Yavuz ALBAYRAK, Ayetullah TEMİZ, Sevilay AKALP ÖZMEN, Fatih ALBAYRAK

Gastric Adenomyoma Case With High-Grade Dysplasia

Adenomyoma nadir görülen benign bir mide tümörüdür. Adenomyoma çoğunlukla safra kesesinde görülmesine rağmen çok az vakada midede de rapor edilmiştir. 70 yaşında erkek hasta epigastrik ağrı ve bulantı şikayetleriyle Gastroenteroloji kliniğine başvurdu. Yapılan üst gastrointestinal sistem endoskopisinde mide korpusunda yaklaşık 1 cm çaplı polip ve antrumda 4 adet yaklaşık 2 cm çapında polipoid lezyonlar izlendi. Korpustaki polipe endoskopik polipektomi uygulandı. Diğer poliplerden ise biopsi yapıldı ve patoloji sonucu High grade displazi olarak tespit edildi. Hasta bu haliyle operasyona alınarak Radikal total gastrektomi yapıldı. Adenomyomaların büyüklüğü ortalama 0.6 cm ile 4.5 cm arasında değişmektedir ve bu lezyonlar genellikle submukozanın üzerinde bazende kas tabakasının üzerinde bulunur. Adenomyomanın teşhisi duktal doku, düz kaslar ve bazı vakalarda pankreatik acini veya Brunner s glandlarına benzeyen glanduler dokuların bulunması ile yapılır. Gastrik adenomyoma çok nadir görülen benign bir tümör olmasına karşın içerisinde invaziv karsinom odakları bulundurabilir. Preoperatif dönemde adenomyoma tanısı konularak wedge rezeksiyon yapılan hastalara frozen yapılarak spesmende karsinom odağı bulunup bulunmadığı tespit edilmeli frozen sonucunda karsinom odağı saptanması durumunda tamamlayıcı radikal cerrahi işlem yapılmalıdır.

HİGH GRADE DİSPLAZİNİN EŞLİK ETTİĞİ GASTRİK ADENOMYOMA VAKASI

Adenomyoma is a rare benign stomach tumor. While adenomyoma is mostly observed in the gall bladder, it is also rarely reported in the stomach. A 70 year-old male patient applied to the gastroenterology clinic with complaints of epigastric pain and nausea. Upper gastrointestinal system endoscopy revealed a polyp of approximately 1 cm diameter in the stomach corpus, and 4 polypoid lesions of approximately 2 cm diameter in the antrum. Endoscopic polypectomy was performed on the polyp in the corpus. Biopsies were performed on the other polyps and the pathological results were identified as high-grade dysplasia. The patient was taken in for a radical total gastrectomy operation in this condition. The size of adenomyomas vary between 0.6 and 4.5 cm on average and these lesions are generally observed on the submucosa, and sometimes on the muscle layer. Adenomyoma is diagnosed when ductal tissue, smooth muscles, and sometimes pancreatic acini or glandular tissues similar to Brunner's glands are observed. While gastric adenomyoma is a rare, benign tumor, it may contain invasive carcinoma foci. For patients who undergo wedge resection in the preoperative period after being diagnosed with adenomyoma, the removed section has to be frozen and the presence of a carcinoma in the specimen has to be determined. Complementary radical surgery has to be performed in case a possible carcinoma is observed as a result of the frozen examination.

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