Sitomorfolojik Bulgularla Pelvis Renalisin Üroteryal Neoplazmı

Year 2009, Volume: 26 Issue: 2, - , 06.12.2010

Figen Barut Gürkan Kertiş Burak Bahadır Şükrü Oğuz Özdamar Banu Doğan Gün İlker Seçkiner Gamze Mocan Kuzey

Abstract

İdrar sitolojisi, sıklıkla mesanede izlenen üroteryal neoplaziler için kullanılan önemli bir tanısal
tekniktir. Pelvikaliksiyel sistem ve üreter tümörlerinin tanısında sitopatolojik kanıtları
ortaya koymak daha zor olmakla beraber sitolojik materyalde tümörün tanısı ve derecelendirilmesi,
tedavi planlanmasında önemli avantaj sağlar.
Gross hematüri etyolojisi araştırılan 55 yaşında erkek hastanın, abdomen bilgisayarlı tomografisinde
“sağ pelvis renalisde tümör?” saptanması üzerine yapılan üreterorenoskopisinde,
pelvis renalisde multipl papiller kitle görünümü izlenmiştir. Bu işlem sırasında alınan
idrar sitolojisi “malignite şüphesi” gösteren yayma olarak rapor edilmiştir. Doku örnekleri
kesitlerinde, fibrovasküler kor çevresinde dizilim gösteren 6–7 epitel hücre tabakasından
oluşan papiller yapılar ile karakterize tümöral oluşum izlenmiştir. Tümör, pleomorfik, iri,
nükleolleri belirgin, hiperkromatik nükleuslu, eozinofilik sitoplazmalı atipik epitelyal karakterde
hücrelerden oluşmaktadır. Lamina propriada invazyon saptanmayan olgu “düşük
malign potansiyelli papiller üroteryal neoplazi (WHO/ISUP 98)” tanısı almıştır. Olgumuz
diyagnostik sitolojik özellikleri nedeniyle sunulmaya değer bulunmuştur.

Urothelial neoplasm of pelvis renalis with cytomorphology findings

Urine cytology is an important diagnostic technique for urothelial neoplasia. Although it is
difficult to demonstrate the cytopathological clues in the diagnos are of pelvicalicial system
and urothelial tumors, tumor grading and diagnosis with cytology provides important
advantages for treatment. After “right pelvis renalis tumor?” determination in abdominal
computerized tomography of a 55 year old male patient for gross hematuria etiology
search, multiple milimetric papillary mass appearance was observed at pelvis renalis in
ureterorenoscopy. In examination of urine sample obtained during this procedure reported
as “suspicious of malignancy”. A tumoral mass characterized with papillary structures
composed of 6-7 epithelial cells layer lined around fibrovasculary core, is designated in
cross sections. Tumor was composed of atypical epithelial cells with pleomorphic, coarse,
apparent nucleoli, hyperchromatic nuclei and eosynophilic cytoplasm features. Tumor with
no lamina propria invasion reported as “papillary urothelial neoplasm with low malignancy
potential (WHO/ISSUP 98)” Our case was worth presentation because of its diagnostic
cytological features.

Keywords

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References

• Dodd LG, Johnston WW, Robertson CN, Layfield LJ., 1997. Endoscopic brush cytology of the upper urinary tract. Evaluation of its efficacy and potential limitations in diagnosis. Acta Cytol. 41, 377–384.
• Highman JW, 1986. Transitional carcinoma of the upper urinary tract: a histological and cytopathological study. J Clin Pathol. 39, 297–305.
• Holmang S, Johansson SL, 1998. Urothelial carcinoma of the upper urinary tract: comparison between the WHO/ISUP consensus classification and WHO 1999 classification system. Urology 2005. 66, 274–278.
• Kirkali Z, Tuzel E, 2003. Transitional cell carcinoma of the ureter and renal pelvis. Crit. Rev. Oncol. Hematol. 47, 155–169.
• Lodde M, Mian C, Wiener H, Haitel A, Pycha A, Marberger M, 2001. Detection of upper urinary tract transitional cell carcinoma with ImmunoCyt: a preliminary report. Urology 58, 362–366.
• McKee G, 2003.Urinary tract cytology. In: Gray W (ed), Diagnostic Cytopathology. 2nd ed. China, Churchill Livingstone. 471– 497.
• Park S, Hong B, Kim CS, 2004. Ahn H. The impact of tumor location on prognosis of transitional cell carcinoma of the upper urinary tract. J. Urol. 171, 621–625.
• Oehlschläger S, Baldauf A, Wiessner D, Gellrich J, Hakenberg OW, Wirth MP, 2004. Bladder tumor recurrence after primary sur- gery for transitional cell arcinoma of the upper urinary tract. Urol. Int . 73, 209–21.
• Ordonez NG, Rosai J, 2004. Urinary tract. In: Rosai J (ed), Rosai and Ackerman’s urgical Pathology. 9th ed. China, Mosby. 1163– 1359.
• Witte D, Truong LD, Ramzy I, 2002. Transitional cell carcinoma of the renal pelvis the diagnostic role of pelvic washings. Am J Clin. Pathol. 117, 444–450.