N. ŞEN TÜRK, A E. ZÜMRÜTBAŞ, C. ACAR, Z. AYBEK

Üreterin primer sarkomatoid karsinomu

Ürotelyal neoplazilerin 2004 Dünya Sağlık Örgütü sınıflaması, üriner sistemin tüm bifazik malign tümörleri için sarkomatoid karsinom teriminin kullanılmasını önermektedir. 77 yaşında erkek hasta, sol yan ağrısı şikayeti ile başvurdu. Bilgisayarlı tomografide sol böbrekte hidronefroz, sol proksimal üreterde dilatasyon ve sol üreterde şüpheli dolum defekti saptandı. Sol nefroüreterektomi materyalinde proksimal üreteri tıkayan düzgün yüzeyli, iyi sınırlı polipoid kitle görüldü. Kitle, 2 cm çapında ve proksimal üreter boyunca 2,5 cm uzunluğunda ölçüldü. Kesi yüzü kirli sarı, beyaz renkte idi. Polipoid kitlenin histopatolojik incelemesinde tümörün hem epitelyal hem de sarkomatöz komponent içerdiği görüldü. Malign epitelyal komponent yüksek dereceli invaziv ürotelyal karsinom ve adenokarsinomdan oluşmaktaydı. Sarkomatöz komponent, yüksek mitotik aktiviteye sahip çok sayıda atipik iğsi hücrelerden oluşmaktaydı. Olgu, sarkomatoid karsinom, pT2 olarak rapor edildi. Ürologların bu nadir agresif tümörün farkında olmaları ve patologların da üreterin bifazik tümörlerinin ayırıcı tanısında sarkomatoid karsinomu dikkate almaları, doğru ve hızlı tanı için önemlidir.

Primary sarcomatoid carcinoma of the ureter

The 2008 World Health Organization classification of urothelial neoplasms recommends the term sarcomatoid carcinoma for all biphasic malignant neoplasms of the urinary tract. A 77-year-old man presented with left flank pain. A computed tomography showed a left hydroureteronephrosis and a suspicous filling defect in the left ureter. A left nephroureterectomy specimen showed a well circumscribed polypoid mass with smooth surfaces that had obliterated the proximal ureter. The mass measured 2 cm in diameter along a poximal 2.5 cm section of the ureter. The cut surface of the tumor was yellowish-white. A histopathological examination of the polypoid mass showed that the tumor had a malignant epithelial component as well as a sarcomatous component. The malignant epithelial component was comprised of a high-grade invasive urothelial carcinoma and adenocarcinoma. The sarcomatous component contained numerous atypical spindle cells with a high mitotic activity. The case was reported as sarcomatoid carcinoma, pT2. It is important for correct and quick diagnosis for urologists to be aware of this rare aggressive neoplasm and also for pathologists to take into account sarcomatoid carcinomas in the differential diagnosis of biphasic tumors of the ureter.

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