Metastatik retroperitoneal lenfadenopati

Özet

Retroperitoneal metastatik lenf nodları, bilinen primer malignitelerde sık görülebilir. Kontrastlı abdomen-pelvis BT, nodların hangi zincirde yer aldığını, şekil ve iç yapı özelliklerini, primer tümörle uyumunu ve üreter ya da damar basısını haritalar. Kısa eksen büyüklüğü tek başına metastazı doğrulamaz; küçük nodlar da tümör içerebilir, reaktif nodlar da iri görünebilir. Metastatik retroperitoneal lenfadenopatinin görünümü, ayrı büyümüş nodlardan tek konglomera kitleye kadar değişebilir; primer tümör öyküsü ve nekroz metastazı destekler.

Faz ve pencere

Portal tanısal

Paraaortik, parakaval, interaortokaval ve iliak zincirlerdeki lenf nodlarının malignite riski, kısa eksen çapının ölçümü ile yuvarlaklaşma veya nekroz gibi morfolojik özelliklerin birlikte değerlendirilmesiyle incelenir; nod istasyonuna göre normal boyut eşikleri farklılık gösterir. Kontrastlı görüntülemede heterojen güçlenme veya primer tümöre benzer desenler malign infiltrasyonu destekleyebilir; ancak nodal metastazı doğrulayan tek başına spesifik bir güçlenme paterni tanımlanmamıştır.

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

BT bulguları

• Zincir boyunca nodlar — paraaortik, parakaval, interaortokaval ve iliak istasyonlardaki nodların dağılımı primer tümörün lenfatik drenajıyla karşılaştırılır.
• Yuvarlaklaşmış nod morfolojisi — uzun eksen boyunca uzamış oval yapı yerine yuvarlak kontur şüpheyi artırır; boyut ve şekil histolojik doğrulama yerine geçmez.
• Santral nekroz — kontrastlanan ince ya da düzensiz periferik doku içinde düşük dansiteli merkez, özellikle nekroza eğilimli metastatik nodları düşündürür.
• Nodal konglomera — metastatik lenfadenopati, ayrı büyümüş nodlardan tek bir konglomera kitleye kadar değişen görünümde olabilir; kitlenin komşu yapılarla ilişkisi değerlendirilir.
• Üreter basısı — nodal kitlenin önünde ya da yanında sıkışan üreterde proksimal genişleme ve böbrek toplayıcı sisteminde hidronefroz gelişebilir.
• Damar komşuluğu — lenfomada infiltratif nodal kitle aorta ve vena kavayı lümenlerini sıkıştırmadan çevreleyebilir. Bu bulgular tek başına metastazı lenfomadan ayırmaz.
• Primer kaynak araştırmasında böbrek, serviks, testis ve prostat kanserleri retroperitoneal metastatik lenfadenopatinin olası kaynakları arasında tutulur.

Normalde

Normal paraaortik, parakaval ve iliak zincirlerde nodlar çevre yağ planları arasında küçük, oval yapılar olarak seçilebilir; üreterler retroperitoneal seyirleri boyunca genişlemeden izlenir. Şüpheli incelemede her nodun kısa eksenini, oval-yuvarlak şeklini ve iç dansitesini aynı istasyondaki komşu nodlarla kıyaslayın; ardından üreter kalibrasyonu ve damar lümenini normal seyirle karşılaştırın.

Ayırıcı tanı

Retroperitoneal lenfoma

çok sayıda istasyonu tutan, homojen nodal kitleler ve damar lümenini koruyarak çevreleme lenfomayı destekler.

Reaktif lenfadenopati inflamatuar süreçlere bağlı gelişebilir; reaktif ve malign lenf nodlarının görüntüleme özellikleri örtüşebildiğinden morfoloji tek başına kesin ayrım sağlamaz.

Primer retroperitoneal sarkom, komşu organları yer değiştiren veya deforme eden bir retroperitoneal kitle şeklinde görülebilir.

Retroperitoneal fibrozis

üreterik obstrüksiyon, retroperitoneal fibrozisi destekleyen bir bulgudur.

Tüberküloz lenfadenitine psoas ve retroperitoneal apseler eşlik edebilir.

Tuzaklar

• Boyutu normal sınırlarda olan nodu kesin benign saymayın; metastazlar boyut eşiğinin altında kalabilir ve morfoloji ile klinik bağlam önemlidir.
• Tek bir büyük nodu otomatik olarak metastaz kabul etmeyin; nodal büyüme reaktif hiperplaziye de bağlı olabilir ve metastaz lenfomadan yalnız görüntülemeyle ayırt edilemeyebilir.
• Santral düşük dansiteyi tek başına metastatik nekroz olarak yorumlamayın; düşük attenuasyonlu nodlar tüberküloz ve fungal enfeksiyonlarda da görülebilir.
• Üreter basısı şüphesinde, belirgin toplayıcı sistem genişlemesi olmasa da obstrüksiyon olasılığını göz önünde bulundurun; retroperitoneal lenfadenopati radyografik dilatasyonu önleyebilir.

Kendini dene

1. Bilinen primer malignite öyküsü olan hastada retroperitoneal zincirde birden çok santral nekrotik nod izleniyor. En olası süreç nedir?

   • Metastatik lenfadenopati
   • Lenfoma
   • Reaktif nodlar
   • Retroperitoneal fibrozis
   Cevabı göster

   Metastatik lenfadenopati. Bilinen primer malignite öyküsüyle uyumlu lenfatik drenaj alanında çok sayıda nod bulunması ve nekroz metastatik lenfadenopatiyi destekler; nekroz tek başına özgül değildir. Lenfoma da retroperitoneal lenfadenopatiye neden olabilir ve görüntüleme bulgularıyla metastatik lenfadenopatiden ayırt edilmesi zor olabilir.

2. Üreter basısına bağlı olarak retroperitoneal lenfadenopatide hangi komplikasyon görülebilir?

   • Hidronefroz
   • Lenfanjiektazi
   • Renal infarkt
   • Üriner ekstravazasyon
   Cevabı göster

   Hidronefroz. Üreter basısı hidronefroza yol açabilir.

İlgili konular

• Retroperitoneal lenfoma

Kaynaklar

Bu sayfadaki 36 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 9 cümle bu karşılaştırmada düzeltildi (2026-10-09).

1. Oncologic Imaging of the Lymphatic System: Current Perspective with Multi-Modality Imaging and New Horizonpmc.ncbi.nlm.nih.gov
2. Nodal stagingpmc.ncbi.nlm.nih.gov
3. Solid Primary Retroperitoneal Masses in Adults: An Imaging Approachpmc.ncbi.nlm.nih.gov
4. Case Report: Successful delivery following chemotherapy in a pregnant patient with metastatic SMARCB1-deficient renal medullary carcinoma.pubmed.ncbi.nlm.nih.gov
5. The Challenges of Diagnosing Nondilated Obstructive Uropathy: A Case Report.pubmed.ncbi.nlm.nih.gov
6. Role of robot-assisted retroperitoneal lymph node dissection in malignant mesothelioma of the tunica vaginalis: case series and review of the literature.pubmed.ncbi.nlm.nih.gov
7. Hemopericardium with subsequent cardiac tamponade secondary to rivaroxaban treatment: a case report.pubmed.ncbi.nlm.nih.gov
8. Concurrent Incidental Presentation of Primary Retroperitoneal Follicular Lymphoma With Acute Pancreatitis.pubmed.ncbi.nlm.nih.gov
9. Primary and secondary diseases of the perinephric space: an approach to imaging diagnosis with emphasis on MRI.pubmed.ncbi.nlm.nih.gov
10. 1,25-dihydroxyvitamin D and PTHrP mediated malignant hypercalcemia in a seminoma.pubmed.ncbi.nlm.nih.gov
11. Onsite cytopathology evaluation and ancillary studies beneficial in EUS-FNA of pancreatic, mediastinal, intra-abdominal, and submucosal lesions.pubmed.ncbi.nlm.nih.gov
12. Low back pain indicative of psoas muscle metastasis and bronchopulmonary cancer.pubmed.ncbi.nlm.nih.gov
13. Malignant testicular unclassified sex cord stromal tumor: a case report.pubmed.ncbi.nlm.nih.gov
14. Imaging features of SMARCA4-deficient thoracic sarcomas: a multi-centric study of 21 patients.pubmed.ncbi.nlm.nih.gov
15. Thrombocytosis as a Rare Paraneoplastic Syndrome Occurring in Hepatocellular Carcinoma: A Case Report.pubmed.ncbi.nlm.nih.gov
16. Unknown primary Merkel cell carcinoma with cutaneous spread.pubmed.ncbi.nlm.nih.gov
17. Choriocarcinoma syndrome: a case report and a literature review.pubmed.ncbi.nlm.nih.gov
18. Untypical bilateral breast cancer with peritoneal fibrosis on 18 F-FDG PET/CT: case report and literature review.pubmed.ncbi.nlm.nih.gov
19. Using endobronchial ultrasound features to predict lymph node metastasis in patients with lung cancer.pubmed.ncbi.nlm.nih.gov
20. Gemstone Spectral CT Virtual Noncontrast Images and Iodine Maps for the Characterization of Thyroid Lesions and Distinguishing Thyroid Papillary Carcinoma from Nodular Goiter.pubmed.ncbi.nlm.nih.gov
21. Computed tomography detection of extracapsular spread of squamous cell carcinoma of the head and neck in metastatic cervical lymph nodes.pubmed.ncbi.nlm.nih.gov
22. Imaging findings of inflammatory myofibroblastic tumor from the greater omentum: One case report.pubmed.ncbi.nlm.nih.gov
23. Venous outflow obstruction with retroperitoneal Kaposi's sarcoma and treatment with inferior vena cava stenting.pubmed.ncbi.nlm.nih.gov
24. A Large Renal Mass: Dilemmas With Unusual Features on Imaging.pubmed.ncbi.nlm.nih.gov
25. Diagnostic Value of Dual-Energy CT Iodine Mapping in Differentiating Malignant and Benign Cervical Lymphadenopathies.pubmed.ncbi.nlm.nih.gov
26. The role of 11C-choline positron emission tomography-computed tomography and videomediastinoscopy in the evaluation of diseases of middle mediastinum.pubmed.ncbi.nlm.nih.gov
27. CT-Guided Percutaneous Needle Biopsy in Patients with Suspected Retroperitoneal Fibrosis: A Retrospective Cohort Study.pubmed.ncbi.nlm.nih.gov
28. Multiple Extrapulmonary Tuberculous Abscesses Developed Postpartum in a Non-HIV Patient Under Anti-tuberculosis Chemotherapy.pubmed.ncbi.nlm.nih.gov
29. Idiopathic myelofibrosis with disseminated hepatosplenic, mesenteric, renal and pulmonary extramedullary haematopoeisis, portal hypertension and tuberculosis: initial presentation and 2 years follow-up.pubmed.ncbi.nlm.nih.gov
30. Fluorescence-guided lymph node identification for biopsy for suspected lymphoproliferative disease or excision of lymph node recurrence.pubmed.ncbi.nlm.nih.gov
31. Lateral neck lumps: A systematic approach for the general paediatrician.pubmed.ncbi.nlm.nih.gov
32. Benign, atypical and malignant lymphoproliferative disorders in rheumatoid arthritis patients.pubmed.ncbi.nlm.nih.gov
33. [Clinicopathologic analysis of extranodal Rosai-Dorfman disease of breast: a report of 12 cases].pubmed.ncbi.nlm.nih.gov
34. Inter- and intra-patient heterogeneity of response and progression to targeted therapy in metastatic melanoma.pubmed.ncbi.nlm.nih.gov
35. Abdominal lymph node size in children at computed tomography.pubmed.ncbi.nlm.nih.gov
36. Predicting perigastric lymph node metastasis in gastric cancer with CT perfusion imaging: A prospective analysis.pubmed.ncbi.nlm.nih.gov
37. Clinical and computed tomography imaging features of renal medullary carcinoma: A report of six cases.pubmed.ncbi.nlm.nih.gov
38. Nasopharyngeal carcinoma with inguinal lymph node metastasis: A case report.pubmed.ncbi.nlm.nih.gov
39. Extreme Carcinoembryonic Antigen Elevation Revealing Clinically Silent Colonic Metastases From Gastric Adenocarcinoma: A Case Report.pubmed.ncbi.nlm.nih.gov
40. Paratesticular rhabdomyosarcoma in adolescents: Challenging diagnosis and poor prognosis of a rare entity.pubmed.ncbi.nlm.nih.gov
41. 불분명한 소아 복부 종괴: 영상 기반 진단 접근법.pubmed.ncbi.nlm.nih.gov
42. A Case of Spontaneous Tumor Lysis Syndrome With Acute Kidney Injury and the Timing of Chemotherapy.pubmed.ncbi.nlm.nih.gov
43. Complications of lymphoma in the abdomen and pelvis: clinical and imaging review.pubmed.ncbi.nlm.nih.gov
44. Lymph Node Assessment with Multiparametric Ultrasound: Normal Values, Morphologic Patterns, and Diagnostic Algorithms.pubmed.ncbi.nlm.nih.gov
45. Lymphedema is a rare manifestation of lymphoma: A case series and literature review.pubmed.ncbi.nlm.nih.gov
46. Human biomarker navigator.pubmed.ncbi.nlm.nih.gov
47. Malignant lymph nodes of the head and neck: imaging pearls, pitfalls, and practical approach to reporting in the era of extranodal extension.pubmed.ncbi.nlm.nih.gov
48. From congenital variants to critical clues: A radiologic review of inferior vena cava pathologies.pubmed.ncbi.nlm.nih.gov
49. Periaortitis and Retroperitoneal Fibrosis in a Patient With a Normal IgG4 Level: A Case Report and Review of the Literature.pubmed.ncbi.nlm.nih.gov
50. Imaging diagnosis and staging of pancreatic ductal adenocarcinoma: a comprehensive review.pubmed.ncbi.nlm.nih.gov
51. Manifestations of Ovarian Cancer in Relation to Other Pelvic Diseases by MRI.pubmed.ncbi.nlm.nih.gov
52. When "Metastatic Disease" Is Not Metastatic: Diffuse Large B-cell Lymphoma Presenting With a Perisplenic Mass, Pulmonary Masses, Pleural Effusion, and Retroperitoneal Lymphadenopathy.pubmed.ncbi.nlm.nih.gov
53. Simultaneous DOTATATE uptake in three non-neuroendocrine pathologies: Follicular lymphoma, Crohn's disease, and vertebral hemangioma.pubmed.ncbi.nlm.nih.gov
54. Metastatic Retroperitoneal Rhabdomyosarcoma in a Child: A Case Report Highlighting the Role of Imaging in Diagnosis, Staging, and Follow-Up.pubmed.ncbi.nlm.nih.gov
55. Marrow to Bowel or Bowel to Marrow: Intestinal Myeloid Sarcoma Presenting With Acute Obstruction.pubmed.ncbi.nlm.nih.gov
56. Renal hilar paraganglioma with atypical clinical presentation and biochemical functionality: A case report of diagnostic pitfalls.pubmed.ncbi.nlm.nih.gov
57. Heavily ossified renal mass as the initial presentation of primary renal osteosarcoma: a case report.pubmed.ncbi.nlm.nih.gov
58. Diffuse large B-cell lymphoma mimicking musculoskeletal nontuberculous mycobacterial infection: A fatal diagnostic challenge.pubmed.ncbi.nlm.nih.gov
59. IgG4-related retroperitoneal fibrosis: A case report of a challenging disease.pubmed.ncbi.nlm.nih.gov
60. Duodenal imaging on the spotlight: from A to Z.pubmed.ncbi.nlm.nih.gov
61. Fenestrated endovascular aneurysm repair addressing para-aortic ulcers in the setting of tuberculous aortitis.pubmed.ncbi.nlm.nih.gov
62. The many faces of extrapulmonary tuberculosis: A case series.pubmed.ncbi.nlm.nih.gov
63. Tuberculosis Beyond the Lungs: A Pictorial Review of Key Diagnostic Imaging Insights.pubmed.ncbi.nlm.nih.gov
64. A Case Report of Extrapulmonary Tuberculosis: A Potpourri of Imaging Manifestations.pubmed.ncbi.nlm.nih.gov
65. Castleman disease: clinical features, pathology, and treatment outcomes in 12 cases.pubmed.ncbi.nlm.nih.gov
66. Imaging approach to retroperitoneal vascular tumors: a narrative review.pubmed.ncbi.nlm.nih.gov
67. Neoplastic Lesions of the Mesentery: A Case Series of Rare Pathologies.pubmed.ncbi.nlm.nih.gov
68. Postpartum Retroperitoneal Fibrosis With IVC Obstruction: A Case Report.pubmed.ncbi.nlm.nih.gov
69. Cytoreductive surgery for ovarian cancer with pelvic ectopic kidney: a case report.pubmed.ncbi.nlm.nih.gov
70. Level of Abdominal Aorta Bifurcation and Its Relation to the Ureter: A Radiological Study with Clinical Implications.pubmed.ncbi.nlm.nih.gov
71. MR Imaging of the Upper Urinary Tract: Techniques, Diagnostic Performance, and Imaging Biomarkers.pubmed.ncbi.nlm.nih.gov
72. Preoperative Computed Tomography-Based Prediction and Patterns of Lymph Node Metastasis in Renal Pelvis and Ureteral Urothelial Carcinomas.pubmed.ncbi.nlm.nih.gov
73. Incidentally Discovered Ovarian Cancer Combined With Obturator Nerve Schwannoma: A Rare Case Report.pubmed.ncbi.nlm.nih.gov
74. Cutaneous Metastasis of Bladder Cancer: A Systematic Review.pubmed.ncbi.nlm.nih.gov
75. When Lynch syndrome is not MSI-H: embryonal testicular carcinoma treated with combined BEP chemotherapy and immunotherapy despite MSS/low TMB: a case report.pubmed.ncbi.nlm.nih.gov
76. Occult squamous cell carcinoma presenting as oligometastatic lymphadenopathy. A systematic review with a case report.pubmed.ncbi.nlm.nih.gov
77. Case Report: Negative initial endoscopy and 18F-FDG PET/CT may not exclude occult gastric cancer.pubmed.ncbi.nlm.nih.gov
78. Metastatic Primary Intratesticular Rhabdomyosarcoma in an Adolescent with Rapid Early Response to VAC Chemotherapy: A Case Report and Literature Review of 99 Cases.pubmed.ncbi.nlm.nih.gov
79. International Society of Paediatric Surgical Oncology (IPSO) Minimally Invasive Surgery (MIS) Guidelines.pubmed.ncbi.nlm.nih.gov
80. Spilling the beans: an inside scoop on the imaging of renal parenchymal disease.pubmed.ncbi.nlm.nih.gov
81. Paraneoplastic Pemphigus Associated With Renal Cell Carcinoma. Rare Case Report and Literature Review.pubmed.ncbi.nlm.nih.gov
82. Aggressive Burkitt Lymphoma Mimicking Acute Pancreatitis: A Case Report.pubmed.ncbi.nlm.nih.gov
83. Colonic pleomorphic undifferentiated sarcoma with a leukemoid reaction: case report.pubmed.ncbi.nlm.nih.gov
84. Mesenteric gastrointestinal stromal tumor mimicking a pelvic mass - the diagnostic value of vascular pedicle tracing and multiplanar reconstructions: A case report.pubmed.ncbi.nlm.nih.gov
85. A case of retroperitoneal malignant schwannoma in a young male: a case report.pubmed.ncbi.nlm.nih.gov
86. Fatal lymphatic-dominant progression in metastatic prostate cancer initially presenting with a clinically suspected inguinal node metastasis: a case report.pubmed.ncbi.nlm.nih.gov
87. Non-Hodgkin's lymphoma presenting as a retroperitoneal mass in the emergency department: a case report.pubmed.ncbi.nlm.nih.gov
88. Retroperitoneal fibrosis: A rare mimicker of a perirenal hematoma.pubmed.ncbi.nlm.nih.gov
89. Robot-Assisted Anderson-Hynes Pyeloplasty for Lower-Moiety Ureteropelvic Junction Obstruction in an Incomplete Duplex Collecting System Presenting as Dietl's Crisis: A Case Report.pubmed.ncbi.nlm.nih.gov
90. Percutaneous nephrostomy vs. double-J stenting for emergency decompression in recurrent ipsilateral stone-related infectious obstruction.pubmed.ncbi.nlm.nih.gov
91. Bladder multilithiasis across different clinical scenarios: Multimodality imaging findings, differential diagnosis, and complication assessment in 4 patients.pubmed.ncbi.nlm.nih.gov
92. A 30-Year Single-Centre Series of Unknown Primary Merkel Cell Carcinoma: Management and Prognosis.pubmed.ncbi.nlm.nih.gov
93. Non-gestational choriocarcinoma presenting as cervical lymphadenopathy in a male patient: a case report.pubmed.ncbi.nlm.nih.gov
94. Achieving Complete Cytoreduction After Systemic Therapy for Stage IV Renal Carcinoma With Multicompartment Recurrence and Peritoneal Carcinomatosis: A Case Report.pubmed.ncbi.nlm.nih.gov
95. Cervical Lymph Node Metastasis As the Initial Manifestation of Colorectal Cancer: Progression to Complete Clinical Response After Systemic Treatment.pubmed.ncbi.nlm.nih.gov
96. Tuberculosis presenting with necrotic retroperitoneal lymphadenopathy in an immunocompetent patient: A case report and literature review.pubmed.ncbi.nlm.nih.gov
97. Radiomics for Differentiating Prostate-Specific Membrane Antigen (PSMA)-Positive and PSMA-Negative Lymph Nodes in Prostate Cancer: An Exploratory 68Ga-PSMA PET-CT Study.pubmed.ncbi.nlm.nih.gov
98. Assessing the reliability of Response Evaluation Criteria In Solid Tumors (RECIST): a systematic review of the factors contributing to inter-observer variability.pubmed.ncbi.nlm.nih.gov
99. A Rare Case of Motor Neuropathy Secondary to Non-Hodgkin Lymphoma.pubmed.ncbi.nlm.nih.gov
100. A Case Report of Metastatic Melanoma of Unknown Primary with Massive Jejunal Involvement Mimicking Intestinal Lymphoma in a Young Adult: Diagnostic Pitfalls and Surgical Challenges.pubmed.ncbi.nlm.nih.gov
101. Report of a case of renal hilum Castleman disease complicated with Paget's disease of the breast.pubmed.ncbi.nlm.nih.gov
102. Adenocarcinoma of the Rete Testis With PI3K/AKT/mTOR Pathway Alteration and a Gene Expression Profile Resembling Papillary Renal Cell Carcinoma: A Case Report.pubmed.ncbi.nlm.nih.gov
103. Clinical and imaging manifestations of metastases from rare sites.pubmed.ncbi.nlm.nih.gov
104. The Relevance of the Virchow Node and Virchow Triad in Renal Cancer Diagnosis.pubmed.ncbi.nlm.nih.gov
105. A case report of a rare retroperitoneal sarcoma in an adolescent.pubmed.ncbi.nlm.nih.gov
106. Giant retroperitoneal leiomyosarcoma of massive proportions: a case report.pubmed.ncbi.nlm.nih.gov
107. Patterns of Presentation and Histopathology of Retroperitoneal Sarcoma in a South Asian Tertiary Center.pubmed.ncbi.nlm.nih.gov
108. Lymphoma as a Rare Cause of Ureteral Obstruction: A Case Report.pubmed.ncbi.nlm.nih.gov
109. Tuberculosis and persistent chylous ascites.pubmed.ncbi.nlm.nih.gov
110. Unveiling the rare: a case report of lumbar pseudoaneurysm secondary to tuberculous spondylitis.pubmed.ncbi.nlm.nih.gov
111. A diagnostic pitfall on cervical ultrasound: Lipoplastic lymphadenopathy mimicking malignancy.pubmed.ncbi.nlm.nih.gov
112. Unicentric Castleman disease of plasma cell type in the adrenal region: a case report and literature review.pubmed.ncbi.nlm.nih.gov
113. Thymic Carcinoma Presenting as Diffuse Bone Marrow Infiltration Mimicking Lymphoma.pubmed.ncbi.nlm.nih.gov

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.