   • Gastrik GİST
   Cevabı göster

   Tip I gastrik NET. Atrofik gastrit ve çoklu küçük korpus odakları tip I örüntüsüne uyar. Tip II gastrik NET gastrinoma/Zollinger–Ellison sendromuyla ve sıklıkla MEN1 ile ilişkilidir; Tip III genellikle tek ve 1 cm’den büyük sporadik lezyondur. Bu karşılaştırma görüntüleme bulgusuyla tek başına tip tayini sağlamaz.

2. Tip III gastrik NET saptandığında evreleme için hangi inceleme önerilir?

   • Abdominal BT
   • Kontrastsız kafa BT
   • HRCT toraks
   • Kemik algoritmalı BT
   Cevabı göster

   Abdominal BT. Kaynak, tüm Tip III gastrik NET’lerde abdominal BT’yi evreleme amacıyla önerir.

Kaynaklar

Bu sayfadaki 42 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 19 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.