{"id":2690,"date":"2024-03-12T18:13:11","date_gmt":"2024-03-12T17:13:11","guid":{"rendered":"https:\/\/ultrazvukdojke.rs\/razvojni\/?p=2690"},"modified":"2024-12-31T10:29:19","modified_gmt":"2024-12-31T09:29:19","slug":"karcinomi-nadbubreznih-zlezda","status":"publish","type":"post","link":"https:\/\/ultrazvukdojke.rs\/razvojni\/karcinomi-nadbubreznih-zlezda\/","title":{"rendered":"Karcinomi nadbubre\u017enih \u017elezda"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"2690\" class=\"elementor elementor-2690\" data-elementor-post-type=\"post\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3836615f e-flex e-con-boxed e-con e-parent\" data-id=\"3836615f\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7ad6869a elementor-widget elementor-widget-text-editor\" data-id=\"7ad6869a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\n<p class=\"wp-block-paragraph\">Karcinomi nadbubre\u017enih \u017elezda se naj\u010de\u0161\u0107e otkrivaju slu\u010dajno \u2013 \u201c<em>incidentalomi<\/em>\u201d. Maligni tumori nadbubrega su: adenokortikalni karcinom, feohromocitom i metastaze. Karcinom se naj\u010de\u0161\u0107e karakteri\u0161e znacima Ku\u0161ingove bolesti, a kod mu\u0161karaca, mada retko, znacima fertilizacije (ginekomastija i atrofija testisa). Hormonski neaktivan tumor daje neodre\u0111ene simptome (bol u le\u0111ima, mu\u010dninu, povra\u0107anje).<\/p>\n\n<h2 class=\"wp-block-heading\" style=\"text-align: center;\">UZ nalaz kod pacijenata sa karcinomom nadbubrega<\/h2>\n\n<p class=\"wp-block-paragraph\">Ultrazvu\u010dna evaluacija normalne nadbubre\u017ene \u017elezde je te\u0161ka. Ovo je zbog gasa u crevima, te se leva nadbubre\u017ena \u017elezda ne mo\u017ee vizualizovati usled akusti\u010dke senke porekla creva, ali i zbog male veli\u0107ine \u017elezde. Normalne nadbubre\u017ene \u017elezde se ultrazvu\u010dno ne diferenciraju.<\/p>\n\n<p class=\"wp-block-paragraph\">Metastaski izmenjene nabubre\u017ene \u017elezde se prikazuju kao jasno ograni\u010dene, heteroehogene mase. Karcinom se \u010desto ne detektuje, dok ne dostigne veli\u010dinu preko 8 cm. Kada se vizualizuje ehosonografski je nehomogen, dominatno hipoehogen sa iregularnim ivicama. Feohromocitom se otkriva kada ima vi\u0161e centimetara u pre\u010dniku, me\u0161ovite je ehogenosti, glatkih ivica i okrugao. Feohromocitom je na dopler pregledu hipervaskularizovan, za razliku od karcinoma i metastaza koje su hipovaskularne lezije.<\/p>\n\n<figure class=\"wp-block-image size-full\"><img fetchpriority=\"high\" decoding=\"async\" width=\"872\" height=\"804\" class=\"wp-image-2692 aligncenter\" src=\"https:\/\/ultrazvukdojke.rs\/razvojni\/wp-content\/uploads\/2024\/03\/1-1.jpg\" alt=\"UZ nalaz kod pacijenata sa karcinomom nadbubrega\" srcset=\"https:\/\/ultrazvukdojke.rs\/razvojni\/wp-content\/uploads\/2024\/03\/1-1.jpg 872w, https:\/\/ultrazvukdojke.rs\/razvojni\/wp-content\/uploads\/2024\/03\/1-1-300x277.jpg 300w, https:\/\/ultrazvukdojke.rs\/razvojni\/wp-content\/uploads\/2024\/03\/1-1-768x708.jpg 768w\" sizes=\"(max-width: 872px) 100vw, 872px\" \/><\/figure>\n\n<h2 class=\"wp-block-heading\" style=\"text-align: center;\">CT i MR nalaz kod pacijenata sa karcinomom nadbubrega<\/h2>\n\n<p class=\"wp-block-paragraph\">Nadbubre\u017ena \u017elezda se sastoji iz korteksa i medule. U korteksu se naj\u010de\u0161\u0107e javljaju adenomi i karcinomi, a u meduli feohromocitom i neuroblastom.<\/p>\n\n<p class=\"wp-block-paragraph\">Adenomi su male, homogene, jasno ograni\u010dene lezije sa uniformnom opacifikacijom. Adenom se karakteri\u0161e prisustvom masnih polja, niskih HU. I benigne i maligne lezije mogu postati nehomogene zbog aplikovanja kontrasta. Prisustvo nekroze upu\u0107uje na malignitet, kao i veli\u010dina lezije ve\u0107a od 4cm.<\/p>\n\n<p class=\"wp-block-paragraph\">Adenokortikalni karcinom je velika nehomogena masa, sa heterogenim postkontrastnim poja\u010danjem denziteta, i nekada mo\u017ee postati toliko veliki da je nemogu\u0107e otkriti njegovo poreklo. Ukoliko su prisutne, kalcifikacije su uglavnom centralno postavljene. \u0160irenje u okolne krvne sudove je \u010desto. Gubitak masnog plana mo\u017ee uputiti na zahva\u0107enost okolnih organa. Metastazira hematogeno u plu\u0107a, jetru i kosti.<\/p>\n\n<p class=\"wp-block-paragraph\">Feohromocitom je redak oblik tumora koji u 10% slu\u010dajeva mo\u017ee biti bilateralan, 10% maligan i 10% asimptomatski. Mali su homogeni, dok su ve\u0107i nehomogeni sa poljima nekroze i krvarenja. Metastaze su naj\u010de\u0161\u0107e tumorske promene na \u017elezdi i sli\u010dne su po karakteristikama adenomu.<\/p>\n\n<p class=\"wp-block-paragraph\">Oko 70% adenoma sadr\u017ei veliku koli\u010dinu masti (lipid-rich adenomi), dok skoro sve maligne lezije ne sadr\u017ee mast. Ako postoji postkontrastno poja\u010danje denziteta 10HU ili manje, radi se o adenomu.<\/p>\n\n<figure class=\"wp-block-image size-full\"><img decoding=\"async\" width=\"660\" height=\"552\" class=\"wp-image-2693 aligncenter\" src=\"https:\/\/ultrazvukdojke.rs\/razvojni\/wp-content\/uploads\/2024\/03\/2-1.jpg\" alt=\"CT i MR nalaz kod pacijenata sa karcinomom nadbubrega\" srcset=\"https:\/\/ultrazvukdojke.rs\/razvojni\/wp-content\/uploads\/2024\/03\/2-1.jpg 660w, https:\/\/ultrazvukdojke.rs\/razvojni\/wp-content\/uploads\/2024\/03\/2-1-300x251.jpg 300w\" sizes=\"(max-width: 660px) 100vw, 660px\" \/><\/figure>\n\n<p class=\"wp-block-paragraph\">Vrednost atenuacije meri se u prekontrastnom CT-u, u ranoj fazi i 15min nakon aplikacije kontrasta. U tabeli ispod prikazana je formula po kojoj se izra\u010dunava <em>wash-out<\/em> promene vizualizovane na nadbubre\u017enoj \u017elezdi koja omogu\u0107ava diferencijaciju benigne od maligne promene.<\/p>\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" width=\"1024\" height=\"92\" class=\"wp-image-2694 aligncenter\" src=\"https:\/\/ultrazvukdojke.rs\/razvojni\/wp-content\/uploads\/2024\/03\/3-1-1024x92.jpg\" alt=\"wash-out promene vizualizovane na nadbubre\u017enoj \u017elezd\" srcset=\"https:\/\/ultrazvukdojke.rs\/razvojni\/wp-content\/uploads\/2024\/03\/3-1-1024x92.jpg 1024w, https:\/\/ultrazvukdojke.rs\/razvojni\/wp-content\/uploads\/2024\/03\/3-1-300x27.jpg 300w, https:\/\/ultrazvukdojke.rs\/razvojni\/wp-content\/uploads\/2024\/03\/3-1-768x69.jpg 768w, https:\/\/ultrazvukdojke.rs\/razvojni\/wp-content\/uploads\/2024\/03\/3-1.jpg 1269w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n<p class=\"wp-block-paragraph\">APW je absolutno ispiranje promena, koja predstavlja koli\u010dnik razlike atenuacije u ranoj fazi CT pregleda sa odlo\u017eenom fazom u odnosu na razliku rane faze i nativne, prikazane u procentima. RPW je relativno ispiranje, koje predstavlja koli\u010dnik razlike rane i odlo\u017eene faze sa ranom fazom pregleda, prikazane u procentima.<\/p>\n\n<p class=\"wp-block-paragraph\">Promene koje pokazuju APW ve\u0107e od 60% i RPW ve\u0107e od 40% su adenomi.<\/p>\n\n<h2 class=\"wp-block-heading\" style=\"text-align: center;\">PET-CT nalaz kod pacijenata sa karcinomom nadbubrega<\/h2>\n\n<p class=\"wp-block-paragraph\">PET-CT je dobra metoda za analizu i detekciju adrenalnih metastaza koja koristi 18F-FDG, dok se drugi radiofarmaceutici koriste za dijagnozu drugih promena. Za dokazivanje feohromocitoma i paraganglioma koristi se F18-FDOPA zato \u0161to se on normalno ne koncentri\u0161e u nadbubregu.<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-39bee72 e-flex e-con-boxed e-con e-parent\" data-id=\"39bee72\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7669610 elementor-widget elementor-widget-author-box\" data-id=\"7669610\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"author-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-author-box\">\n\t\t\t\t\t\t\t<div  class=\"elementor-author-box__avatar\">\n\t\t\t\t\t<img decoding=\"async\" src=\"https:\/\/ultrazvukdojke.rs\/razvojni\/wp-content\/uploads\/2024\/03\/Dejana-225x300.jpg\" alt=\"Picture of dr Dejana Senji\" loading=\"lazy\">\n\t\t\t\t<\/div>\n\t\t\t\n\t\t\t<div class=\"elementor-author-box__text\">\n\t\t\t\t\t\t\t\t\t<div >\n\t\t\t\t\t\t<h4 class=\"elementor-author-box__name\">\n\t\t\t\t\t\t\tdr Dejana Senji\t\t\t\t\t\t<\/h4>\n\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-author-box__bio\">\n\t\t\t\t\t\t<p>specijalista radiologije<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Karcinomi nadbubre\u017enih \u017elezda se naj\u010de\u0161\u0107e otkrivaju slu\u010dajno \u2013 \u201cincidentalomi\u201d. Maligni tumori nadbubrega su: adenokortikalni karcinom, feohromocitom i metastaze. Karcinom se naj\u010de\u0161\u0107e karakteri\u0161e znacima Ku\u0161ingove bolesti, a kod mu\u0161karaca, mada retko, znacima fertilizacije (ginekomastija i atrofija testisa). Hormonski neaktivan tumor daje neodre\u0111ene simptome (bol u le\u0111ima, mu\u010dninu, povra\u0107anje). UZ nalaz kod pacijenata sa karcinomom nadbubrega Ultrazvu\u010dna [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":2692,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[42],"tags":[],"class_list":["post-2690","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-strucni-radovi"],"_links":{"self":[{"href":"https:\/\/ultrazvukdojke.rs\/razvojni\/wp-json\/wp\/v2\/posts\/2690","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ultrazvukdojke.rs\/razvojni\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ultrazvukdojke.rs\/razvojni\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ultrazvukdojke.rs\/razvojni\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/ultrazvukdojke.rs\/razvojni\/wp-json\/wp\/v2\/comments?post=2690"}],"version-history":[{"count":16,"href":"https:\/\/ultrazvukdojke.rs\/razvojni\/wp-json\/wp\/v2\/posts\/2690\/revisions"}],"predecessor-version":[{"id":4053,"href":"https:\/\/ultrazvukdojke.rs\/razvojni\/wp-json\/wp\/v2\/posts\/2690\/revisions\/4053"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ultrazvukdojke.rs\/razvojni\/wp-json\/wp\/v2\/media\/2692"}],"wp:attachment":[{"href":"https:\/\/ultrazvukdojke.rs\/razvojni\/wp-json\/wp\/v2\/media?parent=2690"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ultrazvukdojke.rs\/razvojni\/wp-json\/wp\/v2\/categories?post=2690"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ultrazvukdojke.rs\/razvojni\/wp-json\/wp\/v2\/tags?post=2690"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}