Laparoskopik kolesistektomi materyallerinde insidental safra kesesi karsinomu ve prekanseröz lezyonlar

Amaç: Laparoskopik kolesistektomi olan hastalarda safra kesesinin insidental karsinom, displazi ve adenom sıklığını saptamayı amaçladık.Yöntem: 5063 kolesistektomi materyaline ait patoloji raporunu inceledik ve displazi, adenom, safra kesesi karsinomu tanısı olanlara ait Hematoksilen Eozin boyalı kesitleri gözden geçirdik.Bulgular: İnsidental safra kesesi karsinomu 6 olguda saptanmıştır ve bunların 5'ine displazi eşlik etmektedir. Tek başına displazi 13 olguda, adenom 2 olguda izlenmiştir. Kadın-erkek oranları displazi olguları için 12: 1, karsinom için 4: 2'dir. Ortalama yaş safra kesesi karsinomu olguları için 65,6, displazi/adenom olguları için 56,8'dir. Biliyer intraepitelial neoplazi (BillN3) 4 karsinom olgusuna ve BillN2 1 karsinom olgusuna eşlik etmektedir. İntestinal metaplazi 3 karsinom olgusunda saptandı. İnvaziv karsinom olmaksızın tek başına BillN3 4 olguda, BillN2 3 olguda, BillN1 6 olguda izlenmiştir. İntestinal metaplazi 2 BillN olgusunda, intestinal+pilorik metaplazi 1 olguda ve pilorik metaplazi 1 olguda saptanmıştır.Sonuç: İnsidental safra kesesi karsinomu %0,11 olarak bulundu. Safra kesesi taşları ve ileri yaş karsinom için risk faktörleri olarak izlendi. İnsidental safra kesesi karsinomu, BillN ve metaplastik değişiklikler varlığında beklenebilir. İnsidental safra kesesi karsinomu ve preinvaziv lezyonların tanısında histopatolojik inceleme hala önem taşımaktadır. BillN3 tipik olarak invaziv karsinomla ilişkili olduğundan, ilk histolojik kesitlerde karsinom olmadığında, patolog tarafından eksize edilen organın ayrıntılı ve tam bir incelenmesi yapılmalıdır

Incidental gallbladder carcinoma and precancerous lesions in laparoscopic cholecystectomy specimens

Objective: The purpose of our study was to find out the frequency of incidental carcinomas, dysplasias and adenomas of the gallbladder in patients who underwent laparoscopic cholecystectomy. Methods: We reviewed pathology records of 5063 cholecystectomy specimens Hematoxylin-eosin stained sections of the patients having dysplasia, adenoma, gallbladder carcinoma (GC) were reviewed. Results: Incidental GC was detected in 6 cases, and 5 of them exhibited accompanying dysplasia. Isolated cases of dysplasia, and adenoma were detected in 13, and 2 cases, respectively. Femalemale ratios for dysplasia, and carcinoma were 12: 1, and 4: 2, respectively. Median ages of GC, and dysplasia/adenoma were 65.6, and 56.8 years, respectively. Biliary intraepithelial neoplasia (BillN3) and BillN2 were accompanied with 4, and 1 case with carcinoma. Intestinal metaplasia was noted in 3 carcinoma cases. Isolated cases with BillN3, BillN2, and BillN1without invasive carcinoma were seen in 4, 3, and 6 cases, respectively. Intestinal metaplasia was noted in 2, intestinal+pyloric metaplasia in 1, and pyloric metaplasia in 1 case with BillN.Conclusion: Incidental GC was found in 0.11% of our cases. Gallbladder stones and advance age seem to be the risk factors for GC. Incidental GC may be predicted in the presence of BillN and metaplastic changes of the gallbladder. Histopathological evaluation is still important for the diagnosis of incidental gallbladder carcinoma and preinvasive lesions. BillN3 is typically associated with invasive carcinoma. Thus, complete sampling should be performed by pathologist when carcinoma is not evident on initial histologic sections

Kaynakça

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