Turgay ULAŞ, Sezen KOÇARSLAN, Yusuf YÜCEL, Muhammet Emin GÜLDÜR, Turan EKİNCİ, Rabia APARI

Apendektomi materyallerinde rastlantısal olarak saptanan nöroendokrin tümörlerin sıklığı: on yıllık arşiv taraması

Amaç: Bu çalışmada çeşitli endikasyonlarla apendektomi yapılan olguların apendektomi materyallerinde rastlantısal olarak saptanan nöroendokrin tümör (NET)'lerin sıklığını araştırmak amaçlanmıştır.Yöntemler: Ocak 2004- Mayıs 2014 tarihleri arasında Harran Üniversitesi Tıp Fakültesi hastanesinde apendektomi yapılan ve Patoloji anabilim dalında histopatolojik incelemesi yapılan 2252 olgu retrospektif olarak incelendi.Bulgular: Çalışmaya alınan 2252 olgunun 3 (%0,13)'ünde NET rapor edilmiş idi. NET'li olguların hepsi kadın olup, ortalama yaş ± SD 58,33 ± 18.14 yıl idi. Olguların tamamı akut apandisit nedeni ile opere edilmiş olup, tümörler mikroskopik inceleme sırasında rastlantısal olarak saptanmıştı. Tüm olgularda tümör apendiksin distal kısmına yerleşimli olup, tümör boyutları 1,4cm, 1cm ve 0,7cm (ort:1,03 ± 0,35cm) idi. Her olguda müsküler tabaka ve periapendikal yağlı doku tutulumu mevcut olmakla birlikte, hücresel atipileri minimaldi. Mitotik aktiviteleri 10 büyük büyütme alanında ortalama 1-2 olarak hesaplanmıştı. Tüm olgulara immunohistokimyasal boyama yapılmış ve tamamında tümör hücreleri pansitokeratin, sinaptofizin ve kromogranin ile pozitif boyanma göstermişti. Ki-67 proliferasyon indeksi %1-2 olarak saptanmıştı. Tüm olgularda tümör çevresi apendikste akut apandisit varlığı rapor edilmişti.Sonuç: Apendiks materyallerinin histopatolojik değerlendirmesinde NET ayırıcı tanıda akılda bulundurulmalı ve uygun örneklemeler ile değerlendirilmelidir.

The prevalence of incidental neuroendocrine tumours in the appendectomy materials: Ten- year's archive search

Objective: Aimed to investigate the incidence of neuroendocrine tumors (NET) in the appendectomy specimens of the patients who underwent appendectomy for various indications. Methods: 2252 cases, that were performed appendectomy at Harran University Faculty of Medicine and examined histopathologically in Pathology department between January 2004 and May 2014, were analyzed retrospectively. Results: In the study, it was reported NET in only 3 (0.13%) of these patients. All of the patients with NET were women and mean age ± SD was 58,33 ± 18.14 years. All of the patients had been operated for acute appendicitis and the tumor was detected incidentally during microscopic examination. The tumor was localized to the distal portion of the appendix in all cases, the tumor sizes were 1.4cm, 1cm, 0.7cm (mean: 1,03 ± 0,35), respectively. Although, muscular layer and periappendicular fatty tissue involvement was present in each case, cellular atypia was minimal. Mitotic activity was calculated as 1-2 in 10 high power field. Immunohistochemical staining was performed in all cases and tumor cells showed positive staining with pancytokeratin, synaptophysin and chromogranin in all. Ki-67 proliferative indices were found 1-2%. In all cases, the presence of acute appendicitis had been reported in the peritumoral appendix. Conclusion: On histopathological examination of the excised appendiceal materials, NET should be constantly kept in mind in differential diagnosis and should be evaluated by an appropriate sampling.

PDF

___

Bosman FT, Carneiro F, Hruban RH, Theise ND. WHO Classification of Tumors of the Digestive System 4th edn. Lyon: IARC Press 2010:417-450.
Moertel CG, Weiland LH, Nagorney DM, Dockerty MB. Carcinoid tumor of the appendix: treatment and prog- nosis. N Engl J Med 1987;317:1699-1701.
Connor SJ, Hanna GB, Frizelle FA. Appendiceal tu- mors: Retrospective clinicopathologic analysis of ap- pendiceal tumors from 7,970 appendectomies. Dis Colon Rectum 1998;41:75-80.
Bernick PE, Klimstra DS, Shia J, et al. Neuroendocrine carcinomas of the colon and rectum. Dis Colon Rec- tum 2004;47:163-169.
Modlin IM, Lye KD, Kidd M. A 5-decade analysis of 13,715 carcinoid tumors. Cancer 2003;97:934-959.
Younes R. GETNE (Grupo de Estudo de Tumores Neu- roendócrinos). Neuroendocrine tumors: a registry of 1,000 patients. Rev Assoc Med Bras 2008;54:305- 307.
Estrozi B, Bacchi CE. Neuroendocrine tumors involv- ing the gastroenteropancreatic tract: a clinicopatho- logical evaluation of 773 cases. Clinics (Sao Paulo) 2011;66:1671-1675.
Maggard MA, O'Connell JB, Ko CY. Updated popu- lation-based review of carcinoid tumors. Ann Surg 2004;240:117-122.
McCusker ME, Coté TR, Clegg LX, Sobin LH. Pri- mary malignant neoplasms of the appendix: a pop- ulation-based study from the surveillance, epidemi- ology and end-results program, 1973-1998. Cancer 2002;94:3307-3312.
Hemminki K, Li X. Incidence trends and risk factors of carcinoid tumors: a nationwide epidemiologic study from Sweden. Cancer 2001;92:2204-2210.
Goede AC, Caplin ME, Winslet MC. Carcinoid tumour of the appendix. Br J Surg 2003;90:1317-1322.
Memon MA, Nelson H. Gastrointestinal carcinoid tumors: Current management strategies. Dis Colon Rectum 1997;40:1101-1118.
Klimstra DS, Modlin IR, Coppola D, et al. The patho- logic classification of neuroendocrine tumors: a re- view of nomenclature, grading, and staging systems. Pancreas 2010;39:707-712.
Güllüoğlu M. Gastroenteropankreatik nöroendokrin tümörlerin patolojik sınıflaması ve nöroendokrin belir- leyiciler. Türkiye Klinikleri J Med Oncol-Special Topics 2013;6:1-4.
Erbey A, Karadağ N, Ulutaş H, et al. Multifocal tumor- lets and a carcinoid tumor associated with bronchiec- tasis. J Clin Exp Invest 2012;3: 273-276.
MacGillivray DC, Heaton RB, Rushin JM, Cruess DF. Distant metastasis from a carcinoid tumor of the appendix less than one centimeter in size. Surgery 1992;111:466-471.
Thompson GB, Van Heerden JA, Martin JK Jr, et al. Carcinoid tumors of the gastrointestinal tract: pre- sentation, management, and prognosis. Surgery 1985;98:1054-1063.
Sandor A, Modlin IM. A retrospective analysis of 1570 appendiceal carcinoids. Am J Gastroenterol 1998;93:422-428.