Safra Yolları Malign Tümörlerinin Radyolojik Bulguları
Özet
Safra yolları tümörleri, ampulla vateri, ekstrahepatik ve intrahepatik safra yolları ile safra kesesi malignitelerini kapsayan, düşük insidansa sahip ancak oldukça mortal seyreden epitelyal tümörlerdir. Erken tanının hayat kurtarıcı olduğu bu patolojilerin radyolojik değerlendirmesinde ultrason, bilgisayarlı tomografi (BT) ve manyetik rezonans görüntüleme (MRG) etkin olarak kullanılır. Safra kesesi polipleri benign ve neoplastik olarak ayrılır; ultrasonda duvara fikse izlenen 1 cm'den büyük poliplerde malignite riski yüksek olduğundan cerrahi önerilir. Safra kesesi kanserleri ise sıklıkla fundusta yerleşir ve hipoekoik solid kitle, asimetrik duvar kalınlaşması ya da malign polip formunda bulgu verir; BT ve MRG'de persiste kontrastlanma ve difüzyon kısıtlaması göstermeleri tipiktir. Agresif adenokarsinomlar olan kolanjiyokarsinomlar ise intrahepatik, perihiller (Klatskin tümörü) ve distal olarak sınıflandırılır. İntrahepatik tipte periferden santrale ilerleyen ve geç fazda silinme göstermeyen kontrastlanma paterni ile kapsül çekintisi ayırt edicidir. Perihiller ve distal tipler çoğunlukla periduktal infiltrasyon, safra kanalında darlık ve buna bağlı dilatasyonla seyreder. Obstrüksiyon seviyesinin belirlenmesinde Bismuth-Corlette sınıflandırması kullanılırken, non-invaziv bir yöntem olan MRCP anatomik detayları ortaya koymada ERCP ve PTK kadar etkilidir. Son olarak, nadir görülen biliyer kistadenokarsinomlar ise solid kompanent içeren multiloküle kistik lezyonlar olarak izlenir.
Biliary tract tumors, including tumors of the ampulla of Vater, extrahepatic and intrahepatic bile ducts, and the gallbladder, are epithelial malignancies with a low incidence but an extremely mortal course, where early diagnosis is lifesaving. Ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) are utilized in their radiological evaluation, with ultrasound being the initial modality for evaluating gallbladder polyps, which are categorized as non-neoplastic and neoplastic; since polyps larger than 1 cm carry an 8% malignancy risk, surgical resection is recommended. Gallbladder cancers present as hypoechoic solid masses, focal or asymmetric wall thickening, and malignant polyps, typically demonstrating persistent enhancement on CT/MRI and hyperintensity on diffusion-weighted imaging, which helps differentiate them from benign conditions like adenomyomatosis. Cholangiocarcinomas are classified into intrahepatic, perihilar (Klatskin tumor), and distal types. Intrahepatic cholangiocarcinoma typically displays a progressive peripheral-to-central enhancement pattern without wash-out in late phases, alongside capsular retraction. Perihilar and distal cholangiocarcinomas predominantly manifest as periductal infiltrative forms causing irregular strictures and subsequent intrahepatic biliary dilation, where MRCP and PTK are highly effective in mapping the obstruction level categorized by the Bismuth-Corlette system to determine surgical resectability. Lastly, rare biliary cystadenocarcinomas manifest as multilocular cystic masses, distinguished from benign cystadenomas by the presence of internal solid components.
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