Solid psödopapiller neoplazm (SPN)

Özet

Solid psödopapiller neoplazm, çoğunlukla genç kadınlarda görülen, düşük dereceli malign potansiyelli ve sıklıkla iyi sınırlı pankreas tümörüdür. BT'de solid doku ile kistik/hemorajik alanların bir arada bulunması ve kapsül, tanımayı kolaylaştırır. Kontrastlı çok fazlı BT, tümörün iç mimarisini, kanama odaklarını ve komşu damarlarla ilişkisini göstererek evrelemeye katkı sağlar. Büyük kistik lezyon ya da psödokist sanılıp mural solid bileşen gözden kaçarsa neoplastik kitle yanlış sınıflanabilir.

Faz ve pencere

Kontrastsız tanısal

Kistik alan içinde kanama varsa sıvıdan daha yüksek atenüasyonlu içerik görülebilir; periferik kabuk kalsifikasyonu da bu fazda seçilebilir.

Arteriyel tanısal

Kapsül ve periferik solid tümör dokusu kontrastlanır; merkezdeki dejeneratif kistik alanlar genellikle kontrastlanmadan kalır ve hiper-vasküler PanNET'ten daha az yoğun boyanma eğilimindedir.

Portal tanısal

Solid bileşenin heterojen kontrastlanması, kapsül, çevre organlara bası/uzaklaştırma ve olası karaciğer odakları değerlendirilir.

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

BT bulguları

• Pankreas içinde keskin sınırlı, yuvarlak veya lobüle, kapsüllü kitle
• Periferde canlı solid doku ile merkezde dejeneratif kistik alanların birlikte bulunması
• Kistik bölümde kanamaya bağlı yüksek atenüasyonlu içerik veya sıvı-debris seviyesi
• Arteriyel ve portal fazlarda değişken, çoğunlukla heterojen periferik solid bileşen kontrastlanması
• Lezyon çevresinde ince kapsül ve olası periferik kalsifikasyon
• Büyük kitlelerde çevre damar ve organları invaze etmekten çok yer değiştirme eğilimi
• İleri olguda karaciğer veya peritoneal metastatik odaklar

Normalde

Normal pankreas homojen parankim yapısındadır; solid psödopapiller neoplazm ise sıklıkla gövde ve kuyrukta yerleşen, iyi sınırlı ve kapsüllü bir kitle olarak görünür. Aynı kesit düzeyinde lezyonun parankim içindeki merkezini, ana kanalın itilip itilmediğini ve splenik damarların invazyon yerine düzgünce yer değiştirip değiştirmediğini kıyasla.

Ayırıcı tanı

Kistik PanNET

Arteriyel fazda mural doku belirgin biçimde hipervasküler kontrastlanır; SPN'nin solid bileşeni ise genellikle daha heterojen ve daha az yoğun kontrastlanır.

Pankreatik psödokist

yakın dönem pankreatit, çevre yağ dokusu inflamasyonu ve duvarı olmayan/ince duvarlı sıvı koleksiyonu destekler; SPN'de kapsüllü solid doku vardır.

Müsinöz kistik neoplazm

genellikle gövde ve kuyrukta yerleşen, septalı ve mukin dolu kistik yapılar olarak görünür; SPN ise sıklıkla kanama ve nekroza bağlı hemorajik solid-kistik komponentlerle karışık yapıda olup görüntüleme ile MCN'ye benzediği bilinmektedir.

Pankreatoblastom

özellikle çocukta büyük lobüle kitle, kalsifikasyon ve çevre dokulara invazyon SPN'den daha çok bu tanıyı destekler.

Asiner hücreli karsinom

nadir bir malign epitelial tümör olup, görüntüleme açısından SPN ile karıştırılabilmekte ve bazen yüksek alfa-fetoprotein düzeyi ile fark edilebilmektedir.

Tuzaklar

• Merkezdeki kan ürünleri kontrastsız BT'de yoğun görünüp solid doku sanılabilir; aynı alanın kontrast sonrası davranışını karşılaştır ve gerçek kontrastlanan periferik dokuyu ayrı işaretle.
• Küçük SPN tamamen solid olabilir; belirgin kistik bileşen olmaması tanıyı tek başına dışlamaz, iyi sınırlı kapsül ve yaş/klinik bağlam önemlidir.
• Çevre damarların itilmesi invazyonla karıştırılabilir; damar konturunun korunması ve kitle ile damar arasında düzlem bulunması bası etkisini destekler.

Kendini dene

1. Genç erişkinde kapsüllü pankreas kitlesi; merkezinde kanama, çevresinde heterojen solid kontrastlanan doku var. En olası tanı?

   • Solid psödopapiller neoplazm
   • Kistik PanNET
   • Müsinöz kistik neoplazm
   • Pankreatik psödokist
   Cevabı göster

   Solid psödopapiller neoplazm. Kapsül, hemorajik dejenerasyon ve periferik solid doku birlikteliği SPN için tipiktir. PanNET daha belirgin arteriyel hiper-vaskülerlik gösterebilir; müsinöz kistik neoplazm çoğunlukla multiloküle makrokisttir; psödokistte solid neoplastik doku beklenmez.

2. Pankreas kuyruğundaki kitle splenik damarları düzgün konturları korunarak öteliyor. Bu ilişki en çok neyi gösterir?

   • Kitle etkisi
   • Damar invazyonu
   • Tümör trombozu
   • Psödokist rüptürü
   Cevabı göster

   Kitle etkisi. Damar konturları korunarak yer değiştiriyorsa bası ve deplasman daha olasıdır. Damarların düzgün konturları korunarak yer değiştirmesi kitle etkisini destekler; bu bulgu tek başına invazyonu göstermez.

İlgili konular

• Pankreatik psödokist
• Pankreas metastazları

Kaynaklar

Bu sayfadaki 37 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 6 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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