Gastrointestinal sistemin konjenital nadir görülen kistik lezyonların histopatolojik ve klinik değerlendirmesi

Amaç: Gastrointestinal sistem kaynaklı konjenital kistler oldukça nadir görülmektedir. Mezotelyal/omental kistler, lenfanjiomlar, enterik duplikasyon kistleri, Meckel divertikülü, omfalomezenterik duktus kisti gastrointestinal kaynaklı konjenital kistler olarak tanımlanır. Gastrointestinal sistemden köken alan kistik kitleler, farklı klinik ve histopatolojik özellikler göstermektedir. Kistik kitleler genellikle asemptomatik olup rastlantısal olarak saptanmakta veya komplikasyon geliştiğinde acil operasyona alınmaktadır. Operasyon öncesinde benign kistler ile neoplastik kitleleri ayırt etmek için radyolojik yöntemler kullanılmaktadır. Kesin tanı için ise histopatolojik inceleme gerekmektedir. Bu çalışmada, intraabdominal gastrointestinal sistem kaynaklı konjenital benign kistik lezyonların klinik, histopatolojik özellikleri ve ayırıcı tanıları birlikte değerlendirilmiştir. Gereç ve yöntem: Tıbbi Patoloji Anabilim Dalı arşivi taranarak mide, ince-kalın bağırsak ve mezenter- omentumdan köken alan gastrointestinal sistem kaynaklı neoplastik olmayan 55 olgu çalışmaya dahil edildi. Bulgular: Olgular yaş, cinsiyet, klinik bulgular, yerleşim yeri, histopatolojik özelliklerine göre değerlendirildi. Gastrointestinal sistem kaynaklı kistik lezyonlar içerisinde en sık Meckel divertikülü (n:33) görüldü. Daha sonra olguların görülme sıklığına göre mezotelyal/omental kistler (n:8), kistik lenfanjiomalar (n:7) ve duplikasyon kistler (n:6) ve omfalomezenterik duktus kistler (n:1) sıralandı. Olgularda en sık şikayet, karın ağrısıydı. Sonuç: Kistlerin kökeni ne olursa olsun spesifik tiplendirme, lezyonların histopatolojik olarak değerlendirmesi (epitele sahip olup olmayışı, epitelin tipi) ile yapılmaktadır. Gastrointestinal sistem yerleşimli kistler ile ilgili en önemli sorun, bazen bu kistlerin neoplastik nitelik taşıyan kitlelerden veya parazite bağlı kistlerden ayırt edilememesidir. Fizik muayenede düzgün sınırlı kitle palpe edilen ve görüntüleme yöntemleriyle intraabdominal kistik kitle saptanan, karın ağrısı ile başvuran hastalarda ayırıcı tanıda farklı gelişimsel nitelikler taşıyan kistik kitleler göz önünde bulundurulmalıdır.

Histopathological and clinical evaluations of congenital rare cystic lesions of the gastrointestinal tract

Purpose: Congenital cysts originating from the gastrointestinal tract are very rare. The mesenteric-omental cysts, lymphangioma, enteric duplication cysts, Meckel diverticulum/omphalomesenteric duct cysts are defined as congenital cysts of the gastrointestinal origin. Cystic masses originating from gastrointestinal system have different clinical and histopathological features. Cystic masses are usually asymptomatic and are detected incidentally or operated urgently when complications occur. Preoperative radiological methods are used to differentiate benign cysts and neoplastic masses. Histopathological examination is required for definitive diagnosis. In this study, the clinical, histopathological features and differential diagnoses of the intraabdominal congenital benign cystic lesions originating from the gastrointestinal system were evaluated. Materials and methods: The archives of the Department of Pathology were reviewed and 55 cases which were non-neoplastic lesions originating from the stomach, small-large intestine and mesenteric-omentum were included in the study. Result: The cases were evaluated according to age, sex, clinical findings, location, and histopathological features. Meckel diverticulum (n:33) was the most common cystic lesion originating from the gastrointestinal tract. Mesothelial/omental cysts (n:8), cystic lymphangiomas (n:7), duplication cysts (n:6) and omphalomesenteric duct cysts (n:1) were seen according to the incidence of the cases. Abdominal pain was the most common cause of complaints. Conclusion: Whatever the origin of cysts, specific typing is indicated by histopathological evaluation of lesions (whether epithelium is present, type of epithelium). The most important problem with cysts located in the gastrointestinal tract is that these cysts sometimes cannot be differentiated from neoplastic masses or parasitic cyst. Cystic masses with different developmental characteristics should be considered in the differential diagnosis of patients presenting with abdominal pain, palpated mass in the physical examination and intraabdominal cystic masses detected on radiological imaging.

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