AKCİĞERİN NADİR PRİMER MALİGN TÜMÖRLERİNDE KLİNİK VE RADYOLOJİK DEĞERLENDİRME

Year 2021, Volume: 28 Issue: 4, 551 - 558, 30.12.2021

Gürhan Öz , Çiğdem Özdemir , Suphi Aydın , Ahmet Dumanlı , Ersin Günay , Şule Çilekar , Sibel Günay Adem Gencer , Düriye Öztürk , Funda Demirağ

https://doi.org/10.17343/sdutfd.753812

Abstract

Amaç
Akciğerin en sık görülen primer malign tümörlerini
yassı hücreli karsinom, küçük hücreli karsinom ve
adenokarsinom oluşturur. Ancak, nadir görülen bazı
malign primer akciğer tümörleri de akciğeri etkileyebilir,
tanı ve tedavide zorluklara neden olabilir. Geleneksel
görüntüleme yöntemleri olguların birçoğunda
tanıda yeterince yardımcı olmaz hatta preoperatif
alınan doku örnekleri tanı koymada yetersiz kalabilir.
Endobronşial lezyonu olan vakalarda örneklerin küçük
olması veya endobronşial lezyon olmayan santral
tümörlerde transtorasik biyopsi yapılamaması tanıyı
zorlaştırabilir. Kesin tanı ancak operasyon sonrası
alınan daha büyük doku örnekleri ile ayrıntılı incelemeler
sonunda konabilir. Ayrıca frozen incelemesinde
benign-malign ayrımı yapılamaması cerrahın yapacağı
rezeksiyonu olumsuz yönde etkileyebilir. Eksik ya
da gereksiz rezeksiyona neden olabilir. Çalışmamızın
amacı literatürde çok az bildirilen bu tümörlerin klinik
radyolojik ve histopatolojik görünümlerini değerlendirerek
tanı ve tedavilerine katkıda bulunmaktır.
Gereç ve Yöntem
2010-2019 yılları arasında kliniğimizde opere edilen
oldukça nadir 10 malign primer akciğer tümörü hasta
çalışmaya dahil edildi. Tüm hastalar, yaş, cinsiyet,
semptomlar, preoperatif görüntüleme yöntemleri ve
invazif tanı yöntemleri ile retrospektif olarak incelendi.
Tümör lokalizasyonu, tümör boyutları, yapılan cerrahi
operasyon tipi ve yaşam süreleri kaydedildi.
Bulgular
Çalışmamıza 10 hasta dahil edildi. Hastaların 6 tanesi
erkek, 4 tanesi kadındı. Yaş ortalamaları 53.4
idi. 3 hastaya sol alt lobektomi, 2 hastaya sol pnömonektomi,
3 hastaya wedge rezeksiyon, 1 hastaya
sol üst lobektomi, 1 hastaya orta lobektomi yapıldı.
Hastaların postoperatif histopatolojik tanıları 2 hastada
karsinosarkom, 2 hastada büyük hücreli nöroendokrin
karsinom, 2 hastada epiteloid hemanjioendotelyoma,
1 hastada glomanjiosarkom, 1 hastada
primer pulmoner leiomyosarkom, 1 hastada mukoepidermoid
karsinom, 1 hastada sinovyal sarkom olarak
raporlandı.
Sonuç
Akciğerin nadir görülen primer malign tümörlerine
preoperatif görüntüleme ve invaziv yöntemler ile tanı
koymak zor olabilir. Ameliyat öncesi yapılan tomografi
eşliğinde ince iğne biyopsi, tru-cut biyopsi, bronkoskopik
biyopsi örnekleri ve frozen incelemeleri tanı
koymakta yetersiz kalabilir. Bu durum, operasyonu
yapacak cerrahı yapılacak akciğer rezeksiyonu konusunda
yanlış yönlendirebilir.

Keywords

Nadir Primer Akciğer Tümörleri, Malign, Glomanjiosarkom, Epiteloid Hemanjioendotelyoma

Supporting Institution

Yok

Project Number

Yok

Thanks

yok

CLINICAL AND RADIOLOGICAL EVALUATION IN RARE PRIMARY MALIGNANT TUMORS OF THE LUNG

Abstract

Objective
The most common primary malignant tumors of the
lung are squamous cell carcinoma, small cell carcinoma
and adenocarcinoma. However, some rare malignant
primary lung tumors can also affect the lung
and cause difficulties in diagnosis and treatment.
Conventional imaging methods do not help the diagnosis
in most cases, and moreover, preoperative
tissue samples may fail to establish a diagnosis. In
cases with endobronchial lesions, small samples or
lack of transthoracic biopsy in central tumors without
endobronchial lesions can make diagnosis difficult.
The definitive diagnosis can only be made after larger
examinations with larger tissue samples taken after
the operation. In addition, failure to differentiate benign-
malignant in frozen examination may negatively
affect the resection of the surgeon. It can cause incomplete
or unnecessary resection.
The aim of this study was to evaluate the clinical radiological
and histopathological features of these tumors,
which have been rarely reported in the literature,
and to contribute to the diagnosis and treatment of
these tumors.
Material and Methods
The study included 10 patients with rare malignant
primary lung tumor who were operated on in our clinic
between 2010 and 2019. All patients were retrospectively
evaluated in respect of age, gender, symptoms,
preoperative imaging methods and invasive diagnostic
methods. Tumor localization, tumor size, type of
surgical operation and survival were recorded.
Results
The 10 patients included in the study comprised 6
males and 4 females. Postoperative histopathological
diagnoses of the patients were reported as 2 carcinosarcomas,
2 large cell carcinomas, 2 epithelioid
hemangioendothelioma, 1 glomangiosarcoma, 1 primary
pulmonary leiomyosarcoma, 1 mucoepidermoid
carcinoma, and 1 synovial sarcoma.
Conclusion
It can be difficult to diagnose in rare primary malignant
lung tumors by preoperative imaging and preoperative
invasive diagnostic methods. CT-guided fine needle
biopsy and tru-cut biopsy, endobronchial biopsy
and frozen samples performed before surgery may be
insufficient in diagnosis, which may mislead the surgeon
about lung resection.

Keywords

Rare Primary Lung Tumors, Malignant, Glomangiosarcoma, Epiteloid Hemangioendothelioma

Project Number

Yok

References

• 1. Fraser RS, Muller NL, Coleman N, Pare PD. Diagnosis of Diseases of the Chest, 4th edn. Philadelphia, PA: W B Saunders, 1999
• 2. Travis WD, Brambilla E, Müller-Hermelink HK, Harris CC, eds. World Health science Organization Classification of Tumours, Pathology and Genetics of Tumours of the Lung, Pleura, Thymus and Heart. IARC Pres, Lyon, 2004:12
• 3. Fasano M, Della Corte CM, Papaccio F, Ciardiello F, Morgillo F Pulmonary Large-Cell Neuroendocrine Carcinoma: From Epidemiology to Therapy.J Thorac Oncol. 2015 Aug;10(8):1133- 41. doi: 10.1097/JTO.
• 4. Fernandez FG, Battafarano RJ. Large-cell neuroendocrine carcinoma of the lung: an aggressive neuroendocrine lung cancer. Semin Thorac Cardiovasc Surg 2006;18:206–210.
• 5. Sánchezde Cos Escuín J. Diagnosis and treatment of neuroendocrinelung tumors. Arch Bronconeumol 2014;50:392–396.
• 6. Battafarano RJ, Fernandez FG, Ritter J, Meyers BF, Guthrie TJ, Cooper JD et al. Large cell neuroendocrinecarcinoma: an aggressive form of non-small cell lung cancer. J ThoracCardiovasc Surg 2005;130:166–172.
• 7. Odate S, Nakamura K, Onishi H, Kojima M, Uchiyama A, Nakano K et al. TrkB/BDNF signaling pathway is a potential therapeutic target for pulmonary large cell neuroendocrinecarcinoma. Lung Cancer 2013;79:205–214.
• 8. Doğan C, Cömert SŞ, Çağlayan B, Salepçi B, Sağmen SB, Fidan A et al. A Rare Tumor of the Lung: Sarcomatoid Carcinoma South. Clin. Ist. Euras. 2017;28(2):135-138
• 9. Kim K, Flint JDA, Müller NL. Pulmonary carcinosarcoma: Radiologic and pathologic findings in three patients. AJR 1997; 169: 691 – 694
• 10. Travis WD, Brambilla E, Müller-Hermelink HC, Harris CC .Pathology and genetics. Tumours of the lung, plevra, thymus and heart. World Health science Organisation Classification of Tumours. IARC pres, Lyon, 2004, 53 – 58
• 11. Robinson PG, Shields TW. Uncommon primary malignant tumour of the lung. In.Shields TW, Lo Cicero III J,Pom Rb, Rusch VW (Eds). General thoracic surgery. 6.th edition, Lippincott Williams &Wilkins ,Philadelphia 2005,1810-12
• 12. Koss MN, Hochholzer L, Frommelt RA. Carcinosarcomas of the lung: a clinicopathologic study of 66 patients. Am J Surg Pathol. 1999 Dec;23(12):1514-26.
• 13. S. W. Weiss, K. G. Ishak, D. H. Dail, D. E. Sweet, and F.M. Enzinger, “Epithelioid hemangioendothelioma and related lesions,” Semin Diagn Pathol, vol. 3, no. 4, pp. 259–287, 1986, http://www.ncbi.nlm.nih.gov/pubmed/3303234.
• 14. Mesquita RD, Sousa M, Trinidad C, Pinto E, Badiola IA. New Insights about Pulmonary Epithelioid Hemangioendothelioma: Review of the Literature and Two Case Reports. Case Rep Radiol. 2017;2017:5972940. doi: 10.1155/2017/5972940.
• 15. Carter EJ, Bradburne RM, Jhung JW, Ettensohn DB . Alveolar haemorrhage with epithelioid haemangioendothelioma. Am Rev Respir Dis 1990; 142: 700–701.
• 16. Kradin RL, Mark EJ. Hemoptysis in a 20-year-old man with multiple pulmonary nodules. Massachusetts General Hospital Case Records, case 6-2000. N Engl J Med 2000; 342:572–578.
• 17. Mata JM, Ca´ceres J, Prat J, Lo´pez JI, Velilla O. Intravascular bronchio-alveolar tumor: radio-graphic findings. Eur J Radiol 1991; 12:95–97.
• 18. Buggage RR, Soudi N, Olson JL, C.T.(A.S.C.P.), C.T.(I.A.C.), Jean L et al. Epithelioid haemangioendothelioma of the lung. Diagn Cytopathol 1995; 13:54–60.
• 19. K. Eguchi and M. Sawafuji, “Surgical management of a patient with bilateral multiple pulmonary epithelioid hemangioendothelioma: report of a case,” Surgery Today, vol. 45, no. 7, pp. 904–906, 2014.
• 20. Y.Mizuno, H. Iwata, K. Shirahashi, Y.Hirose, and H. Takemura,“ Pulmonary epithelioid hemangioendothelioma,” General Thoracic and Cardiovascular Surgery, vol. 59, no. 4, pp. 297– 300,2011.
• 21. Yousem SA, Hochholzer L. Mucoepidermoid tumors of the lung. Cancer 1987; 60:1346-52.
• 22. Ishizumi T, Tateishi U, Watanabe S, Matsuno Y. Mucoepidermoid carcinoma of the lung: high-resolution CT and histopathologic findings in five cases. Lung Cancer 2008; 60:125-31.
• 23. Li X, Yi W, Zeng Q. CT features and differential diagnosis of primary pulmonary mucoepidermoid carcinoma and pulmonary adenoid cystic carcinoma. J Thorac Dis. 2018 Dec;10(12):6501- 6508. doi: 10.21037/jtd.2018.11.71.
• 24. Han X, Zhang J, Fan J, Cao Y, Gu J, Shi H. Radiological and Clinical Features and Outcomes of Patients with Primary Pulmonary Salivary Gland-Type Tumors. Can Respir J. 2019 Apr 1;2019:1475024. doi: 10.1155/2019/1475024.
• 25. Zhou X, Zhang M, Yan X, Zhong Y, Li S, Liu J. Challenges in diagnosis of pulmonary mucoepidermoid carcinoma Medicine (Baltimore). 2019 Nov;98(44):e17684. doi: 10.1097/ MD.0000000000017684.
• 26. Pozgain Z, Dulic G, Kristek J, Rajc J, Bogović S, Rimac M et al. Giant primary pleomorphic adenoma of the lung presenting as a post-traumatic pulmonary hematoma: a case report. J Thorac Cardiovasc Surg 2016;11:18.
• 27. Roden AC, Garcia JJ, Wehrs RN, Colby TV, Khoor A, Leslie KO et al. Histopathologic, immunophenotypicand cytogenetic features of pulmonary mucoepidermoid carcinoma. Mod Pathol 2014;27:1479–88.
• 28. Wang S, Ding C, Tu J Malignant glomus tumor of the lung with multiple metastasis: a rare case report. World J Surg Oncol. 2015 Feb 7;13:22. doi: 10.1186/s12957-014-0423-3.
• 29. Abu-Zaid A, Azzam A, Amin T, Mohammed S. Malignant glomus tumor(glomangiosarcoma) of intestinal ileum: a rare case report. Case Reports Pathol. 2013;2013:305321.
• 30. Milia M E, Turri L, Beldi D, Deantonio L, Pareschi R, Krengli M. Multidisciplinary approach in the treatment of malignant paraganglioma of the glomus vagale: a case report. Tumori. 2011;97:225–8.
• 31. Attanoos R.L, Appleton M.A, A.R. Gibbs, Primary sarcomas of the lung: a clinicopathological and immunohistochemical study of 14 cases, Histopathology 29 (1996) 29–36.
• 32. Frances R.L , J.A. Royo Prats. Pulmonary artery leiomyosarcoma diagnosed by magnetic resonance, PET-CT and EBUS-TBNA, Arch. Bronconeumol. 53 (2017) 522–523.
• 33. J.S. Woo, O.L. Reddy, M. Koo, Y. Xiong, F. Li, H. Xu, Application of immunohistochemistry in the diagnosis of pulmonary and pleural neoplasms, Arch. Pathol. Lab Med. 141 (2017) 1195–1213.
• 34. Suurmeijer et al. (2013) Synovial sarcoma. In: Fletcher DM et al.(eds) WHO classification of tumors of soft tissue and bone, 4thedn. IARC, Lyon
• 35. Okamoto S, Hisaoka M, Daa T, Hatakeyama K, Iwamasa T,- Hashimoto HA et al. (2004) Primary pulmonary synovial sarcoma: a clinicopathologic, immunohistochemical, and molecular study of11 cases. Hum Pathol 35:850–856
• 36. Essary LR, Vargas SO, Fletcher CD (2002) Primary pleuropulmonary synovial sarcoma: reappraisal of a recently described anatomic subset. Cancer 94:459–469
• 37. Dennison S, Weppler E, Giacoppe G (2004) Primary pulmonary synovial sarcoma: a case report and review of current diagnostic and therapeutic standards. Oncologist 9:339–342