Uterine Leiomyosarkomların Leiomyomlardan Ayırıcı Tanısında Ameliyat Öncesi Laboratuvar Değerlendirmelerinin Önemi

Öz

Amaç: Uterin leiomyosarkomun (ULMS) preoperatif tanısı zordur çünkü hastalık dejenere uterin leiomyoma (DULM) ve iyi huylu leiomyomu (ULM) taklit edebilir. Bu çalışmanın amacı, uterin ULMS, DULM ve ULM'yi ayırt etmede preoperatif klinik özelliklerin ve hematolojik parametrelerin rolünü araştırmaktır. Özellikle genç yaş grubunda sıklıkla semptomatik olan ve operasyon planlanan olguların leiomyoma kitlesinin maling yönde değişimi öngörülerek gerekli cerrahi ve medikal tedavilerinin eksiksiz yapılmasının sağlanması planıyla bu çalışma literatür tartışması eşliğinde planlanmıştır. Materiyal ve yöntemler: 2022-2025 arasında jinekolojik onkoloji merkezlerinde uterin kitle nedeniyle operasyon geçiren 336 hastanın klinik kayıtlarını retrospektif olarak inceledik. Uterin benign leiomyoma tanısı alan 272 (benign) (ULM) (grup 1), malignite dışlanamayan 43 (presumed malign or dejenere uterin leiomyoma) (DULM) (grup 2) ve 21 leiomyosarkoma (malign) (ULMS) (grup 3) olgu çalışmaya dahil edildi. Uterin leiomyosarkoma grubunda ve kontrol gruplarında (ULM, DULM) hastaların demografik, klinik, patolojik verileri, ultrasonografik özellikleri, laboratuvar testleri ve cerrahi operasyon yöntemleri retrospektif olarak alındı. Ultrasonografik özellikler arasında uterusun en büyük çapı, miyom sayısı ve en büyük miyom çapı yer aldı. Laboratuvar testleri arasında hemoglobin, hematokrit, lökosit, nötrofil sayısı, lenfosit, trombosit, mean platelet volume (MPV), Troid stimulan hormon (TSH), açlık kan glukozu (FBG), cancer antigen-125 (CA-125), carcino-embrionic antigen (CEA), C-reactive protein (CRP), cancer antigen 15-3 (CA-15-3), Eritrosit sedimentasyon hızı (ESR), Alpha-fetoprotein (AFP), cancer antigen (CA-19-9) ve serum laktat dehidrogenaz (LDH) seviyesi yer aldı. Ultrasonografi ve laboratuvar testleri ameliyattan önceki bir ay içinde yapıldı. Bulgular: Olguların yaş ortalaması 47,2±12,6 iken BMI oranları 26,1±6 idi. Grup I ve II arasında nötrofil 3650 (1560-12150)/4200 ( 1990-12490)ve NLR (nötrofil/lenfosit oranı) 1,44 (0,52-7,31)/1,85 (0,74-6,51) oranları açısından istatistiksel anlamlı farklılık izlendi (sırasıyla p değerleri: 0.029, 0.004). 3 grup arasında biokimyasal değerlerin postHoc analizi yapıldığında ise CRP (C reactive protein) değerleri grup I de 4,6 (1,1-26,3) iken grup II de ise 7,3 (1,8-45,1) olup iki grup arasında istatistiksel anlamlı farklılık izlendi (p değeri:0,029). ESR (eritrosit sedimentasyon oranı) açısında grup I: 11,2 (6,4-29,2), Grup II: 20,3 (8,5-32,2) ve grup III ise 22,8 (17,5-30,8) değerleri açısından grup I ile II ve I ile III arasında istatistiksel olarak anlamlı farklılık izlendi (sırasıyla p değerleri: <0,001, <0,001). LDH (laktat dehidrogenaz) düzeyleri grup I de 182 (112-295), grup II de 196 (126-381) ve grup III te ise 246 (164-373) olup her üç grubun karşılaştırılmasında grup I ile II, I ve III ve II ile III arasında istatistiksel olarak anlamlı farklılık izlendi (sırasıyla p değerleri: <0,001, <0,001, <0,001). Sonuç: Preoperatif dönemde Bening uterin leiomyomaları, dejenere uterin leiomyoma ve malign uterin leiomyosarkomalardan ayırıcı tanısında özellikle ESR ve LDH düzeylerinin ayrıcı tanıda önemli olduğu unutulmamalıdır. Cerrahi sonrası histopatolojik incelemenin altın standart olduğu ancak özellikle çok merkezli prospektif çalışmalar ile preoperatif laboratuar belirtleçlerinin de ayırıcı tanıdaki değeri daha net ortaya konulabilir.

Anahtar Kelimeler

• Uterine leiomyoma
• Dejenere Uterin Leiomyoma
• Uterin leiomyosarkoma
• Laktat dehidrogenaz
• Nötrofil-lenfosit oranı
• Eritrosit sedimentasyon hızı.

The Importance of Preoperative Laboratory Evaluations in the Differential Diagnosis of Uterine Leiomyosarcomas from Leiomyomas

Öz

Background: Preoperative diagnosis of uterine leiomyosarcomas (ULMS) is challenging, as it may mimic degenerative uterine leiomyosarcoma (DULM) and benign uterine leiomyoma (ULM). This study investigates the role of preoperative clinical features and hematological parameters in the differential diagnosis of ULMS, DULM, and ULM. In light of the literature, this study was planned to perform the required surgical and medical treatments correctly and completely by predicting the malignant transformation of the leiomyoma mass in patients who are usually young, symptomatic, and planning to undergo surgery. Methods: Clinical records of 336 patients who underwent surgery due to uterine mass lesions in gynecological oncology clinics between 2022 and 2025 were retrospectively analyzed. A total of 272 patients diagnosed with benign uterine leiomyoma (Group 1, benign, ULM), 43 patients in whom malignancy could not be ruled out (Group 2, presumed malignant or degenerated uterine leiomyoma, DULM), and 21 patients with leiomyosarcoma (Group 3, malignant, ULMS) were included in the study. In the uterine leiomyosarcoma group and control groups (ULM, DULM), data about demographic, clinical, pathological, and ultrasonography features, laboratory tests, and surgical methods used were obtained retrospectively. Ultrasonography features included the largest diameter of the uterus, the number of myomas, and the diameter of the largest myoma. Laboratory tests included hemoglobin (HGB), hematocrit (HTC), white blood cell (WBC), neutrophil count, lymphocyte, neutrophil to lymphocyte ratio (NLR), platelet count (PLT), mean platelet volume (MPV), thyroid stimulating hormone (TSH), fasting blood glucose (FBG), cancer antigen-125 (CA-125), carcino-embryonic antigen (CEA), C-reactive protein (CRP), cancer antigen 15-3 (CA-15-3), erythrocyte sedimentation rate (ESR), alpha-fetoprotein (AFP), cancer antigen 19-9 (CA-19-9), and serum lactate dehydrogenase (LDH) level. Ultrasonography and laboratory tests were performed within one month before surgery. Results: The mean age of the patients was 47.2±12.6 years, and the BMI was 26.1±6 kg/m2. A statistically significant difference was found between Group I and II with regard to neutrophil count 3650 (1560-12150)/4200 (1990-12490) and NLR 1,44 (0,52-7,31)/1,85 (0,74-6,51) (p: 0.029 and 0.004, respectively). In post hoc analysis of biochemical values among three groups, CRP values were 4,6 (1,1-26,3) in Group I, they were 7,3 (1,8-45,1) in Group II, and the difference was statistically significant (p: 0,029). A statistically significant difference was found between Group I and II, and between Group I and III (Group I: 11,2 (6,4-29,2), Group II: 20,3 (8,5-32,2), and Group III: 22,8 (17,5-30,8) (p: <0,001 and <0,001, respectively). LDH values were 182 (112-295) in Group I, 196 (126-381) in Group II, and 246 (164-373) in Group III, and a statistically significant difference was found between Group I and II, between Group I and III, and between Group II and III (p: <0,001, <0,001, and <0,001, respectively). Conclusion: It should be kept in mind that preoperative ESR and LDH values are significant in the differential diagnosis of benign uterine leiomyoma, degenerative uterine leiomyoma, and malignant uterine leiomyosarcoma. Postoperative histopathological examination is the gold standard; however, the value of preoperative laboratory biomarkers may be revealed through multi-center prospective studies.

Anahtar Kelimeler

• Uterine leiomyoma
• Degenerative uterine leiomyoma
• Uterine leiomyosarcoma
• Lactate dehydrogenase
• Neutrophil to lymphocyte ratio
• Erythrocyte sedimentation rate.

Destekleyen Kurum

Osmaniye Devlet Hastanesi

Etik Beyan

Bu çalışma Helsinki Bildirgesi'nde açıklanan etik standartlara uygun olarak yürütüldü ve lokal etik komitesinden 18/04/2025 tarih ve 4/6 sayılı numara ile etik kurul onayı alındı.

Teşekkür

Osmaniye Devlet Hastanesi ve Özel Park Hastanesi tüm sağlık çalışanlarına teşekkür ediyoruz.

Kaynakça

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