AKCİĞERİN NADİR PRİMER MALİGN TÜMÖRLERİNDE KLİNİK VE RADYOLOJİK DEĞERLENDİRME

Year 2021, , 551 - 558, 30.12.2021

Gürhan Öz , Çiğdem Özdemir , Suphi Aydın , Ahmet Dumanlı , Ersin Günay , Şule Çilekar , Sibel Günay Adem Gencer , Düriye Öztürk , Funda Demirağ

https://doi.org/10.17343/sdutfd.753812

Abstract

Amaç
Akciğerin en sık görülen primer malign tümörlerini
yassı hücreli karsinom, küçük hücreli karsinom ve
adenokarsinom oluşturur. Ancak, nadir görülen bazı
malign primer akciğer tümörleri de akciğeri etkileyebilir,
tanı ve tedavide zorluklara neden olabilir. Geleneksel
görüntüleme yöntemleri olguların birçoğunda
tanıda yeterince yardımcı olmaz hatta preoperatif
alınan doku örnekleri tanı koymada yetersiz kalabilir.
Endobronşial lezyonu olan vakalarda örneklerin küçük
olması veya endobronşial lezyon olmayan santral
tümörlerde transtorasik biyopsi yapılamaması tanıyı
zorlaştırabilir. Kesin tanı ancak operasyon sonrası
alınan daha büyük doku örnekleri ile ayrıntılı incelemeler
sonunda konabilir. Ayrıca frozen incelemesinde
benign-malign ayrımı yapılamaması cerrahın yapacağı
rezeksiyonu olumsuz yönde etkileyebilir. Eksik ya
da gereksiz rezeksiyona neden olabilir. Çalışmamızın
amacı literatürde çok az bildirilen bu tümörlerin klinik
radyolojik ve histopatolojik görünümlerini değerlendirerek
tanı ve tedavilerine katkıda bulunmaktır.
Gereç ve Yöntem
2010-2019 yılları arasında kliniğimizde opere edilen
oldukça nadir 10 malign primer akciğer tümörü hasta
çalışmaya dahil edildi. Tüm hastalar, yaş, cinsiyet,
semptomlar, preoperatif görüntüleme yöntemleri ve
invazif tanı yöntemleri ile retrospektif olarak incelendi.
Tümör lokalizasyonu, tümör boyutları, yapılan cerrahi
operasyon tipi ve yaşam süreleri kaydedildi.
Bulgular
Çalışmamıza 10 hasta dahil edildi. Hastaların 6 tanesi
erkek, 4 tanesi kadındı. Yaş ortalamaları 53.4
idi. 3 hastaya sol alt lobektomi, 2 hastaya sol pnömonektomi,
3 hastaya wedge rezeksiyon, 1 hastaya
sol üst lobektomi, 1 hastaya orta lobektomi yapıldı.
Hastaların postoperatif histopatolojik tanıları 2 hastada
karsinosarkom, 2 hastada büyük hücreli nöroendokrin
karsinom, 2 hastada epiteloid hemanjioendotelyoma,
1 hastada glomanjiosarkom, 1 hastada
primer pulmoner leiomyosarkom, 1 hastada mukoepidermoid
karsinom, 1 hastada sinovyal sarkom olarak
raporlandı.
Sonuç
Akciğerin nadir görülen primer malign tümörlerine
preoperatif görüntüleme ve invaziv yöntemler ile tanı
koymak zor olabilir. Ameliyat öncesi yapılan tomografi
eşliğinde ince iğne biyopsi, tru-cut biyopsi, bronkoskopik
biyopsi örnekleri ve frozen incelemeleri tanı
koymakta yetersiz kalabilir. Bu durum, operasyonu
yapacak cerrahı yapılacak akciğer rezeksiyonu konusunda
yanlış yönlendirebilir.

Keywords

Nadir Primer Akciğer Tümörleri, Malign, Glomanjiosarkom, Epiteloid Hemanjioendotelyoma

Supporting Institution

Yok

Project Number

Yok

Thanks

yok

CLINICAL AND RADIOLOGICAL EVALUATION IN RARE PRIMARY MALIGNANT TUMORS OF THE LUNG

Abstract

Objective
The most common primary malignant tumors of the
lung are squamous cell carcinoma, small cell carcinoma
and adenocarcinoma. However, some rare malignant
primary lung tumors can also affect the lung
and cause difficulties in diagnosis and treatment.
Conventional imaging methods do not help the diagnosis
in most cases, and moreover, preoperative
tissue samples may fail to establish a diagnosis. In
cases with endobronchial lesions, small samples or
lack of transthoracic biopsy in central tumors without
endobronchial lesions can make diagnosis difficult.
The definitive diagnosis can only be made after larger
examinations with larger tissue samples taken after
the operation. In addition, failure to differentiate benign-
malignant in frozen examination may negatively
affect the resection of the surgeon. It can cause incomplete
or unnecessary resection.
The aim of this study was to evaluate the clinical radiological
and histopathological features of these tumors,
which have been rarely reported in the literature,
and to contribute to the diagnosis and treatment of
these tumors.
Material and Methods
The study included 10 patients with rare malignant
primary lung tumor who were operated on in our clinic
between 2010 and 2019. All patients were retrospectively
evaluated in respect of age, gender, symptoms,
preoperative imaging methods and invasive diagnostic
methods. Tumor localization, tumor size, type of
surgical operation and survival were recorded.
Results
The 10 patients included in the study comprised 6
males and 4 females. Postoperative histopathological
diagnoses of the patients were reported as 2 carcinosarcomas,
2 large cell carcinomas, 2 epithelioid
hemangioendothelioma, 1 glomangiosarcoma, 1 primary
pulmonary leiomyosarcoma, 1 mucoepidermoid
carcinoma, and 1 synovial sarcoma.
Conclusion
It can be difficult to diagnose in rare primary malignant
lung tumors by preoperative imaging and preoperative
invasive diagnostic methods. CT-guided fine needle
biopsy and tru-cut biopsy, endobronchial biopsy
and frozen samples performed before surgery may be
insufficient in diagnosis, which may mislead the surgeon
about lung resection.

Keywords

Rare Primary Lung Tumors, Malignant, Glomangiosarcoma, Epiteloid Hemangioendothelioma

Project Number

Yok

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