Adrenal Bezin Metastatik Tümörleri
Özet
Adrenal bezler, zengin sinüzoidal kan akımları nedeniyle malignitelerin en yaygın metastaz yaptığı bölgelerden biri olup, bu bezlerde saptanan en sık malign tümörler metastatik karakterdedir. Adrenal dışı primer kanseri olan hastalarda adrenal kitlelerinin metastaz olma sıklığı değişkenlik gösterirken, bu lezyonlar genellikle akciğer ve böbrek kaynaklı tümörlerden köken alır. Tanı konulmasından sonra metastaz gelişimi ortalama 2,5 yıl sürer ve glandüler dokunun en az %90'ı yok edilmediği sürece klinik olarak asemptomatik seyrederek adrenal yetmezliğe yol açmaz. BT taramalarında 4 cm’den büyük, düzensiz konturlu ve heterojen kitleler ile bilateral tutulumlar yüksek metastaz olasılığına işaret eder. Tanı sürecinde PET yüksek hassasiyet sunarken, klinik tedaviyi değiştirme potansiyeli olan durumlar hariç genel olarak riskli biyopsi prosedürleri tercih edilmez; ancak BT veya ultrason eşliğinde yapılan perkütan aspirasyon sitolojisi güvenli bir alternatif sunabilir. Metastatik tümörlerin histopatolojik ayırıcı tanısında, akciğer adenokarsinomlarında TTF-1, renal hücreli karsinomlarda PAX8 ve meme metastazlarında GATA-3 gibi primer odağa özgü spesifik immünohistokimyasal belirteçlerden faydalanılarak mikroskopik olarak kötü diferansiye olan lezyonların kökeni kesinleştirilir.
The adrenal glands are among the most common sites for malignancies to metastasize due to their rich sinusoidal blood flow, and metastatic lesions constitute the most frequent malignant tumors in these organs. In patients with an extra-adrenal primary cancer, the incidence of these masses being metastatic varies, and they predominantly originate from lung and primary kidney tumors. The development of metastasis takes an average of 2.5 years following the primary diagnosis, and unless at least 90% of the glandular tissue is destroyed, it remains clinically asymptomatic without causing adrenal insufficiency. In CT scans, bilateral involvement, along with irregular contours, heterogeneous appearance, and masses larger than 4 cm, indicates a high probability of metastasis. While PET imaging offers high specificity during the diagnosis process, invasive biopsy procedures are generally avoided unless they have the potential to alter clinical management; however, CT or ultrasound-guided percutaneous aspiration cytology provides a safer alternative. In the histopathological differential diagnosis of metastatic tumors, primary-specific immunohistochemical markers such as TTF-1 for lung adenocarcinomas, PAX8 for renal cell carcinomas, and GATA-3 for breast metastases are utilized to determine the definitive origin of these microscopically poorly differentiated lesions.
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