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İnsidental Safra Kesesi Karsinomlarında Metaplazi Araştırılması: Tek Merkez Deneyimi

Yıl 2016, Cilt: 7 Sayı: 27, 0 - 0, 30.09.2016
https://doi.org/10.17944/mkutfd.13727

Öz

ÖZET

Amaç: Hastanemiz Akdeniz Bölgesi’nde yer alan bir ilçede hizmet veren tek ikinci basamak sağlık kurumudur. Çalışmamızın amacı hastanemizde insidental olarak saptanan safra kesesi karsinomu sıklığını belirlemek ve safra kesesi karsinomu gelişiminde metaplazi-displazi- karsinom sekansını irdelemektir. Ayrıca safra kesesi karsinomuna eşlik eden preneoplastik patolojik lezyonlar ile klinik bulguları gözden geçirip, bunları literatür bulgularıyla karşılaştırmaktır.  

Gereç ve Yöntem: Kasım 2009- Aralık 2015 tarihleri arasında Silifke Devlet Hastanesi Patoloji Bölümü’ne kendi hastanemiz ve komşu ilçe hastanelerinden ulaşan, kolesistit veya kolelitiazis nedeniyle kolesistektomi yapılmış 1201 hastanın kolesistektomi materyallerine ait tıbbi kayıtları inceledik. Safra kesesi karsinomu olan olguların preperatlarını retrospektif olarak yeniden değerlendirdik. Safra kesesi karsinomu oranımızı, insidental safra kesesi karsinomu oranımızı, safra kesesi karsinomunun  preoperatif ve intraoperatif tanı oranını, yaş ve cinsiyet dağılımını belirledik. Safra kesesi karsinomunun prognostik kriterleri ve displazi gibi preneoplastik lezyonların varlığı ile eşlik eden metaplazi, kolesistit, kolelitiazis, kolesterolozis gibi safra kesesi hastalıklarını belirledik. İnsidental karsinomlarda metaplazi-displazi birliktelik oranlarını belirledik. Eşlik eden metaplazinin tipini belirlemek için Periodic Acid Schiff+ Alcian Blue ( PAS+AB) histokimyasal boyası uyguladık. 

Bulgular ve Sonuç: Safra kesesi karsinomu oranımız % 0,58, insidental olarak saptanan Safra kesesi karsinomu oranımız %0,49’ dur.  Yaş ortalaması 70.7, kadın/erkek oranı:5/2’dir. Çalışmamızda histopatolojik ve histokimyasal incelemede olguların tümünde intratümöral intestinal metaplazi, insidental safra kesesi karsinomlarında ise %83.3 oranında metaplazi-displazi birlikteliği bulundu. Bu birliktelik de metaplazi-displazi-karsinom sekansını desteklemektedir.  Kolesistektomi materyallerinde özellikle intestinal metaplazinin görüldüğü vakaların displazi açısından daha dikkatli değerlendirmesi gereklidir. Bu durumlarda örneklem sayısının arttırılması ile insidental saptanabilen in-situ ve mikroinvaziv karsinom sayısının artacağı kanısındayız.

Kaynakça

  • KAYNAKLAR
  • Hundal R, Shaffer EA. Gallbladder cancer: epidemiology and outcome. Clin Epidemiol 2014;7(6):99-109.
  • Mukhopadhyay S, Landas SK. Putative precursors of gallbladder dysplasia: a review of 400 routinely resected specimens. Arch Pathol Lab Med 2005;129(3):386- 90.
  • Duarte I, Llanos O, Domke H, Harz C, Valdivieso V. Metaplasia and precursor lesions of gallbladder carcinoma. Frequency, distribution, and probability of detection in routine histologic samples. Cancer 1973;72:1878-84.
  • Adsay NV. Gallbladder, Extrahepatic Biliary Tree and Ampulla. In Sternberg’s (eds) Diagnostic Surgical Pathology. 6th ed. Wolters Kluwer Health, Philadelphia, PA 2015, 1770- 846.
  • Sasatomi E, Tokunaga O, Miyazaki K. Precancerous conditions of gallbladdercarcinoma: overview of histopathologic characteristics and molecular genetic findings. J Hepatobiliary Pancreat Surg 2000;7(6):556-67.
  • Roa I, de Aretxabala X, Araya JC, Roa J. Preneoplastic lesions in gallbladder cancer. J Surg Oncol 2006;93(8):615-23.
  • Albores-Saavedra J, Alcántra-Vazquez A, Cruz-Ortiz H, Herrera-Goepfert R. The precursor lesions of invasive gallbladder carcinoma. Hyperplasia, atypical hyperplasia and carcinoma in situ. Cancer 1980;45(5):919-27.
  • Maesawa C, Ogasawara S, Yashima-Abo A, Kimura T, Kotani K, Masuda S, et al. Aberrant maspin expression in gallbladder epithelium is associated with intestinal metaplasia in patients with cholelithiasis. J Clin Pathol 2006;59(3):328-30.
  • Genç V, Onur Kırımker E, Akyol C, Kovaay AF, Karabörk A, Tüzüner A et al. Incidental gallbladder cancer diagnosed during or after laparoscopic cholecystectomy in members of the Turkish population with gallstone disease . Turk J Gastroenterol 2011; 22(5): 513-16.
  • Waghmare RS, Kamat RN. Incidental GallBladder Carcinoma in Patients Undergoing Cholecystectomy: A Report of 7 Case. J Assoc Physicians India 2014;62(9):793-6.
  • Amiraslanov A, Yusif-Zade K, Musayev J. Laparoskopik kolesistektomi uygulanan olgularda safra kesesinin histopatolojik profili. Marmara Medical Journal 2015; 28: 32-7.
  • Kanthan R, Senger JL, Ahmed S, Kanthan SC. Gallbladder Cancer in the 21st Century. J Oncol 2015;2015.
  • Randi G, Franceschi S, La Vecchia C. Gallbladder cancer world wide: geographical distribution and risk factors. Int J Cancer 2006;118(7):1591-602.
  • Shaffer EA. Gallbladder Cancer: The Basics. Gastroenterol Hepatol (N Y) 2008;4(10):737-41.
  • Shrikhande SV, Barreto SG, Singh S, Udwadia TE, Agarwal AK. Cholelithiasis in gallbladder cancer: coincidence, cofactor, orcause!. Eur J Surg Oncol 2010;36(6):514-9.
  • Roa I, Ibacache G, Muñoz S, de Aretxabala X. Gallbladder cancer in Chile: Pathologic characteristics of survival and prognostic factors: analysis of 1,366 cases. Am J Clin Pathol. 2014 May;141(5):675-82.
  • Hennedige TP, Neo WT, Venkatesh SK. Imaging of malignancies of the biliary tract- an update. Cancer Imaging 2014;22:14:14.
  • Sujata J, Rana S, Sabina K, Hassan MJ, Jairajpuri ZS. Incidental Gall Bladder Carcinoma in Laparoscopic Cholecystectomy: A Report of 6 Cases and a Review of the Literature. J Clin Diagn Res. 2013 Jan;7(1):85-8.
  • Albores-Saavedra J, Henson DE, Klimstra DS. Tumors of Gall Bladder, Extrahepatic Bile Ducts, And Ampulla of Vater. Atlas of Tumor Pathology 3rd Series, Fasicle 27. Washington D.C. Armed Forces institude of Pathology 1998; 51-60.
  • Sarli L, Contini S, Sansebastiano G, Gobbi S, Costi R, Roncoroni L. Does laparoscopic cholecystectomy worsen the prognosis of unsuspected gallbladder cancer? Arch Surg 2000; 135: 1340-4.
  • Kwon AH, Imamura A, Kitade H, Kamiyama Y. Unsuspected gallbladder cancer diagnosed during or after laparoscopic cholecystectomy. J Surg Oncol 2008; 97: 241-5.
  • Cubertafond P, Gainant A, Cucchiaro G. Surgical treatment of 724 carcinomas of the gallbladder. Results of the French Surgical Association Survey. Ann Surg 1994; 219: 275-80.
  • Orth K, Beger HG. Gallbladder carcinoma and surgical treatment. Langenbeck’s Arch Surg 2000;385(8): 501-8.
  • Meyers WC, Jones RS. Disorders of the biliary system: V. Neoplasms. In: Meyers WC, Jones RS, Editors. Textbook of Liver and Biliary System. Philadelphia. J.B. Lippincott Company 1990: 319-50.
  • Levy AD, Murakata LA, Rohrmann CA Jr. Gallbladder Carcinoma: Radiologic-Pathologic Correlation. Radiographics 2001;21(2):295-314.
  • Juan Rosai MD. Rosai and Ackerman’s Surgical Pathology 9th Ed, Philadelphia: Mosby; 2004. 1035-60.
  • Bolat F, Kayaselçuk F, Nursal TZ, Bal N, Tuncer İ. Kolesistektomilerde örnek sayısının artırılması ile histopatolojik bulguların korelasyonu. Turk Patoloji Derg 2007;23:137-42.
Yıl 2016, Cilt: 7 Sayı: 27, 0 - 0, 30.09.2016
https://doi.org/10.17944/mkutfd.13727

Öz

Kaynakça

  • KAYNAKLAR
  • Hundal R, Shaffer EA. Gallbladder cancer: epidemiology and outcome. Clin Epidemiol 2014;7(6):99-109.
  • Mukhopadhyay S, Landas SK. Putative precursors of gallbladder dysplasia: a review of 400 routinely resected specimens. Arch Pathol Lab Med 2005;129(3):386- 90.
  • Duarte I, Llanos O, Domke H, Harz C, Valdivieso V. Metaplasia and precursor lesions of gallbladder carcinoma. Frequency, distribution, and probability of detection in routine histologic samples. Cancer 1973;72:1878-84.
  • Adsay NV. Gallbladder, Extrahepatic Biliary Tree and Ampulla. In Sternberg’s (eds) Diagnostic Surgical Pathology. 6th ed. Wolters Kluwer Health, Philadelphia, PA 2015, 1770- 846.
  • Sasatomi E, Tokunaga O, Miyazaki K. Precancerous conditions of gallbladdercarcinoma: overview of histopathologic characteristics and molecular genetic findings. J Hepatobiliary Pancreat Surg 2000;7(6):556-67.
  • Roa I, de Aretxabala X, Araya JC, Roa J. Preneoplastic lesions in gallbladder cancer. J Surg Oncol 2006;93(8):615-23.
  • Albores-Saavedra J, Alcántra-Vazquez A, Cruz-Ortiz H, Herrera-Goepfert R. The precursor lesions of invasive gallbladder carcinoma. Hyperplasia, atypical hyperplasia and carcinoma in situ. Cancer 1980;45(5):919-27.
  • Maesawa C, Ogasawara S, Yashima-Abo A, Kimura T, Kotani K, Masuda S, et al. Aberrant maspin expression in gallbladder epithelium is associated with intestinal metaplasia in patients with cholelithiasis. J Clin Pathol 2006;59(3):328-30.
  • Genç V, Onur Kırımker E, Akyol C, Kovaay AF, Karabörk A, Tüzüner A et al. Incidental gallbladder cancer diagnosed during or after laparoscopic cholecystectomy in members of the Turkish population with gallstone disease . Turk J Gastroenterol 2011; 22(5): 513-16.
  • Waghmare RS, Kamat RN. Incidental GallBladder Carcinoma in Patients Undergoing Cholecystectomy: A Report of 7 Case. J Assoc Physicians India 2014;62(9):793-6.
  • Amiraslanov A, Yusif-Zade K, Musayev J. Laparoskopik kolesistektomi uygulanan olgularda safra kesesinin histopatolojik profili. Marmara Medical Journal 2015; 28: 32-7.
  • Kanthan R, Senger JL, Ahmed S, Kanthan SC. Gallbladder Cancer in the 21st Century. J Oncol 2015;2015.
  • Randi G, Franceschi S, La Vecchia C. Gallbladder cancer world wide: geographical distribution and risk factors. Int J Cancer 2006;118(7):1591-602.
  • Shaffer EA. Gallbladder Cancer: The Basics. Gastroenterol Hepatol (N Y) 2008;4(10):737-41.
  • Shrikhande SV, Barreto SG, Singh S, Udwadia TE, Agarwal AK. Cholelithiasis in gallbladder cancer: coincidence, cofactor, orcause!. Eur J Surg Oncol 2010;36(6):514-9.
  • Roa I, Ibacache G, Muñoz S, de Aretxabala X. Gallbladder cancer in Chile: Pathologic characteristics of survival and prognostic factors: analysis of 1,366 cases. Am J Clin Pathol. 2014 May;141(5):675-82.
  • Hennedige TP, Neo WT, Venkatesh SK. Imaging of malignancies of the biliary tract- an update. Cancer Imaging 2014;22:14:14.
  • Sujata J, Rana S, Sabina K, Hassan MJ, Jairajpuri ZS. Incidental Gall Bladder Carcinoma in Laparoscopic Cholecystectomy: A Report of 6 Cases and a Review of the Literature. J Clin Diagn Res. 2013 Jan;7(1):85-8.
  • Albores-Saavedra J, Henson DE, Klimstra DS. Tumors of Gall Bladder, Extrahepatic Bile Ducts, And Ampulla of Vater. Atlas of Tumor Pathology 3rd Series, Fasicle 27. Washington D.C. Armed Forces institude of Pathology 1998; 51-60.
  • Sarli L, Contini S, Sansebastiano G, Gobbi S, Costi R, Roncoroni L. Does laparoscopic cholecystectomy worsen the prognosis of unsuspected gallbladder cancer? Arch Surg 2000; 135: 1340-4.
  • Kwon AH, Imamura A, Kitade H, Kamiyama Y. Unsuspected gallbladder cancer diagnosed during or after laparoscopic cholecystectomy. J Surg Oncol 2008; 97: 241-5.
  • Cubertafond P, Gainant A, Cucchiaro G. Surgical treatment of 724 carcinomas of the gallbladder. Results of the French Surgical Association Survey. Ann Surg 1994; 219: 275-80.
  • Orth K, Beger HG. Gallbladder carcinoma and surgical treatment. Langenbeck’s Arch Surg 2000;385(8): 501-8.
  • Meyers WC, Jones RS. Disorders of the biliary system: V. Neoplasms. In: Meyers WC, Jones RS, Editors. Textbook of Liver and Biliary System. Philadelphia. J.B. Lippincott Company 1990: 319-50.
  • Levy AD, Murakata LA, Rohrmann CA Jr. Gallbladder Carcinoma: Radiologic-Pathologic Correlation. Radiographics 2001;21(2):295-314.
  • Juan Rosai MD. Rosai and Ackerman’s Surgical Pathology 9th Ed, Philadelphia: Mosby; 2004. 1035-60.
  • Bolat F, Kayaselçuk F, Nursal TZ, Bal N, Tuncer İ. Kolesistektomilerde örnek sayısının artırılması ile histopatolojik bulguların korelasyonu. Turk Patoloji Derg 2007;23:137-42.
Toplam 28 adet kaynakça vardır.

Ayrıntılar

Bölüm Original Articles
Yazarlar

İLKE EVRİM Seçinti

EGEMEN Akıncıoğlu

Yayımlanma Tarihi 30 Eylül 2016
Gönderilme Tarihi 7 Ocak 2016
Yayımlandığı Sayı Yıl 2016 Cilt: 7 Sayı: 27

Kaynak Göster

Vancouver Seçinti İE, Akıncıoğlu E. İnsidental Safra Kesesi Karsinomlarında Metaplazi Araştırılması: Tek Merkez Deneyimi. mkutfd. 2016;7(27).