Foliküler lenfoma BT bulguları

Özet

Foliküler lenfoma genellikle yavaş seyirli B hücreli lenfomadır ve tanı anında birden fazla, birbirine komşu olmayan nodal bölgeyi tutabilir. Kontrastlı BT boyun, toraks, abdomen ve pelviste anatomik tümör yükünü; mezenterik kitleyi ve dalak büyümesini gösterir. Foliküler lenfoma agresif lenfomaya dönüşebilir; tanı lenf nodu biyopsisiyle konur. Lenfomada görüntüleme hastalık yaygınlığının değerlendirilmesine, biyopsi ise tanının doğrulanmasına katkı sağlar.

Faz ve pencere

Portal tanısal: İntravenöz kontrastlı tüm gövde BT'de çok sayıda derin lenf nodu genellikle homojen yumuşak doku atenüasyonunda ve hafif kontrastlanan yapı olarak görünür. Kontrastlı BT'de mezenterik ve retroperitoneal bölgelerde çok sayıda büyümüş lenf nodu homojen kontrastlanır; mezenterik damarları lümen daraltmadan çevreleyen nodal dokuya 'sandviç bulgusu' adı verilir.

Önerilen pencereler: Mediasten (G 350 / M 50), Batın (G 400 / M 50), Yumuşak doku (G 400 / M 40).

BT bulguları

Çok bölgeli nodal hastalık — servikal, aksiller, mediastinal, retroperitoneal, mezenterik ve pelvik istasyonlarda ayrı ayrı büyümüş nodlar bulunabilir.
Homojen nodal kontrastlanma — tedavi öncesi nodlar çoğunlukla düzgün sınırlı ve görece homojen yumuşak doku atenüasyonundadır.
Mezenterik konflu nodlar — damarların çevresinde ve iki yanında yerleşen lobüle doku, damarları sararken lümenleri açık bırakabilir.
Retroperitoneal zincir tutulumu — paraaortik ve parakaval nodlar birbirine yaklaşarak psoas ve büyük damarların önünde konglomera oluşturabilir.
Dalaktaki fokal kitlelerin görüntüleme bulguları özgül olmayabilir; kesin tanı koymak zor olabilir.
Büyük ve tedavi edilmemiş lenf nodlarında nekroz veya kistik değişiklikler görülebilir; bu durum kötü prognozla ilişkilendirilebilir ve kesin tanı için biyopsi gerektirir.

Ölçütler ve sınıflamalar

Lugano anatomik evreleme: Lugano sınıflaması lenfomada güncel dört evreli anatomik sistemi kullanır. Foliküler lenfomada FDG-PET/BT ve klinik veriler anatomik BT dağılımını tamamlar.

Normalde

Lenfoma değerlendirmesinde nodal dağılımı ve mezenterik damarları lümen daralması olmadan çevreleyen nodal kitleyi kaydedin.

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 s0541; organ sınırları veri setinin otomatik segmentasyonundan, birleştirilerek sadeleştirildi. Görüntüler 2,5 mm kesit aralığına yeniden örneklendi.

Ayırıcı tanı

Kronik lenfositer lösemi/küçük lenfositik lenfoma, abdominal görüntülemede lenfomayla karışabilen hematolojik hastalıklar arasındadır; kesin tanı için biyopsi gerekebilir.
Diffüz büyük B hücreli lenfoma: daha hızlı gelişen, hacimli ya da heterojen kitle ve ekstranodal odaklar görülebilir; histoloji gerekir.
Sarkoidozda bilateral hiler lenfadenopatiye perilenfatik akciğer nodülleri eşlik edebilir.
Metastatik hastalık abdominal lenfomayı taklit edebilir ve görüntüleme ayırıcı tanıda zorluk yaratabilir.
Enfeksiyöz lenfadenit: çevresel kontrastlanan nekrotik nodlar ve çevre yağda inflamatuvar değişiklik, klinik bağlamda lenfomadan ayrılır.

Tuzaklar

Lenfoma nodları genellikle homojen kontrastlanır; nekroz veya kistik değişiklik gibi atipik bulgular kötü prognoz gösterebilir ve kesin tanı için patolojik inceleme şarttır.
Lenf nodu boyutu tek başına histolojik alt tipi belirlemez; kesin tanı patolojik incelemeye dayanır.
Lenfoma tanısı görüntüleme bulgularından bağımsız olarak kesin patolojik inceleme ile konmalıdır.

Kendini dene

Kontrastlı BT'de mezenterik ve paraaortik bölgelerde çok sayıda homojen lenf nodu görülmesi lenfoma olasılığını düşündürür. En uygun görüntüleme yorumu hangisidir?
Cevabı göster
İndolen lenfoma paterni. Foliküler lenfoma indolen bir lenfomadır; tanı lenf nodu biyopsisiyle konur. Abdominal lenfoma görüntülemede başka hastalıkları taklit edebilir; kesin tanı için biyopsi gerekir.
Foliküler lenfoma agresif lenfomaya dönüşebilir. Hangi olasılık öne alınmalıdır?
Cevabı göster
Histolojik dönüşüm. Foliküler lenfoma agresif lenfomaya dönüşebilir; lenfoma tanısı biyopsiyle doğrulanır. Lenfomada kesin tanı patolojik incelemeye dayanır.

İlgili konular

Kaynaklar

Bu sayfadaki 37 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 17 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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