Over seks-kord stromal ve germ hücreli tümörler BT bulguları

Özet

Seks-kord stromal tümörler ve germ hücreli tümörler, overin epitelyal tümörlerden farklı hücresel kökenli ve geniş yaş aralığında görülebilen daha seyrek neoplazileridir. Granüloza hücreli tümör hormon etkisiyle endometriumu etkileyebilir; disgerminom ve yolk-sac tümörü ise genç hastada büyük solid veya karma kitle olarak ortaya çıkabilir. Kontrastlı BT, kitlenin solid bileşenlerini, lenf nodlarını ve peritoneal/uzak yayılımı haritalar; alt tipi yalnız görüntüyle kesinleştirmez. Özellikle disgerminomun nodal, yolk-sac tümörünün peritoneal yayılımını gözden kaçırmak hastalık dağılımının eksik raporlanmasına neden olur.

Faz ve pencere

Portal tanısal: Adneksiyel kitlenin solid ve kistik bileşenleri, nekroz/hemorajiyle uyumlu düşük atenüasyonlu alanlar, canlı kontrastlanan septa ve nodüller; retroperitoneal nodlar, asit, peritoneal implantlar ve üst batın metastazları incelenir.

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

BT bulguları

Seks-kord stromal tümörler genellikle solid yapıdadır ve hormonal salgıya bağlı sekonder bulgular tanıda ipucu sağlar.
Seks-kord stromal tümörlerin hormonal etkileri tanıda yardımcı olabilir; bu nedenle hastanın sistemik ve lokal bulgularının bütüncül değerlendirilmesi gerekir.
Sertoli-Leydig ve steroid hücreli tümörler çoğu kez solid over kitlesidir; virilizasyon öyküsü radyolojik görünümle birlikte klinik açıdan anlam taşır.
Disgerminom genç kadınlarda daha sık görülür ve büyük, lobüle, solid bir over kitlesi olarak izlenebilir; patolojide tümör hücreleri lenfosit içeren fibroz septalarla ayrılan yuvalar veya tabakalar oluşturur.
Yolk-sac ve karma germ hücreli tümörlerde heterojen solid-kistik yapı, nekroz/hemoraji ve canlı kontrastlanan solid alanlar bulunabilir.
Disgerminomda retroperitoneal nodal yayılım özellikle araştırılır; germ hücreli alt tipler arasında yayılım paterni aynı değildir.
Peritoneal nodül, omental kalınlaşma, asit ve karaciğer/akciğer metastazı tümörün yayılım kapsamını gösterir.
Östrojen salgılayabilen granüloza hücreli tümörlerde endometriyal kalınlaşma eşlik edebilir; uterus ve endometrium da incelenmelidir.

Normalde

Normal görünümlü overlerde folliküller izlenebilir. Solid over kitlesini değerlendirirken endometrium kalınlığını, asit ve peritoneal implantları, ayrıca retroperitoneal nodları da inceleyin.

Normal BT ile kıyasla

Aynı bölgenin, kaynak veri setinde patoloji içermediği belirtilen bir BT incelemesini kesit kesit kaydırın; organ sınırlarını açarak anatomiyi hasta görüntüsüyle karşılaştırın. Küçük rastlantısal bulgular tümüyle dışlanmamıştır.

Kaynak: TotalSegmentator v2.01 veri seti (Wasserthal ve ark., Radiology: Artificial Intelligence 2023), CC BY 4.0, vaka s0119; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Epitelyal over tümörü: papiller çıkıntılar, düzensiz kalın septalar ve peritoneal implantlar görülebilir; yaş, hormon bulguları ve tümör belirteçleri ayrımı destekler.
Over fibromu: keskin sınırlı, kollajen içeriğine bağlı düşük atenüasyonlu ve az boyanan solid kitle olabilir; genç yaş ve nodal hastalık daha az tipiktir.
Over metastazı: bilateral kitleler, bilinen primer ve peritoneal/uzak metastaz dağılımı ikincil kökeni destekler.
Endometrioma: yüksek atenüasyonlu hemorajik kist şeklinde olabilir; kontrastlanan canlı solid tümör septaları ve nodal yayılımı açıklamaz.

Tuzaklar

Nekroz ve hemoraji hem germ hücreli hem seks-kord stromal tümörlerde olabilir; bu görünüm tek başına alt tip veya derece tayin ettirmez.
Tümörün genç hastada görülmesi germ hücreli kökeni kanıtlamaz; overin kökeni, belirteçler ve patoloji ile bütünleştirilmelidir.
Hormonal salgı yapan tümörlerde sekonder bulgular görülebilir; bu nedenle pelvik yapıların kapsamlı incelenmesi ve patolojik doğrulama beklenmelidir.
Disgerinomlarda fibroz septalar ve lenfosit infiltrasyonu karakteristik olup, tümörün yapısını oluşturur; tanı için patolojik inceleme şarttır.
Over kitlelerinde AFP ve inhibin gibi tümör belirteçleri, virilizasyon eşlik ediyorsa testosteron klinik değerlendirmeye katkı sağlar; görüntüleme histolojik alt tipi tek başına kesinleştirmez.

Kendini dene

Genç kadında büyük, lobüle, solid over kitlesi ve belirgin kontrastlanan septalar disgerminom şüphesini artırır; paraaortik nodlar retroperitoneal yayılımla uyumludur. En olası tümör hangisidir?
Cevabı göster
Disgerminom. Paraaortik nodlar, disgerminomda bilinen retroperitoneal lenfatik yayılım yoluyla uyumludur. Disgerminom bir germ hücreli tümördür; Sertoli-Leydig hücreli tümör virilizasyonla ilişkili olabilir.
Virilizasyon ve testosteron yüksekliği olan hastada solid over kitlesi saptanıyor. Ayırıcı tanıda öncelikle hangi tümör grubu düşünülmelidir?
Cevabı göster
Androjen üretebilen seks-kord stromal tümörler. Androjen etkisi seks-kord stromal kökenli tümörleri düşündürür; kesin alt tip histopatolojiyle belirlenir.

İlgili konular

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 13 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.