Mustafa KÖSEM, İbrahim GELİNCİK, İrfan BAYRAM, Mehmet Çetin KOTAN, Ayhan YILDIRIM

İnvaziv duktal karsinomlarda bcl 2 ve katepsin D’nin prognostik faktörlerle ilişkisi

GİRİŞ Meme kanserlerinden invaziv duktal karsinom, kadınlarda en sık görülen meme kanseridir. Bu tümörlerde erken tanı ve uygun tedavi yaşam süresini önemli ölçüde etkilemektedir. Bu nedenle son yıllardaki çalışmaların, meme kanserlerinde prognozu belirleme ve sistemik yayılımı önleme amacıyla hormonal ve kemoterapötik ajanlarla tedavide yoğunlaştığı görülmektedir. Sadece klasik parametrelerin prognozu ve tedaviyi yönlendirmede yeterli olmaması nedeniyle yeni, güvenilir belirleyicilere gerek vardır. Bu nedenle bu çalışmada, memenin invaziv duktal karsinom (İDK)’unda bcl-2 ve katepsin D’nin birbirleriyle ve diğer prognostik faktörlerle olan ilişkisi araştırıldı. GEREÇ VE YÖNTEM 2004-2006 yılları arasında Yüzüncü Yıl Üniversitesi Tıp Fakültesi Patoloji Ana Bilim Dalında mastektomi ve aksiller diseksiyon materyali incelenen ve invaziv duktal karsinom tanısı alan 50 adet olgu çalışmaya alındı. Bu olguların tümör diferansiyasyonu, histolojik derece ve nükleer skor (NS)’ları ile mitoz sayısı Bloom Richardson'a göre ayrı ayrı değerlendirildi. Bunun yanısıra tümör çevresi lenfatik, kan damarı ve perinöral invazyonun varlığı araştırıldı. Tümörün deri ile ilişkisi saptandı. Tümör çapı ve aksiller lenf nodlarının durumu değerlendirildi. Multifokal ve multisentrik tümörlerde, en büyük tümörün çapı ele alındı. Östrojen, progesteron ve c-erbB-2 ile boyanmış olan lamlar tekrar gözden geçirilerek her biri için ayrı ayrı skorlama yapıldı. Ayrıca 50 invaziv duktal karsinom olgusu, bcl-2 ve katepsin D ile immünhistokimyasal olarak boyandı ve her biri için ayrı ayrı skorlama yapılarak sonuçlar birbirleri ve diğer prognostik faktörlerle karşılaştırılarak değerlendirildi. BULGULAR Progesteron reseptörü ve düşük NS ile bcl-2 ekspresyonu arasında güçlü pozitif bir ilişki tespit edilirken katepsin D ve diğer prognostik faktörlerle bcl-2 ekspresyonu arasında güçlü pozitif bir ilişki tespit edilmedi. Perinöral invazyon, lenf damarı invazyonu, kan damarı invazyonu ve yüksek NS ile katepsin D ekspresyonu arasında güçlü pozitif bir ilişki gözlenirken diğer prognostik faktörler, c-erbB2, progesteron reseptörü, östrojen reseptörü ile katepsin D ekspresyonu arasında güçlü bir ilişki gözlenmedi. SONUÇ Bcl-2’nin düşük dereceli, katepsin D’nin ise yüksek dereceli ve invazyon yeteneği kazanmış invaziv duktal karsinom olgularının belirlenmesinde önemli olabileceği düşünülmektedir.

Anahtar Kelimeler:

İnvaziv duktal karsinom, bcl-2, katepsin D, İmmunhistokimya

The correlation with prognostic factors of bcl-2 and cathepsin D in invasive ductal carcinomas

Introduction: Invasive ductal carcinoma which is cancers of the breast is the most common cancer of the breast in women. In this tumors, early diagnosis and appropriate medical treatment is to influence markedly to life span. For this reason, cancers of the breast is occured intesify at therapy with chemotherapotic agents and hormonal treatment for the purpose of prevention systemic spread and prognosis determination of works in the last years. Just reliable determinatives are necessary, because of not to be adequate to orientate treatment and prognosis only classıc parameters. For this reason, it was evaluated the correlation with each other and other prognostic factors of bcl-2 and cathepsin D in invasive ductal carcinomas of the breast in the present study.Materials and methods: In the present study. it was included 50 cases diagnosed with invasive ductal carcinoma and examined mastectomy and axillary dissection material. Slides stained with estrogen, progesterone and c-erbB-2 were reviewed again and done scoring separately for each slide.Also in the present study it was stained bcl-2 and cathepsin D expression in 50 invasive ductal carcinomas by immünhistochemistry, and evaluated the correlation with other prognostic factors and each other.Results: A strong positive relationship was not detected between bcl-2 expression with other prognostic factors and cathepsin D protein, while a strong positive relationship was detected between bcl-2 expression with low nuclear grade and progesterone receptor’ status. A strong correlation was not observed between cathepsin D expression with oestrogen receptor’ status and progesterone receptor’ status and c-erbB-2 oncogene amplification and other prognostic factors, while a strong correlation was also observed between cathepsin D expression with high nuclear grade and blood vessel invasion and lymph-vessel invasion and perineural invasion. Conclusion: Bcl-2 is thought to be important in determining of invasive ductal carcinoma cases with low grade, while cathepsin D is thought to be important in determining of invasive ductal carcinoma cases with high grade and invasion ability.

Keywords:

Invasive ductal carcinoma, Bcl-2, Cathepsin D, Immunohistochemistry,

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