Klinikoradyolojik Olarak Maligniteleri Taklit Eden Santral Sinir Sistemi Enfeksiyöz Hastalıkları

Öz

Santral sinir sistemi (SSS) enfeksiyonları gelişen tanı ve tedavi yöntemlerine rağmen hala önemli bir morbidite ve mortalite nedenidir. Gözlenen şikayetlerin nonspesifik olması özellikle intrakranial tüberküloma ve beyin absesi başta olmak üzere çeşitli SSS enfeksiyon hastalığının klinikoradyolojik olarak malignitelerle karışabilmesine neden olmaktadır. Bu durum göz önünde bulundurularak çalışmamızda klinikoradyolojik olarak maligniteleri taklit eden SSS enfeksiyöz hastalıklarının klinikoradyolojik ve histomorfolojik özelliklerini olgularımız üzerinden paylaşarak bilimsel literatüre katkıda bulunmak amaçlanmıştır. Bu retrospektif çalışmada patoloji arşivi taranarak, 2010-2023 yılları arasında klinikoradyolojik bulgular doğrultusunda malignite ön tanısı ile opere edilen ancak histopatolojik değerlendirme sonucu santral sinir sisteminin enfeksiyon hastalıkları ile uyumlu tanı alan 19 olgu dahil edildi. Çalışmaya dahil edilen 19 olgunun 8’i kadın, 11’i erkekti. Olguların ortalama yaş değeri 51+15,68 iken yaş dağılımı 21 ile 72 arasında değişmekteydi. Klinikoradyolojik bulgular doğrultusunda 6 olguya glial tümör, 3 olguya tümöral lezyon, 3 olguya neoplaziye bağlı patolojik kırık, 2 olguya meningioma, 2 olguya metastaz, 2 olguya sinir kılıfı tümörü ve 1 olguya hipofiz adenomu ön tanısı ile eksizyon planlandı. Histomorfolojik değerlendirmede olguların %52,6’sında nekrotizan granülomatöz iltihap, %15,8’inde süpüratif inflamasyon ve %10,5’inde kist hidatik ile uyumlu bulgular saptandı. SSS enfeksiyonları farklı predispozan durumlarda farklı etkenlerin neden olduğu, doğru ve etkin tedavi edilmediği takdirde morbidite ve mortalite oranları yüksek hastalıklardır. Bu hastalıkların santral sinir sisteminin primer ve metastatik maligniteleri ile örtüşen şikayet, semptom ve radyolojik bulguya sahip olması doğru tanı koymayı zorlaştıran durumlardır. Olguyu değerlendirirken ihtimaller akılda bulundurulmalı ve olgu klinik öyküsü ile birlikte bir bütün halinde değerlendirilmelidir.

Anahtar Kelimeler

• Enfeksiyöz hastalık
• Glial tümör
• Metastaz
• Santral sinir sistemi

Central Nervous System Infectious Diseases Mimicking Malignancies Clinoradiologically

Öz

Central nervous system (CNS) infections are still an important cause of morbidity and mortality despite improved diagnostic and therapeutic methods. The nonspecificity of the observed complaints causes various CNS infectious diseases, especially intracranial tuberculoma and brain abscess, to be clinicoradiologically misinterpreted as malignancies. Considering this situation, we aimed to contribute to the scientific literature by sharing the clinicoradiologic and histomorphologic features of CNS infectious diseases that mimic malignancies clinicoradiologically. In this retrospective study, pathology archives were reviewed and 19 cases who were operated with a prediagnosis of malignancy based on clinicoradiologic findings between 2010 and 2023 but were diagnosed as infectious diseases of the central nervous system on histopathologic evaluation were included. Of the 19 patients included in the study, 8 were female and 11 were male. The mean age of the patients was 51+15.68 years and the age distribution ranged between 21 and 72 years. Based on clinicoradiological findings, excision was scheduled with the preliminary diagnosis of glial tumor in 6 cases, tumoral lesion in 3 cases, pathological fracture due to neoplasia in 3 cases, meningioma in 2 cases, metastasis in 2 cases, nerve sheath tumor in 2 cases and pituitary adenoma in 1 case. Histomorphologic evaluation revealed necrotizing granulomatous inflammation in 52.6%, suppurative inflammation in 15.8% and hydatid cyst in 10.5% of the cases. CNS infections are diseases caused by different agents in different predisposing conditions and have high morbidity and mortality rates if not treated properly and effectively. These diseases have overlapping complaints, symptoms and radiologic findings with primary and metastatic malignancies of the central nervous system, which makes it challenging to diagnose correctly. Possibilities should be kept in mind while evaluating the case and it should be evaluated as a whole together with the clinical history.

Anahtar Kelimeler

• Infectious disease
• Glial tumor
• Metastasis
• Central nervous system

Kaynakça

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