Kromofob renal hücreli karsinom

Özet

Kromofob renal hücreli karsinom, kortikal kökenli ve diğer RCC alt tipleriyle görüntüleme bulguları örtüşebilen solid bir böbrek tümörüdür. Kontrastlı BT'de kitle genellikle iyi sınırlı ve homojen görünümlüdür; orta düzeyde kontrastlanır ve kontrastlanması normal korteksten ve berrak hücreli RCC'den genellikle daha düşüktür. Merkezi yıldızsı skar veya spoke-wheel kontrastlanma görülebilir ancak onkositomla ortak özelliklerdir ve tanı koydurmaz. Görünümü kesin histoloji gibi yorumlamak benign onkositomla karışıklığa veya tümör yayılımının yetersiz değerlendirilmesine yol açabilir.

Faz ve pencere

Kontrastsız tanısal

Kromofob RCC'de BT'de kalsifikasyon görülebilir; ancak kesitsel görüntülemede patognomonik özellik olmadığından kalsifikasyon tek başına histolojik ayrım sağlamaz.

Arteriyel tanısal

Kontrastlanma orta düzeydedir ve arteriyel/kortikomedüller fazda bile normal korteksten ve berrak hücreli RCC'den daha düşük yoğunluktadır.

Nefrografik tanısal

Nefrografik fazda kromofob kitleler genellikle görece homojendir ve berrak hücreli RCC'den daha az kontrastlanır; tümör içinde merkezi yıldızsı skar görülebilirken nekroz veya kistik değişiklikler nadirdir.

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

BT bulguları

• Korteksten köken alan, genellikle iyi sınırlı ve ekspansil büyüyen solid renal kitle.
• Kontrastlanma genellikle berrak hücreli RCC'den düşüktür; tümör ile bitişik korteks arasında fazlar boyunca kıyaslama yapılmalıdır.
• Kromofob RCC BT'de genellikle solid bir kitle olarak izlenir; santral skar görülebilir, nekroz ise nadirdir. Kromofob RCC'de BT'de nekroz nadir görülür.
• Merkezi yıldızsı skar kitlelerin yaklaşık yüzde yirmisinde görülebilir; bu bulgu onkositomda da izlenir ve özgül değildir.
• Kitlelerde kalsifikasyon görülebilir (14–34%); ancak tek başına kalsifikasyon alt tipi belirlemez.
• Kromofob RCC genellikle renal parankimle sınırlı kalır; metastaz geliştiğinde karaciğer, akciğer, kemik, adrenal bez ve periton tutulabilir.

Normalde

Normal korteks, kromofob RCC kitlesinden tüm kontrastlı fazlarda daha fazla kontrastlanır. Kitleyi aynı böbreğin sağlam korteksiyle fazlar boyunca karşılaştırın ve olası santral skarın normal renal sinüs yağından farklı, tümör içinde yerleşmiş olduğunu doğrulayın.

Ayırıcı tanı

Onkositom

merkezi yıldızsı skar ve homojen yapı kromofob RCC ile örtüşebilir; görüntüleme ile kesin ayrım çoğu zaman mümkün değildir.

Papiller RCC, belirsiz renal kitlelerin görüntüleme ayırıcı tanısında kromofob RCC ile birlikte değerlendirilir.

Berrak hücreli RCC, kromofob RCC'ye göre genellikle daha fazla kontrastlanır.

Yağsız anjiyomiyolipom

makroskopik yağ göstermeyen solid kitle olarak örtüşür; homojen kontrastlanma histoloji ayrımı sağlamaz.

Tuzaklar

• Merkezi yıldızsı skarı onkositom ya da kromofob RCC için özgül kabul etmeyin; her iki lezyonda da benzer şekilde görülebilir.
• Kitle boyutu ve homojenlik iyi huyluluk kanıtı değildir; kromofob RCC büyük ve düzenli sınırlı görünebilir.
• Tek faz kontrastlanma ölçümü alt tip ayrımını zayıflatır; kortikomedüller ve nefrografik görünümü birlikte okuyun.

Kendini dene

1. BT'de kromofob RCC için santral yıldızsı skar hangi sıklıkta bildirilmiştir ve bu bulgu nasıl yorumlanmalıdır?

   • %19–34; tanı koydurucu değildir
   • Yaklaşık %100; kromofob RCC'ye özgüdür
   • %1'den az; onkositomu kesinleştirir
   • %50'den fazla; berrak hücreli RCC'yi gösterir
   Cevabı göster

   %19–34; tanı koydurucu değildir. Kaynakta BT'de santral skar %19–34 oranında bildirilmiştir; kromofob RCC için kesitsel görüntülemede patognomonik bulgu yoktur.

2. Kromofob RCC'de kontrastlanma normal renal kortekse göre nasıldır?

   • Tüm fazlarda daha düşüktür
   • Tüm fazlarda daha yüksektir
   • Yalnız nefrografik fazda daha yüksektir
   • Tüm fazlarda korteksle aynıdır
   Cevabı göster

   Tüm fazlarda daha düşüktür. Kromofob RCC, tüm fazlarda renal korteksten daha az kontrastlanır.

İlgili konular

• Berrak hücreli renal hücreli karsinom
• Papiller renal hücreli karsinom
• Kistik renal hücreli karsinom

Kaynaklar

Bu sayfadaki 33 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 15 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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