TİMUS PATOLOJİLERİNİN CERRAHİSİNDE KLİNİK DENEYİMİMİZ

Yıl 2014, Cilt: 1 Sayı: 1, 1 - 18, 21.11.2014

Osman Tilkan Özgür Karakurt SEDAT Demircan

Öz

Özet

Bu çalışmada Anabilim Dalımızda Temmuz 2002 – Mart 2010 tarihleri arasında timik lezyon nedeniyle takip edilen 30 olgu incelendi. Olgular  yaş, cinsiyet, şikayet, lezyon lokalizasyonu, girişim yolu, yapılan rezeksiyon ve histopatolojik  tanı açısından retrospektif olarak değerlendirildi ve literatür bilgileri ile karşılaştırıldı. Timik tümörlerin en önemli özelliği tümörün kapsüllü olup olmaması ve komşu yapılara invazyon gösterip göstermemesidir. Dolayısıyla da hastanın tedavisinde en önemli husus klinik görünüm, doğru evrelendirilmesi ve histopatolojik tipinin doğru bildirilmesidir. Bununla birlikte hastaya yapılacak olan komplet bir cerrahi rezeksiyon hastanın yaşam kalitesine önemli katkı yapmaktadır. Timomalardaki en önemli prognostik faktörler; hastanın klinik evrelendirilmesi ve histopatolojik sınıflandırılması, komplet rezeksiyon, büyüklüğü ve damarsal yapılara invazyonudur.

Anahtar kelimeler: Timik patoloji, evrelendirme, cerrahi.

OUR CLINICAL EXPERIMENTATION OF THYMIC PATHOLOGICAL SURGERY

Abstract

Thirthy patients who admitted to our clinic with diagnosis of thymic lesions between July 2002 and March 2010 are investigated.  All of the patient were analysed retrospectively for age, gender, complaint, lession localication, surgical procedure and histopathological diagnosis. We compared our results with existing literature.  The most important feature of the thymic tumors is capsulated or not and showing invasion to the neighbouring tissues. Because of these, the most important matter in treatment of patients is clinical appearance, accurate staging of this and accurately report of the histopathological type. Besides, complete surgical resection which is done to the patient provides an important survival. The most important  prognostic factors in the thymomas; the clinical staging of the patients, the histopathological staging, complete resection, its size and the invasion of vascular tissues.

Keywords: Thymic pathology, stage, surgery

Anahtar Kelimeler

Timikpatoloji, evrelendirme, cerrahi.

Kaynakça

• Shields TW (2005). The thymic tumors. In: Shields TW, Lo Cicero III J, Ponn RB,
• Rusch VW ( Ed.), General Thoracic Surgery (pp.2324-2364, 2617-2675). Philadelphia, USA: Lippincott Williams & Wilkins.
• Shields TW. The mediastinum, its compartments, and the mediastinal lymph nodes. In: Shields TW, Lo Cicero III J, Ponn RB, Rusch VW, editors. General Thoracic Surgery. Philadelphia: Lippincott Williams & Wilkins,2005;2343-2346.
• Sarper A, Gürkök S, Özuslu B A, Genç O, Balkanlı K. Mediastinal Kitleler 64 Olgunun Analizi. Türk Göğüs Kalp Damar Cer Derg 2001;9:153-155
• Shields TW. Overview of primary mediantinal tumors and cysts. In: Shields TW, Lo Cicero III J, Ponn RB, Rusch VW, editors. General Thoracic Surgery. Philadelphia: Lippincott Williams & Wilkins,2005;2489-2494.
• Blumberg D, Port JL, Weksler B, Delgado R, Rosai J, Bains MS, et al. Thymoma: a multivariate analysis of factors predicting survival. Ann Thorac Surg 1995;60(October (4)):908—13.
• Evoli A, Minisci C, Di Schino C, et al. Thymoma in patients with MG: characteristics and long-term outcome. Neurology 2002;59:1844 –50.
• Berg N. P., Gatzinski P., Larsson S., Lundin P., Ridell B. Tumors of the Thymus and Thymic Region: clinicopathological studies on Hodgkin’s disease of the thymus. Ann Thoracic Surg. 1978; 25 (2): 99-106
• Cohen D.J., Graeber G.M., Deshong S.J.L., Burge J.R. Manegement of patients with malignant thymoma. J Thorac Cardivasc Surg 1984; 87: 301-307
• Okumura M, Ohta M, Tateyama H, et al. The World Health Organization histologic classification system reflects the oncologic behavior of thymoma: a clinical study of 273 patients. Cancer 2002;94:624 –32.
• Detterbeck FC, Parsons AM. Thymic tumors. Ann Thorac Surg 2004;77(May (5)):1860—9.
• Wright CD, Fidias P, Choi NC, Shepard JA, Hasserjian RP. Case records of the Massachusetts General Hospital. Case 16—2007. A 61-year-old man with a mediastinal mass. N Engl J Med 2007;356(May 24 (21)):2185—93.
• Drenckhahn D., Van Gaudecker B., Müler-Hermelink H.K., Unsieker K., Grosschel-Stewart U. Myosin and actin containing cells in the human postnatal thymus. Virchows Arch [ Cell Pathol] 1979; 32: 33-45
• Drachman DB. Myasthenia gravis. N Engl J Med 1994;330(June 23 (25)):1797—810.
• Kondo K, Monden Y. Thymoma and myasthenia gravis: a clinical study of 1,089 patients from Japan. Ann Thorac Surg 2005;79:219 –24.
• Masaoka A., Yamakawa Y., Niwa H., et al. Extended thymectomy for myasthenia gravis patients: A 20-years review. Ann Thorac Surg 1996; 62(3): 853-859
• Ogawa K, Uno T, Toita T, et al. Postoperative radiotherapy for patients with completely resected thymoma. A multiinstitutional, retrospective review of 103 patients. Cancer 2002;94:1405–13.
• Singhal S, Shrager JB, Rosenthal DI, LiVolsi VA, Kaiser LR. Comparison of stages I-II thymoma treated by complete resection with or without adjuvant radiation. Ann Thorac Surg 2003;76:1635– 41.
• Lucchi M, Melfi F, Dini P, Basolo F, Viti A, Givigliano F, et al. Neoadjuvant chemotherapy for stage III and IVA thymomas: a single-institution experience with a long follow-up. J Thorac Oncol 2006;1(May (4)):308—13.
• Farina G, Garassino MC, Gambacorta M, La VN, Gherardi G, Scanni A. Response of thymoma to cetuximab. Lancet Oncol 2007;8(May (5)):449—50.
• Suster S., Rosai J. Multilocular thymic cyst: An acquired reactive process. Study of 18 cases Am J Surg Pathol 1991; 15 (4): 388-398
• Levine G. D., Rosai J. Thymic hiperplasia and neoplasia. A review of current concepts. Hum Pathol. 1978; 9(5): 495-515.
• Kuo TT. Frequent presence of neuroendocrine small cells in thymic carcinoma: a light microscopic and immunohistochemical study. Histopathology 2000; 37: 19-26.
• Lucchi M, Mussi A, Basolo F, Ambrogi MC, Fontanini G, Angeletti CA. The multimodality treatment of thymic carcinoma. Eur J Cardiothorac Surg 2001;19:566-569.