The significance of touch technique in intraoperative diagnosis of central nervous system tumors

Öz

Anahtar Kelimeler

• -

Merkez sinir sistemi tümörlerinin intraoperatif tanısında impirint yönteminin önemi

Öz

Giriş ve amaç: Smear tekniği, beyin cerrahisinde intraoperatif tanı ve stereotaktik biyopsilerin incelenmesinde önemlidir. Amacımız, merkez sinir sistemi (MSS) lezyonlarında imprint ve “squash” (ezme) preparatları frozen ve parafin kesitlerle karşılaştırmak, sitolojik özelliklerini, intraoperatif tanıya katkılarını, ayrıca imprint preparatlarda DNA içeriği ile AgNOR değerinin yararını araştırmaktır. Gereç ve yöntem: MSS biyopsilerinden frozen yapılan olguların 97’sine imprint, 19’una imprint ve “squash” preparat yapıldı, tümü H+E ve PAP ile, 53’ü gallocyanin chromalum, 28’i de AgNOR ile boyandı. Dizideki olgularımız, 36 glial tümör, 20 meningiom, 6’şar schwannoma ve hipofiz adenomu, 3 kraniofaringiom, 2 hemanjioblastom, 1’er medullablastom, gangliogliom ve lipom, 14 metastatik tümör, 5 non-neoplastik lezyon ve 2 normal beyin içermektedir. Bulgular: DNA içeriği saptanan 53 olgunun kontrol grupları ile karşılaştırılmasında, glial tümörler ile metastatik karsimonlarda kontrol gruplarına göre, istatistiksel olarak, anlamlı bir yükselme izlendi. AgNOR değeri saptanan 28 olgunun, tümör gruplarının kontrollerle karşılaştırılması, istatiksel anlamlı bulunmadı. Sonuç: İmprint yöntemi, özellikle küçük, ödemli, yumuşak dokularda ve dokunun parafin kesitler içinde saklanması gerektiğinde en iyi intraoperatif tanı yöntemidir, sınır lezyonların değerlendirmede yetersizdir. Schwannoma ve kraniofaringiomun imprintleri hiposellüler olduğundan, intraoperatif tanıda, öncelikle frozen kesitle değerlendirme yapılmalıdır. İmpirintlerle birlikte frozen doğru tanı olasılığını arttırır. Ayrıca imprint preparatta DNA içeriği ölçülebilir ve AgNOR değeri saptanabilir

Anahtar Kelimeler

• İmprint preperat, “squash” (ezme) preparat, merkez sinir sistemi tümörleri, intraoperatif tanı, DNA, AgNOR

Kaynakça

1. Sidaway MK, Silverberg SG. Intraoperative cytology: Back to the future? Am J Clin Pathol 1991; 96: 1-3.
2. Cartwrigth DM, Howell LP. Intraoperative cytology as an elective surgical procedure. Analaysis of 57 cases. Acta Cytol 1993; 37(3): 280-286
3. Owing RM. Rapid cytologic examination of surgical specimens: A valuable technique in the surgical pathology labrotory. Hum Pathol Pathol 1984; 15: 605-614
4. Kim K, Phillips ER, Paolino M. Intraoperative imprint cytology: Its significance as a diagnostic adjunt. Diagn Cytopathol 1990; 6: 304-307
5. Mair S, Lash RH, Suskin D, Mendelsohn G. Intraoperative surgical specimen evalution: Frozen section analysis, cyto- logic examination, or both? A comparative study of 206 cases. Am J Clin Pathol 1991; 96: 8-14.
6. Folkerth RD. Smears and frozen sections in the intra- operative diagnosis of the central nervous system lesions. Neurosurg Clinic of North Am 1994; 5(1): 1-17.
7. Mennel HD, Rossberg C, Lorenz H, Schneider H, Hellwig D. Reability of simple cytological methods in brain tumour biopsy diagnosis. Neurochirurgia 1989; 32: 129-134.
8. Cahill EM, Hidvegi DF. Crush preperations of the central nervous system. A useful adjunt to the frozen section. Acta Cytol 1985; 29: 275-285.

9. Reyes MG, Homsi MF, McDonald LW, Glick RP. Imprint, smears and frozen sections of brain tumors. Neurosurgery ; 29(4): 578-579. Torres LFB, Collaço LM. Smear tecnique for the intra- operative examination of nervous system lesions. Acta Cytol 1993; 37(1): 34-39.
10. Stefano DD, Scucchi LF, Cosentino L, Bosman C et al. Intraoperative diagnosis of nervous system lesions. Acta Cytol 1998; 42: 346-356.
11. Martinez AJ, Moosy J. Cytological diagnosis of pituitary adenomas. J Neuropathol Exp Neurol 1983; 42(8): 307.
12. Cappabianca P, Spazianle R, Caput F, Pettinalo G,et al. Accuracy of the analysis of mutiple small fragments of glial tumors obtained by the stereotactic biopsy. Acta Cytol ; 35(5): 505-511. Yachnis AT. İntraoperative consultation for nervous system lesions. Semin in Diag Pathol 2002;19(4): 196-206
13. Dumas-Duport C, Scheithauer BW, Kelly PJ. A histologic and cytologic method for the spatial definations of gliomas. Mayo Clinic Proceeding 1987; 62: 435-449.
14. Finkle HI. Protoplasmic astrocytoma:Cytologic features on tissue imprint preperation. Diagn Cytopathol 1992; 8(4): 431.
15. Hitchcock E, Morris CS, Sotelo MG, Salmon M. Comparison of smear and imprint tecniques for rapid diagnosis in neuro- oncology. Surg Neurol 1986; 26: 176-182.
16. Collins VP. Monoclonal antibodies to glial fibrillary acidic protein in the cytologic diagnosis of brain tumors. Acta Cytol ; 28: 401-405. Ng HK, Lo STH. Immunohistochmical diagnosis of central nervous system. Tumors on smear preperations. Eur Neurol ; 28: 142-145. Meehan SM, Magee H, Corney DN, Dervan PA. The diag- nostic value of silver nucleolar organizer region. Assesment in breast cytology. Am J Clin Pathol 1994; 101: 689-693.
17. Hara A, Sakai N, Yamada H, Hirayama H,et al. Nucleolar organizer regions in vaskuler and neoplastic cells of human gliomas. Neurosurgery 1991; 29: 211-215.
18. Huang MS, Hwang JJ, Tsai MS, Wang TH,Lin MS, Chang IW, Isai SY.Application of staining of nucleolar organizer regions in cytological smears of the bronchus.Kao Hsuing I Hsusch Ko Hsuch Tsa Chin 1992; 8(3): 136-140.
19. Cerdillo MR. AgNOR counts are useful in cervical smears. Diagn Cytopathol 1992; 8(3): 208-210.
20. Plate KH, Rüschoff, Behake J, Mennel HD. Proliferatif potential of human brain tumours as assessed by nucleolar organizer regions (AgNOR) and Ki-67 immunrewactivity. Acta Neurochirurgica 1990; 104: 103-109.
21. Centeno BA, Louis DN, Kupsky WJ, Preffer FI, Sobal RA. The AgNOR tecnique, PCNA immunohistochemistry, and DNA ploidy in the evalation of choroid plexus biopsy specimens. Am J Clin Pathol 1993; 100: 690-696.
22. Plate KH, Arndt D, Hellwig D, Ruschoff J, Mennel HD. Assesment of histogenesis and proliferative potential in cytologic specimens of human brain tumors value of immu- nocytochemistry and nucleolar organizer regions. Analytical and Quantitative Cytology and Histology 1990; 12(3): 157-164.
23. Canda MŞ. Nuclear DNA content of astrocytoma and grading. Aegean Medical Journol 1983;12: 59-74.
24. Reuck JD, Rods H, Eechen HV. Cytophotometric DNA determination in human astroglial tumours. Histopathology ; 3: 107-115. Salmon I, Dewitte O, Pasteels JL, Flament Durand J, Brotchi, Vereerstraeten P, Kiss R. Prognostic scoring in adult astrocytic tumors using patient age, histopathological grade and DNA histogram type. J Neurosurg 1994; 80: 877
25. Base KK, Allison DC, Hruban RH, Pianta SA. A comparison of flowcytometre and absorbtion cytometric values as prog- nostic indicators for pancreatic carcinom. Cancer 1993; 71: 700.
26. Autondilov GG. Perspectives on the use of microspectro- photometry in the diagnosis of pre tumorous process and malignant tumors. Cancer 1976; 38(1): 254-258.
27. Bahr GF, Bartels PH, Dytch HE, Koss LG, Wied GL. Image analysis and applications to cytology. In: Koss LG (ed). Diagnostic Cytology and Its Histopathologic Bases. Philadelphia: W.B. Lippincott Company. 1992; 1572-1612.
28. Shoup SA, Johnson WW, Siegler HF, Tello JW, Schlom J; Bigner DD, Bigner SH. Panel of antibodies useful in the cytologic diagnosis of metastatc melanoma. Acta Cytol , 34(3): 385-382. Martin H, Hufnagl P, Beil M, Wenzelides K, Gott-Chalk J, Rahn W. Nucleolar organizer region associated proteins in cancer cells. Quantative investigations on gliomas, menin- giomas, urinary bladder carcinomas and pleural lesions. Anal Quant Cytol Histol 1992; 14(4): 312-319.
29. Bayındır C, Doğan Ö, Ünal F, Dervişoğlu S. Nucleolar orga- nizer region in pituitary gland adenomas. Cytopathology ; 3: 223-229. Bayındır Ç, Öz B, Dervişoğlu S, Canda T, Çelik S, Primer intrakranial tümörlerde parafin kesit AgNOR değerleri ile sitolojik AgNOR ve DNA içeriğinin karşılaştırılması. IX. Ulu- sal Kanser Kongresi ve VI. Pediatrik Tümörler Kongresi Özet Kitabı. 1991; 281.
30. Borlegie B, Drewinko B, Schhumann J, Göhde W, et al. Cellular DNA content as a marker of neoplasia in man. The Am J of Med 1980; 69: 195-203.
31. Vavruch L, Eneström S, Carstenson J, Nordenskjöld B, et al. DNA index and S-phasase in primary brain tumors. A comparison between fresh and deparaffinized specimens studied by flow cytometry. J Neurosurg 1994; 80: 85-89.