Over epitel tümörü ve karsinomatozis

Özet

Over epitel kanseri çoğu kez ileri evrede saptanır ve kompleks adneksiyel kitleye eşlik eden peritoneal yayılım, asit veya lenf nodu metastazlarıyla ortaya çıkabilir. İntravenöz kontrastlı abdomen-pelvis BT, hastalık dağılımını haritalar, uzak yayılımı araştırır ve cerrahi planlama için rezektabiliteyi etkileyen bölgeleri gösterir. İnce serozal ve mezenterik implantları BT kaçırabileceğinden görüntüleme yayılımı olduğundan az gösterebilir; negatif BT mikroskopik hastalığı dışlamaz. Omental, diyafragmatik veya bağırsak mezenteri tutulumunun atlanması evre ve tedavi planlamasını değiştirebilir.

Faz ve pencere

Portal tanısal

İntravenöz kontrastlı portal venöz abdomen-pelvis serisinde kompleks solid-kistik adneksiyel kitle, kontrastlanan mural nodüller, omental ve peritoneal yumuşak doku implantları, asit, karaciğer/dalak kapsülü odakları ve pelvik-paraaortik lenf nodları değerlendirilir.

BT bulguları

• Uterus yanından köken alan, kalın septalı veya papiller/solid kontrastlanan bileşenleri olan kompleks adneksiyel kitle
• Pelvik periton ve Douglas boşluğunda nodüler yumuşak doku implantları
• Omental yağın düzensiz yumuşak doku ile yer değiştirmesi veya plak biçimli omental kek
• Mezenterik kök, ince bağırsak serozası ve parakolik oluklarda implantlar; kümelenmiş anslar ya da retraksiyon
• Diyafram altı peritonunda ve karaciğer/dalak kapsülü boyunca nodüller; parankim içi metastazdan ayır
• Pelvik ve paraaortik zincirde yuvarlaklaşmış, nekrotik veya kümelenmiş lenf nodları
• Asit ve peritoneal yağ dokusu infiltrasyonu sık görülür; nodüler implantlar eşlik edebilir.
• Plevral sıvı, karaciğer parankim odakları veya karın dışı lenfadenopati gibi uzak yayılım işaretleri

Ölçütler ve sınıflamalar

FIGO over, tuba uterina ve periton kanseri evrelemesi (2014; 2025 güncelleme yazısında özetlenen)

FIGO evre IC1 cerrahi dökülmeyi, IC2 ameliyat öncesi kapsül rüptürünü veya over ya da tüp yüzeyindeki tümörü, IC3 ise asit veya peritoneal yıkama sıvısında malign hücre bulunmasını ifade eder. FIGO evre IIIA1, intraperitoneal yayılım olmaksızın yalnız retroperitoneal lenf nodu metastazını tanımlar: IIIA1(i) en büyük boyutu ≤10 mm, IIIA1(ii) ise >10 mm olan metastazdır; IIIA2, pozitif retroperitoneal lenf nodu olsun veya olmasın mikroskopik pelvik dışı peritoneal tutulumdur. Evre IV over kanserinde en sık uzak yayılım alanı malign plevral efüzyondur; Evre IVA tanısı için pozitif sitoloji gerekir. BT, over kanserinde hastalık yayılımını ameliyat öncesinde değerlendirmede kullanılır; FIGO evrelemesi anatomik yayılım kategorilerini tanımlar.

Normalde

Peritoneal karsinomatoziste sık görülen BT bulguları asit, nodüler implantlar ve peritoneal yağlı dokuda infiltrasyondur. Peritoneal implantları pelvik peritoneal yansımalar, sağ ve sol parakolik oluklar, sigmoid mezokolonun üst bölümü, ileokolik alan ve sağ subdiyafragmatik boşlukta sistematik olarak ara.

Ayırıcı tanı

Peritoneal metastaz yapan gastrointestinal sistem primerleri arasında kolorektal ve mide maligniteleri bulunur.

Primer peritoneal seröz karsinom

yaygın peritoneal hastalık ve asit olabilir; belirgin over kaynaklı kitle bulunmaması ayırıcıdır.

Tubo-ovaryan apse

kalın duvarlı kompleks koleksiyon ve çevresinde belirgin inflamatuvar yağ değişikliği vardır; omental implant paterni beklenmez.

Peritoneal tüberküloz

düzgün peritoneal kalınlaşma, nekrotik nodlar ve septalı asit görülebilir; klinik bağlam ve mikrobiyoloji gerekir.

Tuzaklar

• BT, küçük hacimli peritoneal yayılımı saptamada daha az duyarlıdır; özellikle ince bağırsak ve mezenter tutulumunu olduğundan az gösterebilir.
• Karaciğer yüzeyindeki scalloping bulgusunu karaciğer içindeki odaklardan ayrı değerlendirin.
• Asit ve peritoneal kalınlaşma enfeksiyöz veya inflamatuvar olabilir; nodüler dağılımı, omental dokuyu ve olası primer kitleyi birlikte yorumlayın.
• Pelvik-paraaortik lenf nodları boyutça küçükken metastatik olabilir; boyut eşiğinin altında olmaları tümöral tutulumu dışlamaz.
• BT, hastalık yayılımını haritalayıp optimal sitoredüktif cerrahiyi sınırlayabilecek bölgeleri göstermede kullanılır; ancak cerrahi sonucu tek başına güvenilir biçimde öngöremez.
• Rapor, yayılımı cerrahi açıdan önemli bölgeler bazında haritalamalıdır; kesitsel görüntülemenin özellikle ince bağırsak ve mezenter tutulumunu saptamadaki doğruluğu sınırlıdır.

Kendini dene

1. Kompleks over kitlesine omental kek, mezenter nodülleri ve asit eşlik ediyor. BT'nin temel katkısı nedir?

   • Yayılım dağılımını haritalamak
   • Histolojik alt tipi kanıtlamak
   • Mikroskopik evreyi kesinlemek
   • BRCA durumunu belirlemek
   Cevabı göster

   Yayılım dağılımını haritalamak. Kontrastlı BT, makroskopik peritoneal ve uzak yayılım dağılımını göstererek evreleme öncesi haritalama ve cerrahi planlamaya katkı verir. Histoloji ve moleküler durum görüntülemeyle belirlenmez; mikroskopik yayılım BT'de dışlanamaz.

2. Evre IV over kanserinde en sık görülen uzak metastaz alanı hangisidir ve pozitif sitoloji hangi evreyi tanımlar?

   • Plevra; IVA
   • Karaciğer parankimi; IVB
   • Kemik; IVB
   • Beyin; IVB
   Cevabı göster

   Plevra; IVA. Malignan plevral efüzyon Evre IV over kanserinin en sık görülen uzak metastaz alanıdır ve pozitif sitoloji IVA tanısı için gereklidir.

İlgili konular

• Tesadüfi adneksiyel kist veya kitle

Kaynaklar

Bu sayfadaki 41 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 7 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.