Funda DEMİRAĞ, Osman ÖRSEL, Zafer AKTAŞ, Kurtuluş AKSU, Tuğrul ŞİPİT, Fırat Selma GÜVEN, Funda AKSU

Spindle cell sarcomatoid carcinoma: First case reported in the trachea

Yetmiş sekiz yaşında erkek hasta üç aydır devam eden öksürük, nefes darlığı, kilo kaybı ve hemoptizi şikayetleri ile başvurdu. Hastanın 30 paket/yıl sigara içme öyküsü ve çevresel asbest maruziyeti mevcuttu. Akciğer tomografisinde karina düzeyinde 2 x 1 cm endolüminal kitle görünümü mevcut olup, mediastinal lenf nodu, parankimal tutulum yoktu. Yapılan fiberoptik bronkoskopide ana karinaya oturan, sol ana bronş girişini %90’a yakın, sağ ana bronş girişini %75’e yakın daraltan polipoid tümöral doku izlendi. Endoskopik argon plazma koagülasyon uygulanarak biyopsiler alındı ve lezyonun %90’dan fazlası rezeke edilerek hava yolu açıklığı sağlandı. Mikroskobik incelemede tümörün atipik mitotik figürler ve belirgin nükleer polimorfizm gösteren iğsi hücrelerden oluştuğu ve immünhistokimyasal çalışmada epitelyal membran antijen ile pozitif boyanma gösterdiği izlendi. Bu bulgularla olguya spindle hücreli sarkomatoid karsinom tanısı koyuldu. Baş-boyun bölgesi, larenks, gastrointestinal sistem, meme, genitoüriner sistem, cilt ve akciğer olmak üzere pek çok bölgeden gelişen spindle hücreli sarkomatoid karsinom olguları literatürde yer almakla birlikte trakeal kökenli bildirilen tümör olgusu bulunmamaktadır. Trakeanın primer malign tümörleri solunum sisteminde gelişen tümörlerin %0.2’sini oluşturmaktadır ve nadir olmaları sebebiyle insidans, epidemiyoloji, etyoloji ve tedavi yöntemleri ile prognoza etkisi olan faktörler hakkında bilgiler kısıtlıdır. En sık rastlanan histolojik tipler skuamöz hücreli karsinom ve adenoid kistik karsinomdur. Az rastlanan diğer histolojik tipte malign trakea tümörlerini bildiren serilerde spindle hücreli sarkomatoid karsinom olgusu olmaması ve bu tümörlerin nadir olmaları sebebiyle olgu klinik özellikleriyle birlikte sunulmuştur.

Spindle hücreli sarkomatoid karsinom: Trakeada bildirilen ilk olgu

A 78-years-old man presented with weight loss, dyspnea, cough and hemoptysis. He was an ex-smoker with a smoking history of 30 pack-years. Imaging studies revealed an endoluminal carinal mass and a tumoral mass arising from the posterior wall of the trachea was observed bronchoscopically. Endoscopic argon plasma coagulation was performed to take biopsies and to regain the airway passage. Recanalisation of the right and left main bronchi and the trachea was achieved together with resection of more than 90% of the tumoural mass. Microscopically, the tumor was composed of fascicular pattern of spindle cells with atypical mitotic figures and nuclear pleomorphism, positively reactive to epithelial membrane antigen supporting a diagnosis of tumour with epithelial differentiation. These findings supported the diagnosis of a spindle cell sarcomatoid carcinoma of trachea. Spindle cell carcinoma cases are reported in many sites, such as head and neck region, larynx, digestive tract, breast, kidney, genital tract, skin and lung, but to our knowledge, not in trachea. Primary malignant tracheal tumours consist mainly of squamous cell carcinoma and adenoid cystic carcinoma and generally have an aggressive course with poor prognosis. We report the first presentation of a spindle cell sarcomatoid carcinoma of trachea together with the clinical course of the patient.

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