PNÖMONÝK TIP ADENOKARSÝNOM: HER ÝKÝ AKCÝÐERDE HAVA BRONKOGRAMLARI ÝÇEREN KONSOLÝDE ALANLAR

Radyolojik olarak pulmoner adenokarsinoma sýklýkla soliter nodül þeklinde ortaya çýkar. Bununla birlikte pnömoniden ayýrt edilemeyen sýklýkla hava bronkogramlarý ile birlikte yama tarzýnda, lober veya multilober infiltrasyon þeklinde de görülebilir. Pnömonik tip adenokarsinoma radyolojik ve klinik olarak sadece pnömoniye benzemez, ayný zamanda hipersensivite pnömonileri, bronþiolitis obliterans ve çeþitli vasküler hastalýklar gibi enfeksiyöz olmayan inflamatuar proçeslere de benzeyebilir. Ateþ ve lokositozun yokluðu enfeksiyöz pnömonin tanýsý hakkýnda þüphe uyandýrmalýdýr. Ampirik antibyotik tedavisi ve klinik bulgularýn yeniden deðerlendirilmesi kabul edilir bir yaklaþýmdýr. Multilobar konsolidasyonlar deðiþmediðinde veya progrese olduðunda adenokarsinoma akýlda tutulmalýdýr. Bununla birlikte biyopsi veya sitolojik inceleme diðer etyolojileri ekarte etmekte ve malignite tanýsýný koymakta tek yoldur. Bundan dolayý perkutan transtorasik biyopsi veya pulmoner wedge rezeksiyon antibyotik tedavisine cevap vermeyen hastalarda düþünülmelidir. Bu yazýda pnömonik tip adenkarsinom olgularýna dikkat çekmek amacýyla adenokarsinomanýn yeni sýnýflamasý ve radyolojik formlarý, olgularýmýz ve literatür eþliðinde sunuldu.ý

PNEUMONIC TYPE OF ADENOCARCINOMA: CONSOLIDATED AREAS WITH AIR BRONCHOGRAMS IN BOTH LUNGS

Radiographically, pulmonary adenocarcinoma often presents as a solitary nodule. However, a radiograph may also demonstrate patchy, lobar, or multilobar infiltrates, often with air bronchograms that are indistinguishable from pneumonia. Pneumonic tip adenocarcinoma may radiographically and clinically resemble not only pneumonia, but also noninfectious inflammatory processes of the lung, including hypersensitivity pneumonitis, bronchiolitis obliterans, and various vasculitic processes. Lack of fever and leukocytosis should raise suspicion about a diagnosis of infectious pneumonia. An empirical trial of antibiotics and reassessment of clinical findings is a reasonable approach. Adenocarcinoma should be kept in mind when multilobar consolidations are unchanged or progresed. However, biopsy or cytologic examination is the only means of ruling in a diagnosis of malignancy and ruling out other etiologies. Thus percutan transthoracic biopsy or pulmoner wedge resection should always be considered when patients do not respond to antibiotics. In this article, new classification and radiological forms of adenocarcinoma were presented in the light of our cases and the literature to draw attention to the cases of pneumonic type adenocarcinomas.