Safra Kesesi Kanserlerinde Görüntüleme
Özet
Safra kesesi(SK) kanseri, tüm biliyer sistemin en sık malignitesi olup 6. en sık görülen gastrointestinal sistem malign tümörüdür, yaşlı kadınlarda 4 kat daha sık görülürler, risk faktörleri; Uzun süreli kolesistolithiazis(en sık neden), kronik kolesistit, alkol tüketimi, obezite, diabet, porselen kese, inflammatuar bağırsak hastalığı, familial adenomatöz polipozis sendromu, primer sklerozan kolanjit, <1 cm.den büyük sapsız soliter kese polipleri, pankreatikobilier ductus anomalileri, kurşun-krom gibi karsinojenlere uzun süreli maruziyet vb. sayılabilir. Adenokarsinom, SK kanserinin en yaygın morfolojik alt tipidir, bunu adenoskuamöz ve skuamöz hücre tipi (%10-15) takip eder, küçük hücreli karsinom, nöroendokrin hücre tümörleri, karsinoid ve metastazlar nadir tiplerdir, Melanomlar en sık metastaz yapan tümörlerdir. Görüntülemede; Fokal intraluminal kitle-fokal ya da diffüz irregüler SK duvar kalınlaşması hatta tüm keseyi kaplayan komşu karaciğer (KC) parankimine invazyon gösteren büyük bir kitle halinde prezente olabilirler, cerrahi rezeksiyon tercih edilen tedavi şekli olup, SK karsinomu daha yüksek oranda uzak metastatik hastalıkla ilişkilidir ve kemoterapiden daha fazla fayda sağlayabilir, kemoterapi adjuvan ortamda ve palyatif bakımda kullanılır, genel prognoz kötüdür ve 5 yıllık sağkalım oranları <%20'dir. SK kanseri erken evrede belirti vermemekte ancak hastalığın erken evrede teşhisi çok önemli olup, safra yolu patolojilerinin görüntülemesinde eski konvansiyonel oral kolesistografi, perkütan transhepatik kolanjiografi (PTK) gibi yöntemler kullanılırken, son 20-25 senedir SK kanserinin tanısında Ultrasonografi (USG), Bilgisayarlı Tomografi (BT), Manyetik rezonans Görüntüleme (MRG) ve MRG Kolanjiopankreatografi (MRKP) gibi invaziv olmayan görüntüleme yöntemleri tanı,tedavi ve takip süreçlerinde önemli rol oynamaktadırlar.
Gallbladder (GB) cancer is the most common malignancy of the entire biliary system and the 6th most common malignant tumor of the gastrointestinal system four times more common in elderly women. Risk factors include: long-term cholecystolithiasis (the most common cause), chronic cholecystitis, alcohol consumption, obesity, diabetes, porcelain gallbladder, inflammatory bowel disease, familial adenomatous polyposis syndrome, primary sclerosing cholangitis, sessile gallbladder polyps larger than 1 cm, pancreaticobiliary duct anomalies, long-term exposure to carcinogens such as lead and chromium, etc.
Adenocarcinoma is the most common morphological subtype of GB cancer, followed by adenosquamous and squamous cell types (10-15%). Small cell carcinoma, neuroendocrine cell tumors, carcinoids, and metastases are rare types. Melanomas are the most common metastatic tumors. They may present as focal intraluminal masses, focal or diffuse irregular sac wall thickening, or even a large mass covering the entire sac and invading the adjacent liver parenchyma in the imaging approaches. Surgical resection is the preferred treatment. GB carcinoma is more frequently associated with distant metastatic disease and may benefit more from chemotherapy which is mostly used in adjuvant and palliative care. The overall prognosis is poor, and 5-year survival rates are <20%. GB cancers do not often show symptoms in their early stages, but early diagnosis is crucial. While older conventional methods such as oral cholecystography and percutaneous transhepatic cholangiography (PTC) were used for imaging biliary tract pathologies, non-invasive imaging techniques such as ultrasonography (USG), computed tomography (CT), magnetic resonance imaging (MRI), and MRI cholangiopancreatography (MRCP) have played a significant role in the diagnosis, treatment, and follow-up of GB cancers over the last 20-25 years.
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