Mezenterik lenfoma

Özet

Primer mezenterik lenfoma, mezenterik lenf nodlarından kaynaklanabilir ve sınırlı ya da daha yaygın hastalığın bir bileşeni olarak görülebilir. BT, mezenterik kitlenin boyutunu ve yayılımını değerlendirmeye, komşu yapılarla ilişkisini göstermeye yardımcı olur. Mezenterik damar ve yağın büyümüş lenf nodlarıyla sarılması, mezenterik lenfomada sandwich işareti olarak tanımlanır. Abdominal ve pelvik lenfomada nodal ve ekstranodal tutulum çeşitli komplikasyonlarla ortaya çıkabileceğinden, görüntüleme hastalık yaygınlığının ve komplikasyonların değerlendirilmesinde önemlidir.

Faz ve pencere

Portal tanısal

Kontrastlı portal venöz BT'de mezenterik nodlar çoğunlukla homojen yumuşak doku atenüasyonunda, tek tek veya birleşmiş kitle şeklinde görünür. SMA/SMV ve dallarının nodal yumuşak doku içinde sarılması, damar kalibresinin korunması ya da daralması; retroperitoneal nodlar, dalak, karaciğer ve bağırsak duvarı ile birlikte değerlendirilir.

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

BT bulguları

• Ultrasonografide mezenterik lenfoma hipoekoik kitle veya kalınlaşmış mezenterin sandwich görünümü şeklinde izlenebilir.
• Sandwich işareti — nodal kitle SMA/SMV'yi ve dallarını çevreler; damarlar kitle içinde uzanmayı sürdürür ve belirgin daralma olmadan izlenebilir.
• Büyük mezenterik nodal kitlelerde ince bağırsak anslarıyla ilişkisi değerlendirilmelidir.
• Retroperitoneal paraaortik, iliak veya diğer istasyonlardaki nodlar mezenter tutulumu ile birlikte bulunabilir.
• Lenfomada dalak ve bağırsak tutulumu eşlik edebilir.
• Tedavi edilmemiş nodal kitleler çoğunlukla homojen; nekroz veya kalsifikasyon varsa klinik bağlam ve önceki tedavi öyküsüyle birlikte yorumlanır.
• İleri hastalıkta kitle etkisi üreter, bağırsak veya mezenterik damar dallarına bası yapabilir; lümen açıklığı ve proksimal dilatasyon kaydedilir.
• Sandwich işareti, büyümüş mezenterik lenf nodlarının mezenterik damar ve yağı sarmasıyla oluşur; mezenterik lenfomada sık görülse de metastatik karsinom, Mycobacterium avium kompleksi ve tüberkülozda da görülebilir.

Normalde

Normal mezenterde lenf nodları küçük, ayrı ayrı ve yağ planlarıyla çevrili görünür; SMA/SMV dalları yumuşak doku kılıfı olmadan mezenterik yağ içinde seyreder. Aynı aksiyel/koronal düzeyde damarların iki yanındaki nodal dokuyu, damar lümeninin şeklini ve retroperitoneal nodal zincirleri karşılaştır; normalde tek bir yumuşak doku konglomerası damarları çevrelemez.

Ayırıcı tanı

Mezenterik pannikülit

yağ atenüasyonu artışı içinde küçük nodlar, damar çevresinde korunmuş yağ ve ince psödokapsül bulunabilir; lenfomadaki gibi solid birleşik nodal kitle baskın değildir.

İnce bağırsak nöroendokrin tümör metastazı

NET lokalizasyonunda, bağırsak distansiyonlu tamamlayıcı BT incelemesi lezyonların karakterizasyonunu ve birden fazla ince bağırsak odağının araştırılmasını sağlayabilir.

Peritoneal karsinomatozis

nodlar dışında peritoneal yüzey implantları, omental tutulum, asit ve bilinen primer tümör odağı aranır.

Tüberküloz lenfadeniti

santral nekrozlu nodlar ve peritoneal kalınlaşma/ asit gibi peritoneal enfeksiyon bulguları lenfomadan ayrılmaya yardım eder.

Castleman hastalığı

sınırlı tek veya az sayıda belirgin hipervasküler nodal kitle beklenir; yaygın homojen nodal konglomera daha az tipiktir.

Tuzaklar

• Sandwich işareti lenfomayı düşündürür ancak mutlak özgül değildir; damar lümeninin açık kalması, nodların dağılımı ve diğer istasyonlar beraber yorumlanmalıdır.
• Yağ halkası benzeri korunmuş perivasküler plan pannikülitte de görülebilir; asıl ayrım, lezyonun yağ merkezli inflamasyon mu yoksa nodal yumuşak doku konglomerası mı olduğudur.
• Nekrozsuz homojen lenf nodları kitle şeklinde birleşebilir; yalnızca nekroz yokluğuna dayanarak lenfomayı dışlama.
• Sadece mezenteri içeren sınırlı alan görüntülenmişse evreleme tamamlanmış sayılmaz; raporlanan inceleme alanında görülen nodal ve organ dağılımını açıkça belirt.

Kendini dene

1. Büyümüş mezenterik lenf nodları mezenterik damar ve yağı çevreliyor. Bu işaretin adı nedir?

   • Sandwich işareti
   • Yağ halkası işareti
   • Kahverengi yağ işareti
   • Hedef işareti
   Cevabı göster

   Sandwich işareti. Mezenterik damar ve yağın büyümüş lenf nodlarıyla sarılması sandwich işareti olarak adlandırılır. Bu görünüm, mezenterik damar ve yağın büyümüş lenf nodlarıyla sarılmasını tanımlar.

2. Kesitsel görüntülemede mezenterik damarlar ve yağ büyümüş mezenterik lenf nodlarıyla çevrelenmişse bu bulgunun adı nedir?

   • Sandwich işareti
   • Yağ halkası işareti
   • Hedef işareti
   • Misty mesentery
   Cevabı göster

   Sandwich işareti. Mezenterik damarlar ve yağın büyümüş mezenterik lenf nodlarıyla sarılması sandwich işareti olarak tanımlanır.

İlgili konular

• Mezenterik pannikülit
• Sklerozan mezenterit
• Mezenterik lenfadenit

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 17 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.