NUKET ÖZKAVRUK ELİYATKIN, Şehnaz SAYHAN, Demir Sibel KEÇECİ, Hakan POSTACI, Birgül AVCI

Pulmoner hamartomlarda papiller projeksiyonların ve mast hücrelerinin varlığı (8 olguluk çalışma)

Giriş: Soliter pulmoner nodüllerin yaklaşık % 6'sını oluşturan pulmoner hamartomlar, en sık görülen benign pulmoner neoplazilerdir. Genellikle değişen oranlarda matür kıkırdak, fibröz ve yağ doku ile epitelyal elemanların karışımından oluşur. Bu çalışmada pulmoner hamartomlarda lezyonu oluşturan komponentlerin oranı, villus benzeri papiller projeksiyonların varlığı ve mast hücrelerinin-lezyon içindeki dağılımı araştırıldı. Gereç-Yöntem: SSK İzmir Eğitim Hastanesi Patoloji Bölümünde 2001-2004 yılları arasında tanı almış 8 pulmoner hamartom olgusuna ait bloklardan elde edilen kesitler hematoksilen-eozin (H&E), aldan blue, von Giesson, %1'lik toluidine blue, vimentin, S-100, sitokeratin 7, CD.34 ve Ki 67ile değerlendirildi. Bulgular-Sonuç: Olguların yaş ortalaması 50.1 olup, ortalama tümör boyutu 2.7 cm olarak bulundu. En sık mezenkimal komponent kıkırdak olarak saptandı. Villus benzeri papiller projeksiyonlar 2 olguda belirgin, 3 olguda daha az oranda izlendi. Bu olgularda mast hücreleri yoğundu ve Ki 67 proliferasyon indeksi diğer olgularınkinden daha yüksekti. Hamartomlarda bulunan çok sayıdaki mast hücresinin önemi ve stromal proliferasyonun indüklenmesindeki rolü belirsizdir ve daha ileri araştırmaları gerektirmektedir

Anahtar Kelimeler:

Akciğer hastalıkları, Hamartom, Mast hücreleri

Papillary projections and mast cells in the pulmonary hamartomas (8 cases study)

Introduction: Pulmonary hamartoma represents the most common benign tumour of the lung, accounting approximately for % 6 of all solitary pulmonary nodules. It is usually composed of an admixture of mature cartilage, epithelial elements, fibrous and fat tissue in different proportions. In this study, the components of hamartoma, the existence of villuslike papillary projections and the distrubution of mast cells in the lesion were investigated. Material-Method: Between the years of 2001 and 2004, cut sections of 8 patient diagnosed as pulmonary hamartoma in pathology department of SSK Izmir Hospital were evaluated by hematoxylin-eosin (H&E), aldan blue, von Giesson, toluidine blue %1, vimentin, S-100, cytokeratin 7, CD 34 and Ki 67. Results-Conclusion: The mean age of the cases was 50,1 and the average size of the tumor diameter was 2,7 cm. The cartilage was the most common mesenchymal component. Villuslike papillary projections were prominent in 2 patients arid few in other 3. In these cases, mast cells were intense, and Ki-67 proliferation index was higher than that of the others. The importance of mast cells in pulmonary hamartomas and their role in induction of stromal proliferation are not clear and should be investigated.

Keywords:

Lung Diseases, Hamartoma, Mast Cells,

PDF

___

1. Saunders W.B Dorland's Illustrated, Medical Dictionary. 27th edition Philadelphia, 1988:730.
2. Van Den Bosch JMM, Wagenaar SS, Corrin B, et al. Mesenchymoma of the lung: (so called hamartoma): a review of 154 parenchymal and endobronchial cases. Thorax 1987; 42: 790-3.
3. Hansen CP, Holtveg H, Francis D, Rasch L, Bertelsen S. Pulmonary hamartoma. J. Thorac Cardiova'sc Surg 1992; 104: 674-8.
4. Kervacıoğlu R, Bayram MM, Eybeyli L. Giant pulmonary hamartoma. Am J Roentgenol. 1997; 168 (2): 573.
5. Rossi G, Cavazza A, Vali R, et al. Atypical lipomatous tumour (lipoma-like well-differentiated liposarcoma) arising in a pulmonary hamartoma and clinically presenting with pneumothorax. Lung Cancer 2003; 39:103-106.
6. Takemura T, Kasafuka K, Fujiwara M, et al. An immunohistochemical study of the mesenchymal and epithelial components of pulmonary chondromatous hamartomas. Pathology International 1999; 49 (11): 938.
7. Ruliang X, Murray M, Jagirdar J, Delgado Y, Melamed J. Placental Transmogrification of the Lung Is a Histologic Pattern Frequently Associated With Pulmonary Fibrochondromatous Hamartoma. Archives of Pathology and Laboratory Medicine 2002; 126:562-566.
8. Albrecht E. Ueber hamartome. Verh Dtsch Ges Pathol 1904; 7:153-7.
9. Goldsworthy NE. Chondroma of lung (hamartoma chondromatosum polmonis), with report of case. J Pathol Bacteriol 1934; 39:291-298.
10. Fletcher JA, Pinkus GS, Donovan K, Naeem R, Sugarbaker DJ, Mentzer S et al. Clonal reaarrangement of chromosome band 6p21 in the mesenchymal component of pulmonary chondroid hamartoma. Cancer Research 1992; 52: 6224-6228.
11. Panzini L, Potalivo S, Saed G, Rapisarda M, Bisetti A. Panminerva Medica 1999; 41: 359-62.
12. King TC, Myers J. Isolated metastasis to a pulmonary hamartoma. Am J Surg Pathol 1995; 19(4): 472-475.
13. Cosio B, Villena V, Echave-Sustaeta J, de Miguel E, Alfaro J, Hernandez L et al. Endobronchial hamartoma. Chest 2002; 122:202-205.
14. Mills SE. Sternberg's Diagnostic Surgical Pathology. Shimosato Y, Noguchı M, ed. Pulmonary neoplasms. 4th edition. Philadelphia: Lippincott Williams & Wilkins, 2004:1208-1209.
15. Bini A, Grazia M, Petrella F, Chittolini M. Multipl chondromatous hamartomas of the lung. Interactive Cardiovascular and Thoracic Surgery 2002; 1(2): 78-80.
16. Kiryu T, Kawaguchi S, Matsui E, Hoshi H, Kokubo M, Shimokava K. Multipl chondromatous hamartomas of the lung (A case report and review of the literature with special reference to Carney syndrome) Cancer 1999; 85(12): 2557-2561.
17. Kaptanoğlu M, Nadir A, Yıldız E, Elagoz S. Pulmonary hamartoma, a rare presentation. Eur J Cardiothorac Surg 2001; 20 (5):1031.
18. Hasleton PS. Spencer's Pathology of the Lung. Hasleton PS. Benign Lung Tumors and Their Malignant Counterparts. 5th edition. The McGraw-Hill Companies 1996:875-879.
19. Rosai J. Rosai and Ackerman's Surgical Pathology. Lung and Pleura. 9th edition.China: Elsevier Inc, 2004: 406-407.
20. Bateson EM. So-called hamartoma of the lung -a true neoplasm of fibrous connective tissue of the bronchi. Cancer 1973; 31 (6): 1458-1467.
21. Şenol M, Fireman P. Human skin mast cell: Current concepts. Turk J Dermatopathol 1997; 1-2: 63-69.
22. Bahadır S, Reis A, Özoran Y, et al. Psoriazisde mast hücreleri. Turk J Dermatopathol 1997; 1-2:18-21.