Sümeyye EKMEKCİ, Esra Canan KELTEN TALU, Erdem KISA, Ülkü KÜÇÜK

Prostat Adenokarsinomlarında Morfolojik Tümör Heterojenitesinin Lenf Nodu Metastazı ile İlişkisi

Amaç: Çalışmamızın amacı prostat karsinomu histopatolojik alt tiplerinin lenf nodu metastazına (LNM) etkisini araştırmaktır. Gereç-Yöntem:Çalışmaya radikal prostatektomi (RP) ve pelvik lenf nodu diseksiyonu uygulanan toplam 102 hasta dahil edildi.Tümör dereceleri, eşlik eden intraduktal karsinom (IDC-P)/duktal adenokarsinom (PDA), LNM, ekstraprostatik yayılım (EPE) ve seminal vezikül invazyonu (SVI) kaydedildi. Bulgular: Tümörlerin 76'sında pür asiner adenokarsinom (AK) histolojisi bulunurken, 17'sinde IDC-P, 9'unda PDA'ya AK eşlik etti.IDC-P ve PDA'ya eşlik eden tümörlerin tümü evre 3 ve evre 4 idi.Saf AK vakalarında, artmış tümör derecesi ile ileri evre arasında istatistiksel olarak anlamlı bir ilişki gözlendi.Saf AK olgularında yüksek GG ile LNM, SVI ve EPE arasında pozitif ilişki saptandı.17 olgunun 11'inde LNM, 10'unda IDC-P, SVI ve 16'sında EPE izlendi.Tümöre eşlik eden PDA'lı 9 olgunun hepsinde EPE, 8 olguda LNM ve SVI vardı.LNM, SVI, EPE varlığı ile eşlik eden IDC-P/PDA arasında istatistiksel olarak anlamlı bir ilişki gözlendi. Yüksek dereceli tümörler incelendiğinde, yukarıda belirtilen sonuçlara benzer şekilde, IDC-P/PDA'nın AC'ye eşlik ettiği ve bu nedenle LNM olma riskinin arttığı görülmüştür. Sonuç: Çalışmamızda tümöre eşlik eden IDC-P/PDA varlığının LNM riskini anlamlı olarak arttırdığı belirtilmiş ve LNM risk analizinde bu iki verinin de dikkate alınmasının tedavi planlamasında daha doğru bir yaklaşım sağlayabileceği düşünülmüştür.

Anahtar Kelimeler:

Prostat, adenokarsinom, lenf nodu, metastaz

The relationship of morphological tumor heterogeneity with lymph node metastasis in prostatic adenocarcinomas

Aim:The aim of our study isto investigate effect of prostatic carcinoma histopathological subtypes to the lymph node metastasis (LNM). Materials- Methods:A total of 102 patients who underwent radical prostatectomy (RP) and pelvic lymph node disection were included in the study. Tumor grades, accompanying intraductal carcinoma (IDC-P)/ductal adenocarcinoma (PDA), LNM, extraprostatic extension (EPE) and seminal vesicle invasion (SVI) were recorded. Results: While 76 of the tumors had pure acinar adenocarcinoma (AC) histology, IDC-P accompanied AC in 17 and PDA in 9 cases. The tumors accompanying IDC-P and PDA were all stage 3 and stage 4. In pure AC cases, a statistically significant relationship was observed between the increased tumor grade and advanced stage. The positive relationship was determined between high GG with LNM, SVI and EPE in pure AC cases. LNM was observed in 11 of 17 cases accompanied by IDC-P, SVI in 10, and EPE in 16 cases. All 9 cases with PDA accompanying the tumor had EPE, 8 of the cases had LNM and SVI. A statistically significant relationship was observed between presence of LNM, SVI, EPE and accompanying IDC-P/PDA. When high graded tumors were examined, similar to results mentioned above, it was observed that IDC-P/PDA has accompanied AC thus, the risk of having LNM increased. Conclusion: In our study, it was noted that the presence of IDC-P/PDA accompanying the tumor significantly increased the risk of LNM, and it was thought that considering both these data in LNM risk analysis may provide a more accurate approach in treatment planning.

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