Klinik Atölye

Pankreas · Patoloji · Orta öncelik

Asiner hücreli karsinom

Acinar cell carcinoma

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Asiner hücreli karsinom: yayımlanmış olgu görüntüsü, aksiyel kesit

4 adım

Görüntü: Hellerhoff, “Azinuszellkarzinom des Pankreasschwanz - CT axial”, Wikimedia Commons · CC BY-SA 3.0. Değişiklik: kırpıldı, yeniden boyutlandırıldı, odak işaretleri eklendi.

Özet

Pankreatik asiner hücreli karsinom, pankreasın asiner hücrelerinden gelişen nadir bir malignitedir ve çoğunlukla büyük, oval, iyi sınırlı, solid bir kitle olarak görülür. Kontrastlı BT'de heterojen boyanma, nekroz ve ekzofitik büyüme görülebilir; duktal adenokarsinomun aksine belirgin kanal genişlemesi olmayabilir. Pankreas protokolü ve portal faz görüntüleri tümör sınırlarını, damar ilişkisini ve karaciğer/peritoneal yayılımı ortaya koyar. Kanal tıkanması yok diye kitle gözden kaçırılırsa tanısal gecikme ve evreleme eksikliği oluşabilir.

Faz ve pencere

Arteriyel tanısal
Tümör çoğunlukla normal pankreas dokusuna göre heterojen ve daha düşük ya da değişken kontrastlanır; canlı periferik alanlar nekrotik merkezden ayrılabilir.
Portal tanısal
Kitle sınırı ve ekzofitik uzanım, portal/mezenterik ven ve splenik damarlarla temas, karaciğer metastazları ve peritoneal nodüller değerlendirilir.

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

BT bulguları

  • Pankreasın herhangi bir bölümünde iyi sınırlı, oval ya da yuvarlak solid kitle
  • Ekzofitik büyüyen veya pankreas konturunu lobüle biçimde genişleten kitle
  • Kontrastlı BT'de heterojen kontrastlanma
  • Büyük tümörde merkezî hipodens nekroz, kistik dejenerasyon veya kanama
  • Tümör boyutuna kıyasla ana pankreatik kanal genişlemesinin hafif olması ya da bulunmaması
  • Damarları çevrelemek yerine itebilen kitle; ileri olguda doğrudan damar veya komşu organ tutulumu
  • Karaciğer, periton veya uzak lenf düğümlerinde metastatik hastalık
  • Asiner hücreli karsinomda kontrastlanma heterojen olabilir; kaynaklarda kitle çoğunlukla iyi sınırlı olarak tanımlanır. BT bulguları histopatolojik tanının yerine geçmez.

Normalde

Normal pankreas başı, gövdesi ve kuyruğu çevre yağ dokusundan seçilen, homojen kontrastlanan bir parankim şeridi oluşturur; kontur dışına taşan solid kitle görülmez. Pancreatik kanal dilatasyonunu, vasküler ilişkileri ve karaciğer ile peritoneumda metastazı değerlendirmeye çalış.

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 s0541; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Pankreatik duktal adenokarsinom
infiltratif hipoenhans kitle, ana kanal kesilmesi ve distal parankim atrofisi daha tipiktir.
PanNET’ler BT’de iyi sınırlı ve hiperenhans kitleler olarak görülebilir; asiner hücreli karsinomda kontrastlanma heterojen olabilir ve tümörlerin çoğu çevre pankreas parankiminden daha az vaskülerdir.
SPN’de kitle kapsüllü olabilir; merkezî kistik bileşen çevresindeki solid bileşenlerle birlikte bulunabilir ve heterojen görünüm hemorajik ya da nekrotik içeriği yansıtabilir.
Pankreatoblastom
çocukta görülme olasılığı, lobüle büyük kitle ve kalsifikasyon tanıyı öne çıkarır; erişkin asiner karsinomda yaş ve bağlam farklıdır.
Pankreatik metastaz
bilinen primer malignite ve birden çok parankimal odak metastazı destekler; primer asiner tümör çoğunlukla dominant tek kitle şeklindedir.

Tuzaklar

  • Ana kanalın genişlememesi kitleyi dışlamaz; pankreas boyunca duktal obstrüksiyon yerine parankimal kontur bozulmasını ve ekzofitik bileşeni ara.
  • Nekrotik merkez nedeniyle kitle kistik neoplazm veya psödokist gibi görünebilir; çevrede nodüler kontrastlanan solid dokunun varlığını kontrol et.
  • Karaciğer metastazları PACC’de görülebilir; incelemede karaciğeri metastaz açısından değerlendir.

Kendini dene

  1. Kontrastlı BT’de asiner hücreli karsinom için kaynakta tarif edilen görünüm hangisidir?

    Cevabı göster

    Heterojen kontrastlanan, solid ve iyi sınırlı lezyon. Asiner hücreli karsinom kontrastlı BT’de heterojen kontrastlanan, solid ve iyi sınırlı bir lezyon olarak tarif edilir.

  2. Büyük asiner hücreli karsinomlarda hangi intratümöral değişiklikler görülebilir?

    Cevabı göster

    Nekroz, kistik değişiklikler veya tümör içi kanama. Büyük asiner hücreli karsinomlarda nekroz, kistik değişiklikler ve tümör içi kanama görülebilir.

Kaynaklar

Bu sayfadaki 34 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 7 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.