Endoscopic ultrasound-guided fine-needle aspiration results in upper gastrointestinal system mesenchymal tumors

Yıl 2016, Cilt: 24 Sayı: 2, 36 - 42, 31.08.2016

Ahmet Aydın Nevin Oruç Deniz Nart , Ali Veral

https://doi.org/10.17940/endoskopi.328236

Öz

Background and Aims: Gastrointestinal mesenchymal tumors have characteristic

endoscopic and endosonographic imaging findings, whereas endoscopic

biopsies are usually not helpful for diagnosis. Endosonography-guided

fine-needle aspiration biopsy might allow the procurement of samples

from the lesion. We report retrospective results and efficiency of endosonography-

guided fine-needle aspiration in upper gastrointestinal mesenchymal

tumors. Materials and Methods: Patients admitted to our endosonography

unit with pre-diagnosis of upper gastrointestinal system mesenchymal

tumors between 2009 and 2010 were evaluated. Patients who underwent

endosonography-guided fine-needle aspiration (n=27) were included in the

study. The cytopathology specimens were evaluated by two blinded pathologists.

The final diagnoses were recorded. Results: Eighteen male and 9 female

patients with a mean age of 52.6±12.1 years (30–84 years) were included

in the study. Lesions were located in the esophagus in 14 patients and in

the stomach in 13 patients. The mean lesion diameter was 29.5±15.6 mm

(7-57 mm). Endosonography-guided fine-needle aspiration procedures were

performed by two gastroenterologists. Cytopathology specimens were evaluated

and the presence of spindle cells was reported in 14 samples (51.8%).

Out of 14 samples, two were reported as malignant gastrointestinal stromal

tumors, whereas 4 specimens were reported as suspicious for mesencymal

tumors. Immunohistochemistry for CD117 was applied to nine specimens

and two samples were positive. Malign gastrointestinal stromal tumor was

reported in two patients. Those two patients also had pathologic lymph node

metastasis and endosonography-guided fine-needle aspiration was applied

to the lymph nodes as well. Repeated endosonography-guided fine-needle

aspiration was applied to three samples and with repeated fine-needle aspiration,

the overall diagnostic efficiency of endosonography-guided fine-needle

aspiration in upper gastrointestinal mesencymal tumors reached 59.25%.

Conclusion: Endosonography-guided fine-needle aspiration supports the

diagnosis of mesencymal tumors in 51.8% of patients. With repeated endosonography-

guided fine-needle aspiration , the diagnostic yield was 59.25%.

Although endosonography is very helpful in the diagnosis of mesencymal

tumors, endosonography-guided fine-needle aspiration adds less to the definite

diagnosis.

Anahtar Kelimeler

Gastrointestinal mezencymal tumour, endosonography, fine needle aspiration

Üst gastointestinal sistemde mezenkimal tümör düşünülen olgularda endosonografik ince iğne aspirasyon biyopsi sonuçları

Öz

Giriş ve Amaç: Gastrointestinal mezenkimal tümörler belirgin endoskopik

ve endosonografik özelliklere sahip olmalarına karşın histopatolojik tanıda

endoskopik biyopsinin başarısı düşüktür. Endosonografik ince iğne aspirasyon

biyopsisi lezyonlardan daha derin örnekleme olanağı sağlayan bir yöntemdir.

Bu çalışmada retrospektif olarak üst gastrointestinal sistem mezenkimal

tümörü düşünülen ve endosonografik ince iğne aspirasyon biyopsisi

uygulanan olguların sonuçları irdelenmiştir. Gereç ve Yöntem: Çalışmaya

2009-2010 yıllarında kliniğimize başvuran ve üst gastrointestinal sistem mezenkimal

tümor şüphesi ile endosonografik ince iğne aspirasyon biyopsisi

uygulanan 27 vaka dahil edilmiştir. Olgularda tanımlanan lezyonlardan alınan

endosonografik ince iğne aspirasyon biyopsisi materyalleri sitopatolojik

incelemeye gönderilmiştir. Materyaller iki ayrı patolog tarafından değerlendirilerek

materyalin yeterliliği ve tanı bildirilmiştir. Bulgular: Çalışmaya

yaş ortalaması 52.6±12.1 yıl (30-84 yaş aralığında) olan 18 erkek, 9 kadın

dahil edilmiştir. Lezyonların 14’ü özofagus, 13’ü midede yer almaktadır ve

ortalama çap 29.5±15.6 (7-57 mm) ölçülmüştür. Lezyonlara uygulanan endosonografik

ince iğne aspirasyon biyopsisi sonucu elde edilen materyalin

sitopatolojik incelemesinde 14 adedinde (%51.8) iğsi hücreler görülmüştür.

Bunlardan 2 olguda malign davranışlı gastrointestinal stromal tümör tanısına

ulaşılmış, 4 olguda mezenkimal tümor açısından kuşkulu sitoloji bildirilmiş,

kalan 8 olguda iğsi hücre toplulukları görülmüştür. Dokuz olguda hazırlanan

hücre bloklarına immünohistokimyasal olarak CD117 boyası uygulanmıştır.

Malign gastrointestinal stromal tümör tanısına ulaşılan olgularda

midede mezenkimal kitle ve perigastrik lenf nodu metastazı saptanarak her

iki lezyona endosonografik ince iğne aspirasyon biyopsisi uygulanmıştır. Üç

olguya ikinci kez biyopsi uygulanmış ve iki olguda iğsi hücreler görülmüştür.

Bu olgularla birlikte tanı oranı %59.25’e ulaşmıştır. Sonuç: Gastrointestinal

mezenkimal tümörlerde endosonografik ince iğne aspirasyon biyopsisi,

tanıyı %51.8 olguda destekler bulgular vermiş, iki olguda malign gastrointestinal

stromal tümör tanısına ulaşılmıştır. Tekrarlayan endosonografik ince

iğne aspirasyon biyopsisi ile tanı oranı %59.25’e ulaşmıştır. Sonuç olarak

üst gastrointestinal mezenkimal tümörlerde endosonografik inceleme oldukça

yararlı iken endosonografik ince iğne aspirasyon biyopsisi tanıya yeterli

katkı sağlamamaktadır.

Anahtar Kelimeler

Gastrointestinal mezenkimal tümör, endosonografi, ince iğne aspirasyon biyopsisi

Kaynakça

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