Kistik dejenerasyonlu PanNET

Özet

Kistik dejenerasyonlu pankreatik nöroendokrin tümör, kistik/nekrotik alanların eşlik ettiği ve tanınabilir canlı solid tümör bileşeni bulunabilen, çoğu kez işlevsel olmayan bir PanNET’tir. Kontrastlı BT'de kistik merkez çevresindeki canlı hiper-vasküler rim veya septalar tanısal ipucu verir. Arteriyel ve portal faz görüntüleri tümörün vasküler davranışını ve karaciğer metastazlarını saptamada önem taşır. Lezyon yalnız basit kist gibi değerlendirilirse solid tümör bileşeni ve karaciğer yayılımı gözden kaçabilir.

Faz ve pencere

Arteriyel tanısal

Kistik PanNET’lerde periferik kontrastlanma görülebilir; bazı olgularda kontrastlanan mural nodül ve iç septalar da eşlik edebilir.

Portal tanısal

Rim ve septaların devam eden kontrastlanması, komşu pankreas dokusuyla sınır ve portal fazda karaciğerdeki olası hipervasküler metastatik odaklar değerlendirilir.

BT bulguları

• Pankreas parankimi içinde iyi sınırlı, uniloküler veya bölmeli kistik-solid kitle
• Merkezde kontrastlanmayan hipodens sıvı/nekroz alanı
• Arteriyel fazda kalın hiper-vasküler periferik tümör rimi veya canlı mural nodül
• Kontrastlanan iç septalar ya da kistik boşluğa uzanan solid doku
• Büyük lezyonda intratümöral kanama veya heterojen nekrotik bileşen
• Ana pankreatik kanalda çoğu kez belirgin genişleme olmadan ekzofitik büyüme
• Karaciğerde arteriyel fazda belirginleşebilen hipervasküler metastatik odaklar

Normalde

Normal pankreas parankimi homojen kontrastlanır ve içinde kontrastlanmayan kistik merkezle çevrelenmiş kalın, canlı bir rim bulunmaz. Aynı pankreas düzeyinde ana kanalın kalibresini, lezyonun parankime göre kontrastlanma yoğunluğunu ve karaciğer fazında yeni hipervasküler odak olup olmadığını karşılaştır.

Ayırıcı tanı

Solid psödopapiller neoplazm

kapsüllü, hemorajik merkezli kitle ve daha heterojen solid kontrastlanma öne çıkar; kistik PanNET'te hiper-vasküler rim daha karakteristiktir.

Seröz kistik neoplazm

çok sayıda küçük kist ve ince septalar oluşturur; belirgin hiper-vasküler canlı tümör duvarı tipik değildir.

Müsinöz kistik neoplazm

kalın duvarlı makrokist ve septalar görülebilir; arteriyel fazda çevresel canlı dokunun belirgin hiper-vaskülerliği PanNET lehinedir.

Pankreatik psödokist akut veya kronik pankreatitle ilişkili olabilir; kistik PanNET ise görüntülemede psödokistlerle karışabilir ve bazı olgularda kontrastlanan mural nodül gösterebilir.

Pankreatik duktal adenokarsinom

radyolojik olarak diğer kistik lezyonlarla karışabilir; kesin tanı için histopatolojik inceleme gereklidir.

Solid psödopapiller neoplazm özellikle genç kadınlarda görülür; kapsüllü, solid-kistik ve kanama ya da nekroz içerebilen görünümü kistik PanNET ile ayırıcı tanı gerektirir.

Tuzaklar

• Kistik PanNET'in canlı rim kontrastlanması her olguda belirgin olmayabilir; yalnız rim yokluğuna dayanarak tanıyı dışlama ve portal faz/ince kesitleri de incele.
• Periferik halka şeklindeki kontrastlanma yalnız tümör yatağını gösterir; lezyonun tamamını solid sayma, merkezî kontrastlanmayan nekrotik-kistik kısmı ayrıca tanımla.
• Küçük hipervasküler karaciğer odakları portal fazda silikleşebilir; arteriyel karaciğer görüntülerini primer pankreas kitlesiyle birlikte gözden geçir.
• Kistik PanNET’ler diğer pankreatik kistik neoplazileri taklit edebilir; bu nedenle periferik kontrastlanma görülen kistik lezyonlarda canlı duvar, septa veya mural nodül bileşeni diğer kistik tümörlerle birlikte değerlendirilmelidir.

Kendini dene

1. Kontrastlı BT’de pankreatik nöroendokrin tümörlerin tipik görünümü hangisidir?

   • Yuvarlak, solid ve hipervasküler kitle
   • İnce duvarlı, yalnızca sıvı içeren kist
   • Pankreas kanalını dolduran taş
   • Yağ yoğunluğunda homojen kitle
   Cevabı göster

   Yuvarlak, solid ve hipervasküler kitle. Kaynakta pankreatik nöroendokrin tümörlerin kontrastlı BT’de tipik olarak yuvarlak, solid ve hipervasküler kitleler şeklinde görüldüğü belirtiliyor.

2. Kistik pankreas kitlesinin duvarı arteriyel fazda parlak kontrastlanıyor; hangi bileşen bu parlaklığı oluşturur?

   • Canlı nöroendokrin tümör
   • Basit kist sıvısı
   • Müsin içeriği
   • Pankreatit sıvısı
   Cevabı göster

   Canlı nöroendokrin tümör. Hiper-vasküler kontrastlanma canlı nöroendokrin tümör dokusundan kaynaklanır. Basit sıvı, müsin ve inflamatuvar koleksiyon kontrastlanmaz; duvarda kontrastlanan yumuşak doku görülmesi neoplastik bileşeni gösterir.

İlgili konular

• Pankreatik psödokist
• Pankreas metastazı

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 6 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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