Uğur TEMEL, Aslı Gül AKGÜL, Mustafa Faik SEÇKİN

Sarkomda cerrahi doğrulama ve yalancı pozitiflik

Akciğer metastazlarında cerrahi rezeksiyon günümüzde standart tedavi yöntemi olarak kabul görmekte ve pek çok göğüs cerrahisi kliniğince rutin şekilde uygulanmaktadır. Komplet cerrahi eksizyon düşük mortalite ve morbidite ile sıklıkla teknik olarak uygun olmaktadır ve eğer primer tümör kontrol altında ise ilk basamak tedavi olarak kabul edilmektedir. Osteosarkomda akciğer metastazı yaklaşık %30 oranında gözlenmektedir. Agresif cerrahi yaklaşım ve kemoterapiyi içeren tedavi disiplinleri ile sağ kalım %45'lere kadar çıkabilmektedir. Akciğer metastazı olan osteosarkom vakalarında uzun dönem sağ kalım için metastatik evreden çok komplet cerrahi önem taşımaktadır. Burada osteosarkom tanılı, takiplerinde akciğer lezyonu tespit edilen ve PET-BT ile transtorasik biyopsi sonucu maligniteyi işaret eden, rezeksiyon sonrası patolojisi ise benign olarak öğrenilen vakamızı sunduk.

Anahtar Kelimeler:

sarkom, yanlış pozitif görüntüleme, cerrahi

Surgical verification and false positivity in sarcoma

Surgical resection of pulmonary metastases is now considered a standard therapeutic procedure in properly selected cases and is routinely performed in many departments of thoracic surgery. Complete surgical excision of all pulmonary deposits is often technically feasible with low morbidity and mortality. It is widely accepted that surgical resection is the first-line therapy for isolated pulmonary metastases if the primary site of tumor is under control. Lung metastases are found in up to 30% of patients with osteosarcoma. Survival rates up to 45% are possible in interdisciplinary concepts with aggressive surgical approach and chemotherapy. Pulmonary metastasectomy is mandatory for long-term survival in patients with pulmonary metastases in osteosarcoma. This depends usually on complete surgical resection which is the main prognostic factor for survival, more than the metastatic stage. Herein we report a case of osteogenic sarcoma, operated because of a lung tumor diagnosed as malignant at PET-CT and tranthoracic biopsy in whom the final diagnosis was not metastasis, was a benign lung pathology.

Keywords:

sarcoma, false positive imaging, surgery,

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Putnam JB. Pulmonary Metastases. In: Fran- co KL, Putnam JB; eds. Advanced Theraphy in Thoracic Surgery. Ontario: BC Decker Com- pany;1998:117-126.
Shields TW. B. Pathology of carcinoma of the lung. In: Shields TW, LoCicero J, Ponn RB, edi- tors. General thoracic surgery. Philadelphia: Lip- pincott Williams & Wilkins; 2000.p.1235-1268.
Yüksel M, Kalaycı G. Metastatik akciğer tümör- leri. In: Yüksel M, Kalaycı G (eds). Göğüs Cer- rahisi. İstanbul: Bilmedya Grup, 2001:307-328.
Margaritora S, Porziella V, D’Andrilli A, et al. Pulmonary metastases: can accurate radiologi- cal evaluation avoid thoracotomic approach? Eur J Cardiothorac Surg 2002;21:1111-1114.
Parsons AM, Detterbeck FC, Parker LA. Accura- cy of helical CT in the detection of pulmonary metastases: is intraoperative palpation still ne- cessary? Ann Thorac Surg 2004;78:1910-1918.
Kondo H, Okumura T, Ohde Y, et al. Surgical tre- atment for metastatic malignancies. Pulmonary metastasis: indications and outcomes. Int J Clin Oncol 2005;10:81-85.
Monteiro A, Arce N, Bernardo J, et al. Surgical resection of lung metastases from epithelial tu- mors. Ann Thorac Surg 2004;77:431-437.
Belli L, Scholl S, Livartowski A, et al. Resection of pulmonary metastases in osteosarcoma. A retrospective analysis of 44 patients. Cancer 1989;63:2546-2550.
Goorin AM, Shuster JJ, Baker A, et al. Changing pattern of pulmonary metastases with adjuvant chemotherapy in patients with osteosarcoma: Results from the multi-institutional osteosarco- ma study. J Clin Oncol 1991;9:600-6005.
Meyer WH, Schell MJ, Kumar AP, et al. Thoraco- tomy for pulmonary metastatic osteosarcoma. An analysis of prognostic indicators for survival. Cancer. 1987;59:374-379.
Saltzman DA, Snyder CL, Ferrel KL, et al. Ag- ressive metastasectomy for pulmonic sarcoma- tous mertastases: a follow-up study. Am J Surg 1993;166:543-547.
Snyder CL, Saltzman DA, Ferrel KL, et al. A new approach to the resection of pulmonary osteo- sarcoma metastases. Results of aggressive me- tastasectomy. Clin Orthop 1991;270:247-253.
Putnam JB Jr. Secondary tumors of the lung. In: General Thoracic Surgery, Ed: Shields TW. 5th edition, Philadelphia; William & Wilkins 2000:1555-1576.