Emine DÜNDAR, Muzaffer METİNTAŞ, Sinan ERGİNEL, İrfan UÇGUN, Füsun ALATAŞ, Akçayır İlknur ŞAHİN

Senkron primer akciğer kanserleri: Dört olgu nedeni ile

Iki ayrı primer akciğer kanseri eş zamanlı olarak bulunuyorsa buna senkron tümör denir ve tüm akciğer kanserlerinin %0. l -1.6'sını oluşturur. Çalışmamızda, Haziran 1999-Mayıs 2002 tarihleri arasında tanı koyduğumuz dört senkron primer akciğer kanseri olgusunu sunduk. Hastaların tümü erkek olup yaş ortalaması 63 idi. Tüm hastalar ağır sigara içicisi idi (ortalama 58 paket/yıl). Tümör tipleri iki olguda skuamöz kanser-adeno kanser, bir olguda skuamöz kanser-küçük hücreli kanser ve bir olguda skuamöz kanser-skuamöz kanser idi. Tüm olgularda tümöral lezyonlar iki farklı akciğerde yerleşmişti, sisternik ve mediasünal yayınları yoktu, iki olgunun direkt akciğer grafılerinde ikinci primer akciğer kanser lezyonu görülemedi. Bunların birinde lezyon bilgisayarlı tomografide, diğerinde ise sadece bronkoskoplde görülebildi. Lezyon yerleşimleri sol alt, sağ alt, sağ orta ve sol üst lobungula bronşunda eşit sıklıkta (%25) idi. Tanı testlerinde ise bir olguda bronkoskopi yeterli olurken, üç olguda transtorasik akciğer aspirasyon biyopsisi gerekti. Her iki lezyonun da ayrı ayrı evrelemesi ve uygun olanlarda rezeksiyonu önerilirken, olgularımızda ileri yaş, küçük hücreli akciğer kanser varlığı ve hesaplanan cerrahi sonrası solunum rezervi yetersizliği nedenleri ile cerrahi uygulanamadı, sistemik kemoterapi verildi. Olguların üç tanesi öldü (ortalama sağkalım 11 ay). Bu çalışma nedeniyle, birden çok akciğer lezyonu olan hastalarda, multipl primer akciğer kanserleri (MPAK) olabileceği düşüncesi ile her lezyondan ayrı ayrı biyopsi yapılması ve tedaviye yönelik girişimlerin buna göre planlanması gerektiği vurgulandı.

Synchronous primary lung cancers: Due to the four cases

If two primary lung cancers are present in the same time, it diagnosed as synchronous lung cancer. It constitutes 0.1-1.6% of all lung cancers. In this report, we described four cases diagnosed synchronous multiple primary lung cancers (MPLC) in between June 1999 and May 2002. Mean age was 63, and all of those were male. All patients were heavy smoker (mean 58 packet/year). Histology of lung cancers, was squamous-adeno in two cases, squamous-small cell lung cancer in one case, and squamous-squamous in two cases. All patients had bilateral mass lesions and no mediasünal and systemic spread. Lesion of second primary lung cancer was unable to seen in two patient's chest X-ray. Their lesions were seen by computerized tomography in one case, and by bronchoscope only in the other case. Lesion site was left lower lobe, right lower lobe, right middle lobe, and left upper lobe (25% for each). Diagnosis of lung cancer was made by transthoracic needle biopsy in three lesion, and made by bronchoscopic biopsy in other lesions. While it is recommended that, all ofMPLC lesions were staged separately and treated surgically, due to the advanced age, presence of small cell lung cancer, and inadequate postoperative respiratory reserve, surgical treatment could not apply to these patients and they received chemotherapy. Three of them was died (mean survival was U months). Due to the this report, we emphasized that diagnostic procedures should be done separately for each lesions in patients who had more than one lesion, and treatment should plane according to these results.

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