Melih AKINCI, Muzaffer AKKOCA, Kerim Bora YÖLMAZ, Demet YÖLMAZER, Serhat TOKGÖZ

Erişkin intraabdominal Kitlelerinde Tanı ve Tedavi Yaklaşımları

Amaç: Bu çalışma ile; karın içi kitle nedeni ile ameliyat edilen hastaların; semptom, bulgu, tanı ve tedavi sistematiği açısından literatür bilgileri doğrultusunda değerlendirilmesi amaçlandı. Gereç ve Yöntem: Mayıs 2010-- Mayıs 2017 tarihleri arasında karın içi kitle nedeni ile ameliyat edilen hastalar geriye dönük olarak incelendi. Karın içi kitle nedeni ile ameliyat edilen hastaların; yas, cins, semptom, semptom, bulgu, kitlenin tespit edilme şekli, hangi tanı yöntemi ile tespit edildiği, hangi organ veya dokudan köken aldığı, ameliyat öncesi biyopsi yapılıp yapılmadığı, kitlenin boyutu, kitlenin benign veya malign olusu,hangi ameliyatın yapıldığı ve patolojik tanının ne olduğu belirlendi. Bulgular: Çalışmaya dahil edilen karın içi kitleli 45 hastanın ortalama yaşının 54,3 (19--86) oldugu 18'inin erkek (%40), 27'sinin ise kadın (%60) olduğu görüldü. En fazla semptom 26 hastada (%57,8) karın ağrısı, 15 hastada ise (%33,4) abdomende ele gelen kitle idi. Fizik muayene bulgusu olarak 28 hastada (%62,2) palpasyonda karın içi kitle tespit edilebildi. Görüntüleme çalısmalarından en fazla tercih edilen 36 hasta (%80) ile abdomen ultrasonografi (USG) idi. USG'yi 28 (%62,2) hasta ile abdomen bilgisayarlı tomografi (BT), 10 hasta ile (%22,2) abdomen manyetik rezonans görüntüleme (MRG), hasta ile (%4,4) pozitron emisyon tomografi--bilgisayarlı tomografi (PET--BT) takip etmekte idi. Ameliyat öncesi 27 hastaya (%60) endoskopi, 21 hastaya da (%46,7) biyopsi yapıldığı görüldü. Kitlelerin uzun ekseni ortalama 13cm (4cm--50cm) idi. 29 hastanın (%64,4) kitlenin total olarak eksize edilmesi ile, 14 hastanın (%31,1) kitlenin barsak rezeksiyonu ile birlikte enblok rezeke edilmesi ile, hastanın (%2,2) distal pankreatektomi ile, hastanın da (%2,2) pankreatikoduodenektomi ile birlikte tedavi edildiği saptandı. 15 hastanın (%33,3) patoloji sonucu benign, 30 hastanın (%66,7) ise malign olarak raporlandığı görüldü. Benign kitlelerden en sık mezenter kistine (n:5, %11,1), malign kitlelerden ise gastrointestinal stromal tümörlere (GİST) (n:10, %22,2) rastlandı. Tartışma ve Sonuç: Karın içi kitleler; farklı organlardan köken alan, farklı klinik ve histopatolojik özelliklere sahip olan kitleler olmakla birlikte tanı ve tedavi yaklaşımları açısından sistematik değerlendirilmesi gereken patolojilerdir.

Diagnosis and Treatment Approaches for Intraabdominal Masses in Adults

Aim: To evaluate patients who underwent surgery because of an intra-abdominal mass, in respect of symptoms, findings, diagnosis and treatment in accordance with information in literature. Material and Methods: retrospective examination was conducted on patients who underwent surgery because of an intra—abdominal mass between May 2010 and May 2017. For each patient record was made including age, gender, symptoms, findings, type of mass determined, diagnostic methods used, the organ or tissue of origin, whether or not preoperative biopsy was taken, dimension of the mass, benign or malignant nature of the mass, type of operation performed and pathological diagnosis. Results: Evaluation was made on 45 patients with an intra—abdominal mass. The patients comprised 18 (40%) males and 27 (60%) females with mean age of 54.3 years (range, 19—86 years). The most common symptom was abdominal pain in 26 (57.8%) patients, and feeling the mass in the abdomen in 15 (33.4%) patients. The intra—abdominal mass could be determined on palpation in 28 (62.2%) as finding in the physical examination. USG was the most preferred imaging examination method in 36 (80%) patients, followed by CT in 28 (62.2%), MRI in 10 (22.2%) and PET—CT in (4.4%). Preoperative endoscopy was applied to 27 (60%) patients and biopsy to 21 (46.7%). The long axis of the mass was mean 13cm (range, 4—50 cm). Treatment was applied as total excision of the mass in 29 (64.4%) patients, enbloc resection of the mass together with the bowel in 14 (31.1%), together with distal pancreatectomy in (2.2%) and together with pancreaticoduodenectomy in (2.2%). The pathology result was reported as benign in 15 (33.3%) patients and as malignant in 30 (66.7%). Of the benign masses, mesenteric cyst was determined most frequently in (11.1%) patients and gastrointestinal stromal tumors (GIST) were determined as the most common malignant masses in 10 (22.2%) patients. Conclusion: Although intra—abdominal masses originate from different organs and have different clinical and histopathological properties, they are pathologies that require systematic evaluation for diagnosis and treatment approaches.

PDF

___

American College of Surgeons ACS 8. Gazelle GS, Haaga JR: Guided McCarter MD, Antonescu CR, Ballman KV Surgery Principal and Practice. Abdominal masses, p 488-500, 2012.
Swartz MH: Textbook of Physical Diagnosis: History and examination, 5th ed. Saunders Elsevier, Philadelphia, 2006, p 479.
Brady MS, Gaynor JJ, Brennan MF: Radiation associated sarcoma of bone and soft tissue. Arch Surg 127:1379, 1992.
Barker CS, Lindsell DRM: Ultrasound of the palpable abdominal mass. Clin Radiol 41:98, 1990.
Lawler LP, Fishman EK: Three- dimensional CT angiography with multidetector CT data: study optimization, protocol design, and clinical applications in the abdomen. Crit Rev CT 43:77, 2002.
Fishman EK, Horton KM: Imaging pancreatic cancer: the role of multidetector CT with three-dimensional CT angiography. Pancreatology 1:610, 2001.
GascinCM, HelmsCA.Lipomas, lipoma variants,and welldifferentiated liposarcomas (atypical lipomas): results of MRI evaluations of 126 consecutive fatty masses.AJR Am J Roentgenol. 2004 Mar;182(3):733-9. percutaneous biopsy of intraabdominal lesion. AJR Am J Radiol 153:929, 1989.
Caspers JM, Reading CC, McGahan JP, et al: Ultrasound-guided biopsy and drainage of the abdomen and pelvis. Diagnostic Ultrasound, 2nd ed. Rumack CM, Wilson SR, Charboneau JW, Eds. Mosby, St Louis,1998, p 600.
Nishida T, Blay JY, Hirota S, et al. Gastric cancer . Vol. 19. Gastric; 2016. The standard diagnosis, treatment, and follow-up of gastrointestinal stromal tumors based on guidelines; pp. 3–14.
Mesenteric stromal tumor: An unusual cause of abdominal mass (Journal in French-English) Tarchouli M, Bounaim A, Boudhas A, et al. Pan Afr Med J. 2015;21:161.
A rare case of concomitant huge exophytic gastrointestinal stromal tumor of the stomach and Kasabach-Merritt phenomenon. Watanabe T, Segami K, Sasaki T, et al. World J Surg Oncol. 2007;5:59.)
Pinaikul S, et al. Gastrointestinal stromal tumor (GIST): Computed tomographic features and correlation of CT findings with histologic grade. J Med Assoc Thai. 2014;97:1189–1198. et al. American College of Surgeons Oncology Group (ACOSOG) Intergroup Adjuvant Gist Study Team Microscopically positive margins for primary gastrointestinal stromal tumors: analysis of risk factors and tumor recurrence. J Am Coll Surg. 2012;215:53–59.
McCarter MD, Antonescu CR, Ballman KV et al. American College of Surgeons Oncology Group (ACOSOG) Intergroup Adjuvant Gist Study Team Microscopically positive margins for primary gastrointestinal stromal tumors: analysis of risk factors and tumor recurrence. J Am Coll Surg. 2012;215:53–59.
Gronchi A, Miceli R, Shurell E, et al. Outcome prediction in primary resected retroperitoneal soft tissue sarcoma: histology-specific overall survival and disease-free survival nomograms built on major sarcoma center data sets. J Clin Oncol 2013;31:1649–55.
Toulmonde M, Bonvalot S, Ray-Coquard I, et al. Retroperitoneal sarcomas: patterns of care in advanced stages, prognostic factors and focus on main histological subtypes: a multicenter analysis of the French Sarcoma Group. Ann Oncol 2014;25:730–4.
Wang JH, Lin JT, Hsu CW. Laparoscopic excision of mesenteric duplication enteric cyst embedded in sigmoid mesocolon mimicking retroperitoneal neurogenic tumor in adults. Surg Laparosc Endosc Percutan Tech 2012;22:e294–6.
Challa SR, Senapati D, Nulukurthi TK, Chinamilli J. Mucinous mesenteric cyst of the sigmoid mesocolon: a rare entity. Br Med J Case Rep 2016;pii: bcr2015210411.