Kolorektal Kanserlerde Venöz İnvazyonun Elastik Lif Boyası Eşliğinde Yeniden Değerlendirilmesi

Abstract

Amaç : Kolorektal kanserlede ( KRK) venöz invazyonun(Vİ) prognostik önemi uzun yıllardır bilinmektedir. Vİ uzak organ metastazları için bağımsız prediktör olarak kabul edilmektedir. KRK'lerde beklenen Vİ oranı en az % 25’dir. Gastrointestinal kanal spesmenlerine spesifik bakan patologların olduğu merkezlerde bu oran genel patalogların baktığı spesmenlerle karşılaştırıldığında daha fazladır. Elastik Lif Boyası (ELB) kullanımının VI oranlarını artırdığı ileri sürülmektedir. Bu çalışmada amacımız Vİ olmayan KRK olgularına ELB uygulayarak yeniden değerlendirmek, yanlış yorumlamaya neden olan etkenleri belirlemek ve ELB'nin rutinde kullanımını sorgulamaktır. Gereç ve Yöntemler: 2018-2020 tarihleri arasında tanı almış 166 KRK materyalinden Vİ bulunmayan, Vİ belirlenirken boyama işlemi yapılmamış, 77 olgunun preparatları yeniden incelendi. Seçilen bir bloğa ELB uygulandıktan sonra yeniden değerlendirildi. Bulgular: Olguların 49’u Erkek (%63,6), 28’i Kadın (%36,4), E/K oranı: 1,75 idi. Yaş ortalaması 63,5 (29-101) yaş idi. Ortalama tümör çapı 4,85 cm (1-11 cm) idi. Olguların 6’sı (%7.8) high grade, 71’i (%92.2) low grade histolojik dereceye sahipti. Olguların patolojik T evreleri sırasıyla, 3 olgu pT1 (%3,9), 14 olgu pT2 (%18,2), 50 olgu pT3 (%65), 10 olgu pT4 (%12,9) idi. Patolojik N evreleri sırasıyla, 2 olgu pNx (%2,6), 57 olgu pN0 (%74), 14 olgu pN1 (%18,2), 4 olgu pN2 (%5,2) idi. ELB yapılan preparatlar yeniden değerlendirildi. 77 olgunun 6’sında (%7,8) ELB boyama sonrası Vİ tespit edildi. Sonuç: Çalışmamızda ELB ile Vİ tespit edilen olgularda, oblitere olmuş damar duvarlarında tümörü çevreleyen alanın desmoplastik stroma lehine değerlendirildiğini gözlemledik. Sonuç olarak H&E kesitlerde Vİ bulunmayan olguların tamamına ELB gibi damar duvarı belirleyicilerinin uygulanmasını önermekteyiz. Böylece hastanın tedavi protokolünü ve sağ kalımını etkileyen Vİ’nin yorumlanmasında oluşabilecek hatalar azaltılmış olacaktır.

Keywords

• Kolon kanseri
• Venöz İnvazyon
• Elastik lif boyası

Reevaluation of Venous Invasion with Elastic Tissue Stain in Colorectal Cancers

Abstract

Objective: The prognostic importance of venous invasion(VI) in colorectal cancer(CRC) has been known for many years. VI was considered an independent predictor for distant organ metastases. In cases with VI, visceral organ metastases of the tumor occur more rapidly than lymphatic spread. A VI rate of at least 25% was expected in CRC. It was claimed that the use of Elastic Tissue Stain(ETS) increases the VI ratios. In this study, our aim is to reevaluate CRC cases without VI by applying ETS, and to question the routine use of ETS. Materials and Methods: Between 2018- 2020, 166 colorectal resection materials diagnosed with cancer were found. VI negative ones were selected. When determining VI, 77 cases were identified that did not have histochemistry/immunohistochemistry. Tissues of 77 cases were reevaluated after ETS was applied. Results: 49 of the cases were male(63.6%), 28 of them were female(36.4%). The mean age was 63.5 (29-101) years. The mean tumor diameter was 4.85 cm(1-11 cm). Six of the cases(7.8%) had high and 71(92.2%) had low grade. The pT stages of the cases were respectively 3 cases pT1(3.9%), 14 cases pT2(18.2%), 50 cases pT3(65%), 10 cases pT4(12.9%). N stages were pNx in 2 cases(2.6%), pN0 in 57 cases(74%), pN1 in 14 cases (18.2%), and pN2 in 4 cases(5.2%), respectively. ETS preparations were reevaluated. VI was detected after ETS staining in 6(7.8%) of 77 cases. Conclusion: As a result, we recommend the application of vessel wall markers such as ETS to all cases without VI on HE sections. Thus, the errors that may occur in the interpretation of VI, which affect the treatment protocol and survival of the patient, will be reduced.

Keywords

• Colon cancer
• venous invasion
• elastic tissue stain

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