AKCİĞERİN NADİR PRİMER MALİGN TÜMÖRLERİNDE KLİNİK VE RADYOLOJİK DEĞERLENDİRME

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.

Anahtar Kelimeler:

Nadir Primer Akciğer Tümörleri, Malign, Glomanjiosarkom, Epiteloid Hemanjioendotelyoma

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

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,

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