Over fibrom/tekomu ve Meigs örüntüsü

Özet

Over fibromu ve tekomu seks-kord stromal tümörlerdir; fibromlar çoğunlukla iyi sınırlı, solid kitlelerdir ve hafif kontrastlanabilir. Asit ve plevral efüzyonla birlikte görüldüğünde fibrom benzeri benign tümör Meigs örüntüsünü düşündürür, ancak BT tek başına benigniteyi kanıtlamaz. Kontrastlı abdomen-pelvis BT, kitlenin over kökenini ve peritoneal yayılım olup olmadığını araştırırken toraks kapsamı plevral sıvıyı gösterir. Bu örüntünün epitelyal over kanseri sanılması evreleme ve klinik yorumda yanılgıya yol açabilir; malignite bulguları da ayrıca aranmalıdır.

Faz ve pencere

Portal tanısal

Adneksiyel solid veya solid-kistik kitleye asit ve plevral efüzyon eşlik edebileceğinden, görüntü alanındaki bu bulguları değerlendir.

BT bulguları

• Fibrom/tekom çoğunlukla tek taraflı, düzgün veya hafif lobüle sınırlı, overle devamlılığı gösterilebilen solid adneksiyel kitledir.
• Solid doku uterus miyometriyumuna yakın veya daha düşük atenüasyonda olabilir ve kontrast sonrası genellikle hafif-orta derecede boyanır.
• Fibromlarda stromal ödem, kistik dejenerasyon ve iskemiye bağlı nekroz görülebilir; nekroz tek başına malignite göstergesi değildir.
• Meigs örüntüsünde tümörle birlikte asit ve plevral efüzyon bulunur; plevral sıvı sıklıkla sağda belirgin olabilir.
• Benign fibrom lehine destekleyici bağlamda peritoneal nodül, omental kek veya düzensiz solid invazyon görülmemesi beklenir; yoklukları maligniteyi kesin dışlamaz.
• Tekomalar ve fibrothekomalar hiperöstrojenizmle ilişkili olabilir; endometrial hiperplazi veya polip eşlik edebilir.
• Overden bağımsız leiomyom veya ligament kaynaklı kitle olasılığında uterusla köprüleşen damarlar ve over damar pedikülünün yönü değerlendirilir.

Normalde

Aynı pelvik seviyede kitle ile over dokusu arasındaki devamlılığı, karşı overi, uterusla damar bağlantılarını ve peritoneal yüzeyleri kıyasla.

Ayırıcı tanı

Epitelyal over kanseri

papiller/solid düzensiz bileşen, bilateral kitle, omental kalınlaşma veya peritoneal implantlar daha kuşkuludur.

Pedinküllü uterin leiomyom

myometriyumla devamlılık veya köprüleşen uterin damarlar bulunabilir; over ayrı seçilebilir.

Over metastazı

bilateralite, çok odaklı peritoneal hastalık ve bilinen gastrointestinal ya da meme primeri ikincil kökeni destekler.

Sklerozan stromal tümör

MR'da periferik hiperintensite gösterebilir.

Over fibrosarkomu

yüksek mitotik aktivite (>3/10 HPF) ve sitolojik atipi, benign selülar fibromadan ayrılmasını sağlar.

Tuzaklar

• Asit ve plevral efüzyon maligniteye özgü değildir; solid kitlenin sınırlarını ve omentum/peritonu tek tek incelemeden yalnız sıvı varlığıyla kanser evresi çıkarma.
• Fibromda nekroz çoğunlukla iskemiktir ve tek başına malignite göstergesi sayılmamalıdır; Meigs ile ilişkili fibrothekoma peritoneal nodüllerle karsinomatozu taklit edebilir.
• Yüksek CA-125 Meigs örüntüsünde de görülebilir; BT'de CA-125 değerini görüntüleme bulgusu gibi kullanma.
• Kitle uterusla bitişikse over kökenini varsayma; over damar pedikülü, uterin damar köprüleri ve karşı overi birlikte izle.
• Klasik Meigs tanımı için fibroma/fibroma benzeri benign tümörle birlikte asit ve plevral efüzyonun bulunması, ayrıca sıvıların tümör çıkarıldıktan sonra gerilemesi gerekir; yalnız BT’deki üçlü görünüm sendromu doğrulamaz.

Kendini dene

1. Postmenopozal hastada düzgün sınırlı, hafif boyanan tek taraflı solid over kitlesi; asit ve sağ plevral efüzyon var, implant yok. Örüntü hangisidir?

   • Meigs örüntülü fibrom
   • Seröz over karsinomu
   • Krukenberg metastazı
   • Over lenfoması
   Cevabı göster

   Meigs örüntülü fibrom. Fibrom benzeri solid over tümörü, asit ve plevral efüzyon birlikteliği Meigs örüntüsünü destekler. Seröz karsinom ve metastazda peritoneal hastalık veya bilateral/kompleks kitleler daha kaygı vericidir; lenfoma çoğunlukla iki overi ve nodal istasyonları tutar. Bu, görüntüleme örüntüsüdür; klasik Meigs sendromu tümör çıkarıldıktan sonra efüzyonların gerilemesiyle doğrulanır.

2. Adneksiyel solid kitle ile uterus arasında köprüleşen damarlar izleniyor; kitle over damar pedikülünden ayrı. En olası kaynak nedir?

   • Pedinküllü leiomyom
   • Over fibromu
   • Over metastazı
   • Granüloza hücreli tümör
   Cevabı göster

   Pedinküllü leiomyom. Myometriyumla damar köprüleşmesi ve over pedikülünden ayrılık pedinküllü uterin leiomyom kökenini destekler. Over fibromu ve granüloza tümörü overle ilişkili olur; metastaz için bu damar paterni tipik değildir.

İlgili konular

• Over epitel tümörü ve karsinomatozis
• Tesadüfi adneksiyel kist veya kitle

Kaynaklar

Bu sayfadaki 37 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 4 cümle bu karşılaştırmada düzeltildi (2026-10-09).

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