Boyun Kitlelerine Yaklaşım
Özet
Boyun kitleleri, özellikle yetişkin popülasyonda ciddi ve potansiyel olarak malign bir patolojinin tek belirtisi olabilen, nispeten yaygın baş ve boyun problemleridir. Bu kitlelerin değerlendirilmesine öykü ve fizik muayene ile disiplinli bir şekilde yaklaşılmalı; kitleler enfeksiyöz, malign ve malign olmayan (konjenital) olarak sınıflandırılmalıdır. Hastanın yaşı teşhiste kritik bir faktör olup, 40 yaş üstü erişkinlerdeki kitleler aksi kanıtlanana kadar malign kabul edilmelidir. Laboratuvar testleri, ultrason, kontrastlı BT, MRG ve PET/BT gibi görüntüleme çalışmaları tanıda önemli rol oynar; kontrastlı BT yetişkinlerde ilk seçilecek çalışmadır. Tanısal süreçte ince iğne aspirasyonu (İİA) en çok tercih edilen yöntemken, doku mimarisinin incelenmesi gereken durumlarda kor biyopsi kullanılabilir. Ayırıcı tanıda yer alan inflamatuar kitleler genellikle viral veya bakteriyel enfeksiyon kaynaklıdır. Çocuklarda yaygın olan brankiyal yarık ve tiroglossal kanal kistleri gibi konjenital kitleler ise yetişkinlerde malignite şüphesiyle değerlendirilmelidir. Neoplastik kitleler arasında metastatik baş ve boyun karsinomları, tiroid kitleleri, tükürük bezi tümörleri, paragangliomalar, schwannomalar ve lenfomalar yer alır. Son dönemde, COVID-19 aşılaması sonrası gelişen reaktif lenfadenopatilerin de metastatik kitlelerle karışabileceği unutulmamalı ve görüntüleme zamanlaması buna göre planlanmalıdır.
Neck masses are relatively common head and neck problems that can be the sole manifestation of a serious and potentially malignant pathology, particularly in the adult population. The evaluation of these masses must be approached in a disciplined manner through history and physical examination, categorizing them into infectious, malignant, and non-malignant (congenital) groups. Patient age is a critical factor in diagnosis, and a neck mass in an adult over 40 should be considered malignant until proven otherwise. Diagnostic workflows rely on laboratory tests and imaging studies such as ultrasound, contrast-enhanced CT, MRI, and PET/CT, with contrast CT being the first choice for adults. Fine-needle aspiration (FNA) is the preferred diagnostic approach for most masses, while core biopsy is used when tissue architecture needs to be examined. In the differential diagnosis, inflammatory masses are typically caused by viral or bacterial infections. Congenital masses, such as branchial cleft and thyroglossal duct cysts, are common in children but must be evaluated with a high index of suspicion for malignancy when presenting in adults. Neoplastic masses include metastatic head and neck carcinomas, thyroid masses, salivary gland tumors, paragangliomas, schwannomas, and lymphomas. Recently, it is crucial to note that reactive lymphadenopathy following COVID-19 vaccination can mimic metastatic masses, and the timing of imaging should be scheduled accordingly.
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