Ayşegül Sarı, Murat Ermete, Aylin Çallı, Cengiz Girgin

Ürotelyal Karsinomlu 191 Olgunun Radikal Sistektomi Materyalinde Histopatolojik İnceleme

Amaç: Bu çalışmada 1997 Ocak -2005 Aralık yılları arasında İzmir Atatürk Eğitim ve Araştırma Hastanesi, Patoloji bölümünde ürotelyal karsinom tanısı alan 191 adet radikal sistektomi materyalinin histopatolojik özelliklerini (tümör boyutu, karsinoma insitu varlığı, vesiküla seminalis tutulumu, prostat tutulumu, lenfovasküler ve sinir invazyonu ile lenf nodu metastaz varlığı) değerlendirilerek, bu parametrelerin birbirleri ile ilişkisini araştırmak amaçlandı. Gereç ve Yöntem: Tümör evresi ve derece arasındaki ilişki spearman korelasyon analizi ile, evre ve diğer değişkenler arasındaki ilişki ise Mann-Whitney U testi ile değerlendirildi. Derece ile diğer parametreler arasındaki ilişki incelenirken derece 1 ve derece 2 tümörler bir grup altında birleştirilerek ki kare testi uygulandı. Diğer kategorik veri setlerinin karşılaştırılmasında ise ki-kare testi kullanıldı. Evrelemede TNM sınıflaması, Ürotelyal karsinomun derecelendirilmesinde ise Dünya Sağlık Örgütünün (WHO) sınıflaması kullanıldı. Bulgular: Yüzdoksanbir olgunun ( 13 kadın; 178 erkek) ortalama yaşı 61,3 idi. Olguların evrelere göre dağılımı: %15 (n=29) pT1; %12 (n=23) pT1; %26,7 (n=51) pT2; %26,2 (n= 50) pT3; %19,9 (n=38) pT4 şeklinde, derecelere göre dağılımı ise: %3 (n=6) derece I; % 12 (n=23) derece II; % 84,8 (n=162) derece III şeklinde idi. Olguların %33'ünde (n=63) lenfovasküler invazyon, %8'inde (n=15) ise sinir invazyonu vardı. Lenf nodu disseksiyonu uygulanmış 119 olgunun % 29,4'ünde (n=35) metastaz mevcuttu. Lenfovasküler invazyon, sinir invazyonu, vesikulo seminalis infiltrasyonu veya lenf nodu metastazı bulunan olguların tamamını kas invaziv ve derece III tümörler oluşturmaktaydı. Yüzyetmişsekis erkek olgunun % 13'ünde (n=23) prostat tutulumu, %9,6'sında (n=17) vesikula seminalis tutulumu gözlendi. Prostat insidental karsinomu ise 16 (%9) olguda izlendi. Sonuç : Tümör patolojik evresi ve derecesi arasında istatistiksel olarak anlamlı ilişki saptandı. İleri patolojik evreye sahip tümörler yanısıra derece III tümörlerde lenfovasküler invazyon ve lenf nodu metastazı bulunma olasılığının istatistiksel olarak arttığı izlendi. Lenfovasküler invazyonun lenf nodu metastazı için risk oluşturduğu gözlemlendi. Vesikulo seminalis infiltrasyonu olan tümörlerin hepsi derece III olup, bu olgularda lenfovasküler invazyon bulunma olasılığı istatistiksel olarak anlamlı derecede yüksek bulundu. Anahtar kelimeler: Mesane karsinomları, Sistektomi, Ürotelyal karsinom

Anahtar Kelimeler:

Mesane karsinomları, Sistektomi, Ürotelyal karsinom

Overview of Histopathologic Features in 191 Radical Cystectomy Specimens with Urothelial Carcinoma

Aim: All cases of urethelial carcinoma of the bladder undergoing radical cystectomy between 1997 January and 2005 December were retriewed from the files of İzmir Ataturk Training Hospital, Pathology department and reviewed. The aim of this study was to evaluate the histopathological features (such as tumor size, presence of carcinoma in-situ, infiltration of vesicula seminalis and prostatic gland, vascular invasion, perineural invasion, and lymph node status) of these 191 radical cystectomy specimens and to detect if there was a relation between these parameters. Material and Method: The tumours were staged according the TNM staging system and graded according to grading schema proposed by World Heath Organization. The relationship between pathologic stage and grade was analysed by Spearman correlation test. Mann Whitney U tests were used to determine the relation between stage and other parameters. Grade 1 and grade 2 tumors were gathered as one group and chi-square tests were performed to determine the relation between grade and other parameters. The relationship of the other parameters with each other were analysed by chi-square tests. Results: The male/ female ratio was 13/178, and the mean age was 61,3. The pathologic stages of the cases was as follows: 15% (n=29) pTa; 12% (n=23) pT1; 26,7% (n=51) pT2; 26,2% (n= 50) pT3; 19,9% (n=38) pT4. The grades of the tumors were as follows: 3% (n=6) grade I; 12% (n=23) grade II; 84,8 % (n=162) grade III. Lymphovascular invasion was seen in 33% (n=63) of patients and perineural invasion in 8% (n=15). Lymph node metastases was observed in 29,4% (n=35) of the 119 lymph nodes extracted cases. Cases with lymphovascular invasion, perineural invasion, vesicula seminalis infiltration or lymph node metastases were composed of muscle invasive and grade III tumors. Among 178 male patients, prostatic infiltration and vesicula seminalis infiltration was present in 13% (n=23) and %9,6 (n=17) of the cases respectively. Incidental adenocarcinoma of prostat was detected in 9% (n=16) of the specimens. Conclusions: There was a statistically significant relationship between tumoral pathologic stage and grade. High pathologic stage or grade III tumors had statistically significant correlation with the presence of lymphovascular invasion and lymph node metastases. Presence of lymphovascular invasion was found to be a risk factor for the lymph node metastases. All the tumors which showed vesicula seminalis infiltration were grade III and these tumors were statistically associated with the presence of lymphovascular invasion. Key words: Bladder carcinomas, Cystectomy, Urothelial carcinoma

Keywords:

Bladder carcinomas, Cystectomy, Urothelial carcinoma,

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