Matür mediastinal teratom

Özet

Matür mediastinal teratom, genellikle prevascular ön mediastende yerleşen ve farklı germ yaprağı dokularını içerebilen germ hücreli tümördür. BT'nin en değerli katkısı yağ, sıvı, yumuşak doku ve kalsiyum bileşenlerini aynı kitle içinde göstermesidir; bu bileşenlerin birlikteliği tanı için güçlü bir örüntüdür. Kitle çoğunlukla iyi sınırlı olsa da komşu akciğer, plevra veya perikarda açılarak rüptüre olabilir. Plevral efüzyon, anterior mediastinal teratomun nadir bir belirtisi olduğundan hekimleri yanıltabilir.

Faz ve pencere

Kontrastsız tanısal

BT'de makroskopik yağ, sıvı ve kalsifikasyon aynı kitlede görülebilir; bu birliktelik matür teratomu destekler.

Venöz tanısal

Kontrastlı BT'de kitle içinde hafif kontrastlanan solid bileşen ve duvar kalınlaşmalı septalar görülebilir.

BT bulguları

• Anterior-superior mediastende iyi sınırlı, multiloküle kistik kitle görülebilir.
• Aynı lezyon içinde makroskopik yağ, sıvı ve yumuşak doku atenüasyonlarının karışımı.
• Kitle içinde makroskopik yağ ve sıvı bileşenlerinin birlikte bulunması matür teratomun tipik BT bulgularındandır.
• Duvar veya iç septalarda kalsifikasyon görülebilir.
• Kontrastlanan solid bileşen, teratomun içindeki yumuşak doku elemanlarını kistik içerikten ayırır.
• Rüptüre teratom plevral veya perikardiyal boşluklara, akciğere ya da bronşlara uzanabilir.
• Rüptür kuşkusunda, kitlenin plevral veya perikardiyal boşluklara, akciğere ya da bronşlara uzanımını ve eşlik eden plevral sıvıyı değerlendirin.
• Matür mediastinal teratomlarda tipik yağ veya kalsifikasyon bulguları bulunmayabilir; kistik bileşenin baskın olduğu lezyonlarda BT görünümü değişken olabilir.

Normalde

BT'de kitlenin komşu yapılardaki bası etkisini ve plevral veya perikardiyal boşluklara ya da akciğere olası rüptürünü değerlendir. Timus yaşla ilişkili görüntüleme değişiklikleri gösterir.

Ayırıcı tanı

İmmatür/malign teratomlarda daha büyük, düzensiz solid bileşenler ve az miktarda yağ görülebilir.

Daha büyük, düzensiz solid bileşenleri ve az miktarda yağı bulunan teratomlar immatür veya malign teratom lehine olabilir; malign dönüşümü yalnızca klinik ve radyolojik değerlendirmeyle ayırt etmek güçtür, histopatolojik inceleme gerekir.

Timolipom, anterior mediastende baskın yağ atenüasyonlu kitle olarak görülebilir.

Kistik timoma, ön mediastende multiloküle kistik kitle ve hafif kontrastlanan solid bileşen ya da duvar kalınlaşmalı septalarla ayırıcı tanıda düşünülebilir.

Tuzaklar

• Kitlede yağ bulunması tek başına teratom tanısı koydurmaz; timolipom ve lipomatöz tümörleri ayırmak için kistik bileşen, kalsifikasyon ve kapsül örüntüsünü birlikte değerlendir.
• Kontrastlı BT'de kitle içinde hafif kontrastlanan solid bileşen ve duvar kalınlaşmalı septalar bulunabileceğini göz önünde bulundur.
• Rüptüre teratom komşu plevral veya perikardiyal boşluklara, akciğere ya da bronşlara uzanabilir.
• Yalnız en belirgin aksiyel kesiti incelemek rüptür yolunu saklayabilir; koronal ve sagittal rekonstrüksiyonlarda plevra, perikard ve bronşlarla devamlılığı izle.

Kendini dene

1. BT'de kistik kitle içinde makroskopik yağ ve kalsifikasyon görülmesi en çok hangi tanıyı destekler?

   • Matür teratom
   • Timolipom
   • Kistik timoma
   • Mediastinal lenfoma
   Cevabı göster

   Matür teratom. Matür teratomlar tipik olarak kistik kitle içinde yağ ve kalsifikasyon gösterebilir.

2. Mediastinal matür teratom hangi komplikasyonla plevral veya perikardiyal boşluklara, akciğere ya da bronşlara uzanabilir?

   • Rüptür
   • Lenfatik yayılım
   • Venöz tromboz
   • Timik involüsyon
   Cevabı göster

   Rüptür. Mediastinal matür teratom rüptürü plevral veya perikardiyal boşluklara, akciğere ya da bronşlara uzanabilir.

İlgili konular

• Timik kist
• Mediastinal seminom
• Nonseminomatöz mediastinal germ hücreli tümör

Kaynaklar

Bu sayfadaki 34 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 12 cümle bu karşılaştırmada düzeltildi (2026-10-10).

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