Çocukluk Yaş Grubunda Benign Renal Kitlesel Lezyonlar
Özet
Çocukluk çağında renal kitleler çoğunlukla rutin incelemeler veya diğer hastalıkların değerlendirilmesi sırasında insidental olarak tespit edilir. Renal malign kitleler tüm çocukluk çağı kanserlerinin %7'sini oluşturacak kadar nadir olduğundan, tespit edilen kitlesel lezyonların benign ve malign ayrımının doğru şekilde yapılması büyük önem taşır. Bu ayrımda pediatrik nefroloji, pediatrik onkoloji, radyoloji, cerrahi ve patoloji uzmanlarını kapsayan multidisipliner bir yaklaşım benimsenmelidir. Tanı aşamasında klinik öykü, fizik muayene ve laboratuvar bulgularının yanı sıra ultrasonografi (US), bilgisayarlı tomografi (BT) ve manyetik rezonans görüntüleme (MRG) gibi kesitsel görüntüleme yöntemlerinden yararlanılır. US kistik ve solid yapıların ayırt edilmesini sağlarken; yüksek doku kontrastına sahip MRG, radyasyon riski içermemesi nedeniyle ön plana çıkar. Çocuklarda saptanan benign renal lezyonlar arasında en sık rastlanan ve Bosniak Kategori 1 ile 2 altında değerlendirilen basit kistler; %80 olguda tuberoskleroza eşlik eden ve mTOR inhibitörleri ile tedavi edilebilen anjiyomiyolipomlar; nadir epitelyal/stromal tümörlerden olan metanefrik adenom; merkezinde skar dokusu barındıran onkositom; hipertansiyon, hipokalemi ve yüksek renin aktivitesiyle karakterize reninoma; ağrısız makroskopik hematüriye yol açan infantın ossifiye renal tümörü; cerrahi rezeksiyon gerektirebilen multikistik kistik nefroma ve fokal piyelonefrit veya konjenital anomalilere sekonder gelişen renal psödotümörler bulunmaktadır.
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