Menenjiyom

Özet

Menenjiyom, araknoid kap hücrelerinden köken alan ve çoğunlukla dura komşuluğunda büyüyen ekstraaksiyel tümördür; rastlantısal bulunabileceği gibi çevre beyin dokusuna bası da yapabilir. Kontrastsız BT tümör kalsifikasyonunu ve komşu kafatasındaki hiperostozu iyi gösterir; kitle ile beyin arasındaki sınır için MRG daha duyarlıdır. Dural tabanlı yerleşim tanıyı desteklese de dural metastaz ve başka ekstraaksiyel kitleler benzer görünür. Komşu vazojenik ödem, korteks itilmesi ve kemik değişikliklerinin (hiperostoz veya osteoliz) gözden kaçırılması, kitenin gerçek etki boyutunun yanlış değerlendirilmesine yol açabilir.

Faz ve pencere

Kontrastsız tanısal

Dura komşuluğundaki kitle kortekse göre sıklıkla izo- ya da hiperdens olup yaklaşık dörtte birinde kalsifikasyon görülür; komşu kemikte hiperostoz veya nadiren osteoliz aranırken, kontrastsız BT aşamasında tümörün canlı dokusunun veya reaktif dural kalınlaşmanın kontrastlanması ile dural kuyruk işareti değerlendirilemez. Kontrastsız BT’de dural kuyruk ve tümör dokusunun belirgin kontrastlanması değerlendirilemez.

Kontrastlı tanısal

Dural tabanlı kitle çoğunlukla belirgin kontrastlanır; dural kuyruk görülebilir ancak menenjiyoma özgü değildir ve dural metastazlarda da bulunabilir. Kontrastlanma paterni tek başına histolojiyi veya dereceyi belirlemez.

Önerilen pencereler: Beyin (G 80 / M 40), Kemik (G 1800 / M 400).

BT bulguları

• Dural tabanlı ekstraaksiyel kitle — konveksite, falx, tentorium veya kafa tabanı boyunca geniş temas yüzeyi vardır.
• BOS yarığı — kitle ile komşu korteks arasında seçilebilen ince BOS aralığı ekstraaksiyel yerleşimi destekler; BT’de her zaman belirgin değildir.
• İç kalsifikasyon — noktasal ya da kaba hiperdens odaklar kitle içinde görülebilir.
• Komşu kemikte hiperostoz — kemik penceresinde iç tabula kalınlaşması ve yoğunluk artışı şeklindedir.
• Kemik destrüksiyonu — daha az tipiktir; dural metastaz veya daha agresif tümör olasılığını artırır.
• Peritümöral vazojenik ödem — komşu beyaz cevherde hipodensite ve sulkus basısı yapabilir.
• Kitle büyükse komşu korteksi içe iter ve parankimde geniş vazojenik ödem oluşturur.

Ölçütler ve sınıflamalar

WHO CNS5 menenjiyom derecelendirmesi

Menenjiyomlar CNS WHO derece 1, 2 veya 3 olarak sınıflandırılır. Derece histopatolojik ve uygun moleküler ölçütlerle belirlenir; BT görünümü tek başına derece atamaz.

Normalde

Aynı konveksite düzeyinde normal iç tabula ince ve düzgün, komşu korteks ise kafatasının iç yüzünü izleyen kesintisiz gri cevher konturudur. Şüpheli tarafta kemik kalınlığı ve yoğunluğunu karşı tarafla; korteksin itilmesini, aradaki BOS yarığını ve sulkusların açıklığını komşu normal giruslarla kıyasla.

Ayırıcı tanı

Dural metastaz

bilinen sistemik kanser, birden fazla dural odak ve kemik destrüksiyonu menenjiyomdan çok metastazı destekler.

Soliter fibröz tümör

dural tabanlı olabilir; menenjiyomdaki hiperostoz ve kalsifikasyon daha az karakteristiktir, kemik erozyonu eşlik edebilir.

Primer santral sinir sistemi lenfoması

sıklıkla parankimal/periventrikülerdir; dural yerleşim daha atipiktir.

Kalsifiye ekstraaksiyel lezyon

yerleşim, dural bağlantı ve kemik değişiklikleri birlikte değerlendirilmeden yalnız yoğunluğa göre menenjiyom denmemelidir.

Tuzaklar

• Dural kuyruk işaretini menenjiyoma özgü kabul etme: metastazlar ve diğer dural kitleler de benzer kontrastlanma yapabilir.
• Komşu kemikte hiperostoz sıklıkla görülür; WHO derecesi ve kemik invazyonu histopatoloji ile belirlenir, radyolojik bulgular tek başına kesin ayırım yapmaz.
• Kemik penceresini atlama: küçük konveksite veya sfenoid kanat menenjiyomunda kemik kalınlaşması yumuşak doku penceresinde geri planda kalabilir.
• Ödemi tümör sınırı sanma: ekstraaksiyel kitle komşu parankimde geniş vazojenik ödem oluşturabilir.

Kendini dene

1. Konveksitede dura ile geniş tabanlı temas eden, kalsifiye kitle ve komşu kemikte kalınlaşma izleniyor. En olası tanı nedir?

   • Menenjiyom
   • Glioblastom
   • Beyin apsesi
   • Ensefalomalazi
   Cevabı göster

   Menenjiyom. Dural taban, iç kalsifikasyon ve komşu hiperostoz menenjiyomu destekleyen BT özellikleridir. Glioblastom intraaksiyeldir; apse parankimal enfeksiyon odağıdır; ensefalomalazi doku kaybı gösterir.

2. Bilinen meme kanserli hastada birden çok dural kitle ve komşu kemikte erozyon var. En önemli taklitçi hangisidir?

   • Dural metastaz
   • Oligodendrogliom
   • Kavernom
   • Akut enfarkt
   Cevabı göster

   Dural metastaz. Kanser öyküsü, çoklu dural odak ve litik kemik değişikliği dural metastazı düşündürür. Diğer seçenekler dural tabanlı çoklu kitle ve kalvaryal erozyon örüntüsünü açıklamaz.

İlgili konular

• Primer santral sinir sistemi lenfoması

Kaynaklar

Bu sayfadaki 42 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla tek tek karşılaştırıldı; 6 cümle bu karşılaştırmada düzeltildi (2026-10-08).

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