Malign Meme Lezyonları
Özet
Kadınlarda en sık görülen kanser tipi olan meme karsinomları, tarama mamografileri ve radyolojik görüntüleme yöntemlerinin yaygınlaşması ile daha erken evrede tanınmaktadır. Etkin tedavi yöntemlerinin de geliştirilmesiyle sağkalım oranlarında belirgin artış sağlanmıştır. Malign meme lezyonlarının radyolojik görüntüleme yöntemleri ile tanınması erken tanı ve tedavi için önemlidir. Bunun dışında radyolojik görüntüleme bulguları ile doku tanısı için uygun biyopsi şeklinin belirlenmesi ve meme karsinomu alt tiplerinin tahmin edilmesi de mümkündür. Meme karsinomları tümörün histolojik olarak bazal membranı aşma durumuna göre invaziv ya da noninvaziv; çeşitli immünohistokimyasal belirteçlere göre moleküler olarak alt gruplara ayrılmaktadır. Noninvaziv karsinomlar genellikle klinik olarak asemptomatikken; invaziv meme karsinomlarının büyük kısmı palpabl kitle, ağrı, meme başında akıntı-ülser-çekilme ya da meme cildinde retraksiyon-portakal kabuğu görünümü nedeniyle semptomatiktir. Mamografide malign tümörler temel olarak düzensiz sınırlı, spiküle konturlu, yüksek dansiteli kitle; lineer ya da segmenter dağılım gösteren, pleomorfik veya ince lineer dalllanan mikrokalsifikasyonlar ya da asimetrik dansite şeklinde izlenirken; ultrasonografide sıklıkla düzensiz şekilli, konturları spikülasyon, mikrolobulasyon veya angulasyon gösteren, parankime göre belirgin hipoekoik kitle görülür. Ek olarak manyetik rezonans görüntülemede dinamik kontrastlı serilerde periferal, halka tarzında kontrastlanma ya da kitlesel olmayan kontrastlanma paternleri görülebilir. Belirlenen alt tip, lenf nodu tutulumu ve uzak metastaz varlığına göre uygun tedavi yöntemi belirlenmektedir.
Breast carcinomas, the most common cancer type in women, are now being diagnosed at an earlier stage due to the widespread use of screening mammography and radiological imaging methods. There has been a significant increase in survival rates with the development of effective treatment methods. Recognition of malignant breast lesions by radiological imaging methods is crucial for early diagnosis and treatment. Additionally, it is possible to determine the appropriate biopsy type for tissue diagnosis and to predict breast carcinoma subtypes with radiological imaging findings. Breast carcinomas are subdivided into invasive or noninvasive subtypes histologically and molecular subtypes according to various immunohistochemical markers. While noninvasive carcinomas are usually clinically asymptomatic, the majority of invasive breast carcinomas are symptomatic due to palpable mass, pain, nipple discharge or retraction, or peau d'orange appearance on the breast skin. On mammography, malignant tumors are generally seen as high-density masses with obscured margins and spiculated contoured; pleomorphic, or linear branching microcalcifications with linear or segmental distributions; or asymmetric densities. Ultrasonography often shows a hypoechoic mass with spiculated, microlobulated, or angular margin. In addition, peripheral, ring-shaped or non-mass contrast enhancement may be seen in dynamic series on magnetic resonance imaging. The appropriate treatment is determined according to the subtype of breast carcinoma, lymph node involvement, and the presence of distant metastasis.
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