Ganime ÇOBAN, Ebru AKAY, KEMAL DENİZ, İMDAT YÜCE, Süleyman BALKANLI

Laringeal skumaöz hücreli karsinomlarda lenfatik damar yoğunluğu ve mikrodamar yoğunluğunun değerlendirilmesi

Amaç: Larinks karsinomlarında boyun lenf nodlarına metastaz, sağ kalımı önemli oranda azaltan bir etkendir. Bu çalışmanın amacı; larinksin skuamöz hücreli tümörlerinde tümör içi ve tümör dışı alanlarda lenfatik damar yoğunluğu ve mikrodamar yoğunluğunun lenf nodu metastazı ile ilişkisini ortaya koymaktır. Yöntemler: Çalışmamızda 2000-2006 yılları arasında Erciyes Üniversitesi Tıp Fakültesi Patoloji Ana Bilim Dalı’nda larinks skuamöz hücreli karsinom tanısı almış 86 olgu incelemeye alındı. Tümör içi ve tümör dışı alanlarda immünhistokimyasal bir belirteç olan D2-40 ile lenfatik damar yoğunluğu ve CD34 ile mikrodamar damar yoğunluğu değerlendirildi. Sonuçlar tümör derecesi, tümör yerleşim yeri, lenf nodu metastazı ile karşılaştırıldı. Bulgular: Olguların tümör içi ve tümör dışı lenfatik damar yoğunluğu sırası ile 8,93±12,5 ve 24,1±20,1 idi (p=0,001). Tümör içi mikrodamar yoğunluğu değeri 217,53±89,8 ve tümör dışı mikrodamar yoğunluğu değeri 330,43±92,4 olarak sayıldı (p=0,001). İyi diferansiye tümörlerde tümör içi lenfatik damar yoğunluğu değeri, iyi diferansiye olmayan tümörlere göre yüksekti, fakat anlamlı sonuç elde edilemedi (p=0,100). Kötü diferansiye tümörlerde tümör dışı mikrodamar yoğunluğu değeri anlamlı olarak yüksek bulundu (p=0,050). Tümör içi mikrodamar yoğunluğu değeri lenf nodu metastazı olan tümörlerde anlamlı olarak düşüktü (p=0,028). Lenf nodu metastazı olan ve olmayan her iki grupta da tümör dışı lenfatik damar yoğunluğu değeri yüksekti, istatiksel olarak anlamlı bir sonuç elde edilemedi (p=0,084). Sonuç: Bu çalışmada iyi diferansiye tümörlerde tümör içi mikrodamar yoğunluğu ve kötü diferansiye olgularda tümör dışı mikrodamar yoğunluğu daha yüksek idi. Lenfatik damar yoğunluğu değeri ile diferansiasyon arasında bir ilişki saptanmadı. Metastaz yapmayan grupta tümör içi ve tümör dışı mikrodamar yoğunluğu değeri yüksek bulundu. Metastaz ile lenfatik damar yoğunluğu değeri arasında bir ilişki izlenmedi. D2-40 ve CD34 ‘ün birlikte kullanımı ile lenfatik damar yoğunluğunun değerlendirilmesinin, metastazın erken belirlenmesinde daha önemli olabileceğini düşünmekteyiz.

The evaluation of lymphatic vessel density and microvessel density in laryngeal squamous cell carcinoma

Aim: Metastasis to the cervical lymph nodes in laryngeal carcinomas is a factor reducing survival significantly. The present study aimed to reveal the association of lymph node metastasis with lymphatic vessel density and microvessel density in the intratumoral and extra-tumoral areas of laryngeal squamous cell carcinoma. Methods: Eighty-six cases diagnosed with laryngeal squamous cell carcinoma in Pathology Department of Erciyes University Faculty of Medicine between 2000-2006 were included in the present study. Lymphatic vessel density and microvessel density were assessed with D2-40 which is an immunohistochemical marker in intratumoral and extra-tumoral areas and CD34, respectively. The results were compared with tumor grade, tumor localization, and lymph node metastasis. Results: Intratumoral and extra tumoral lymphatic vessel density value were 8.93±12.5 and 24.1±20.1, respectively (p=0.001). Mean intra tumoral microvessel density was calculated as 217.53±89.8 while extra tumoral microvessel density was calculated as 330.43±92.4 (p=0.001). Intratumoral lymphatic vessel density value was higher in the well-differentiated tumors compared to the poorly differentiated tumors but no significant result was obtained (p=0.100). Extra tumoral microvessel density value was found to be significantly higher in the poorly differentiated tumors (p=0.05). Intratumoral microvessel density value was significantly lower in tumors with lymph node metastasis (p=0.028). Extra-tumoral lymphatic vessel density value was higher in both groups with and without lymph node metastasis, however, no statistically significant result could be obtained (p=0.084). Conclusion: In the present study, intratumoral microvessel density was higher in well differentiated tumors whereas extra tumoral microvessel density was determined to be higher in poorly differentiated cases. No significant association was noted between lymphatic vessel density and differentiation. Extra tumoral and intra tumoral microvessel density values were found to be higher in the group without metastasis. No association was detected between metastasis and lymphatic vessel density value. We suggest that assessing lymphatic vessel density with the co-administration of D2-40 and CD34 may be more important for early detection of metastasis.

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