Mesane Kanseri Nedeniyle Transüretral Rezeksiyon Yapılan 177 Olgunun Retrospektif Analizi

Yıl 2018, Cilt: 8 Sayı: 3, 190 - 193, 01.12.2018

Erkan Hirik Mecdi Gürhan Balcı

Öz

Amaç: Dünyada en sık görülen kanserler arasında dokuzuncu sırada yer alan mesane kanserleri, üriner sistemin en sık görülen maligniteleridir. 60 yaşın üzerinde ve erkeklerde daha sık görülürler.
En sık görülen belirtisi hematüridir. En sık görülen histopatolojik tipi ürotelyal hücreli karsinomlardır. Oldukça yüksek rekürrens ve
invazyon oranlarına sahiptirler. Mesane kanseri nedeniyle transüretral rezeksiyon (TURM) yapılan hastalar ilk iki yıl boyunca en az
üç-dört ayda bir, sonraki üç yıl boyunca her altı ayda bir, daha sonra yılda bir defa klinik/sistoskopik olarak takip edilirler. Çalışmanın
amacı, mesane tümörü tanısıyla TURM uygulanan vakaları ve bu
vakaların nüks materyallerindeki re-TUR sonuçlarını invazyon ve
histolojik grade açısından karşılaştırmalı olarak değerlendirmek,
sonuçları literatürle paylaşmak, hastaların prognozunun belirlenmesine, klinik takibi ve tedavisine katkı sağlamaktır.
Materyal ve Metot: Çalışmada üniversitesimizin patoloji arşivi kullanıldı. Mesane ürotelyal karsinom tanısı alan vakalar çalışmaya dahil
edildi. 2013–2018 tarihleri arasında mesane tümörü tanısıyla TURM
yapılan 177 olgu incelendi. Bu olguların parafin bloklarından alınan
kesitler Hematoksilen-Eozin boyamayla değerlendirildi. İlk doku teşhisi ile re-TUR sonuçları karşılaştırıldı.
Bulgular: Hastaların 153’ü erkek, 24’ü kadındı. Histopatolojik olarak 103 olguda yüksek dereceli, 74 olguda düşük dereceli ürotelyal
karsinom mevcuttu. 66 vakada noninvaziv ürotelyal karsinom mevcuttu. 102 vakada lamina propria invazyonu, 9 vakada muscularis
propria invazyonu saptandı. 46 (%26) vakada nüks olduğu saptandı. Tümör histolojik grade’i yüksek olan vakalarda ve invaziv vakalarda nüks oranları istatistiksel olarak anlamlı derecede yüksekti.
Nüks eden 11 düşük grade’li vakanın 3 (%27,2) tanesinde rekürrens materyallerinde yüksek grade’li tümör saptandı. Nüks eden 11
noninvaziv vakanın 2 (%18,2)’sinde invazyon saptandı.
Sonuç: Mesane TURM ve re-TUR sonuçları literatürle paylaşıldı.
İlk doku teşhisi ile nüks materyalinde invazyon varlığı ve histolojik
grade değişiklikleri mevcutsa, hastaların tedavi ve takibinin yeniden
planlanması gerektiği vurgulandı.

Anahtar Kelimeler

mesane; transüretral rezeksiyon; ürotelyal karsinom; rekürrens

Retrospective Analysis of 177 Cases Treated with Transurethral Resection

Öz

Aim: Bladder cancers are the ninth most common malignancies in
the world. These are the most common malignancies of the urinary
tract. The most common histological type of this cancer is urothelial cell carcinoma. It has very high rates of recurrence and invasion. The aim of this study is to evaluate the results of bladder TUR
and re-TUR cases in terms of invasion and histological grade, to
share the results with the literature, to determine the prognosis of
patients and to contribute to the clinical follow-up and treatment.
Material and Method: Pathology archive of Erzincan Binali
Yıldırım University was used in this study. Cases with urothelial
carcinoma of the bladder were included in the study. A total of
177 cases who underwent bladder TUR between 2013–2018 were
examined. Sections from the paraffin blocks of these cases were
evaluated with Hematoxylin-Eosin staining. Re-TUR results were
compared with the first TUR diagnosis.
Results: 153 of the patients were male and 24 were female. In 103
cases, the tumor was high-grade and 74 patients had low-grade tumor. Sixty-six cases had non-invasive urothelial carcinoma. Lamina
propria invasion was detected in 102 cases and muscularis propria
invasion in 9 cases. 46 (26%) cases had a recurrence. Recurrence
rates were significantly higher in the cases with high-grade tumor
and in the invasive cases. 3 (27.2%) of the recurrent 11 low-grade
cases had a high-grade tumor in the recurrence material. The invasion was detected in 2 (18.2%) of 11 noninvasive cases.
Conclusion: Bladder TUR and re-TUR results were shared with
the literature. It was emphasized that if there is invasion and histological grade changes in the recurrence and the first TUR diagnosis, treatment and follow-up of patients should be re-planned.

Anahtar Kelimeler

bladder; transurethral resection; urothelial carcinoma; recurrence

Kaynakça

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