Yetkin AĞAÇKIRAN, A. İrfan TAŞTEPE, Sadi KAYA, S. Ş. Erkmen GÜLHAN, Taner EGE, Gürkan ÖZ, Ülkü YAZICI, Serdar ÖZKAN

Akciğer sklerozan hemanjiyomlarının klinik değerlendirmesi

Amaç: Çalışmamızda nadir olarak gözlemlenen akciğer sklerozan hemanjiyomlarının klinik özellikleri, cerrahi yaklaşımlarımız ve takip bilgilerimiz değerlendirildi. Çalışma planı: Ocak 1998 - Aralık 2008 tarihleri arasında kliniğimizde akciğer sklerozan hemanjiyomu t anısı i le a meliyat ed ilen a ltı kadın hasta (ort. yaş 53.5 yıl; dağılım 43-59 yıl) çalışmaya dahil edildi. Ameliyat sırasında donmuş kesit analizi yapılarak, beş hastaya kama rezeksiyon, bir hastaya alt lobektomi ve sistematik mediastinal lenfadenektomi ameliyatı uygulandı.Bulgular: Ameliyat sonrası yapılan histopatolojik değerlendirme sonuçları da tüm hastalarda sklerozan hemanjiyom tanısını doğruladı. Ameliyat sonrası erken dönemde herhangi bir komplikasyon gözlemlenmedi. Tüm hastalar, uzun dönem takiplerinde hastalıksız olarak izlenmektedir.Sonuç: Sklerozan hemanjiyomlar benign tümörler olarak kabul edilmektedir. Fakat lenf nodu metastazı ve lokal rekürens gösterebilmesi nedeni ile malign davranış potansiyelinin mevcut olup olmadığı henüz net değildir. Günümüzde cerrahi yaklaşım olarak kama rezeksiyonu yeterli kabul edilmektedir. Ameliyat sırasında kesin tanı konulamayan olgularda sistematik lenfadenektomi ile beraber anatomik rezeksiyon önerilmektedir.

Clinical evaluation of pulmonary sclerosing hemangioma

Background: In our study, we evaluated the clinical features of pulmonary sclerosing hemangiomas, which are rarely observed, our surgical approaches and follow-up information. Methods: Six female patients (mean age 53.5 years; age range 43 to 59 years) who have been operated on in our clinic with the diagnosis of pulmonary sclerosing hemangioma and between January 1988 and December 2008 were included in the study. We have performed intraoperative frozen section analysis and five patients underwent wedge resection, and one underwent lobectomy together with systematic mediastinal lymph node lymphadenectomy.Results: The results of the postoperative histopathological evaluation also confirmed the diagnosis of sclerosing hemangioma in all patients. No complications were observed in the early postoperative period. All of the patients are currently under long-term follow-up and disease-free.Conclusion: Sclerosing hemangiomas are considered as benign tumors. However, the presence of the potential for malignant behavior is not clear since it may show lymph node metastases and local recurrence. Currently wedge resection is accepted to be a sufficient surgical approach. Anatomic resection is advised together with systematic lymphadenectomy in cases of uncertain intraoperative diagnosis.

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1) Liebow AA, Hubbell DS. Sclerosing hemangioma (histiocytoma, xanthoma) of the lung. Cancer 1956;9:53-75.
2) Jungraithmayr W, Eggeling S, Ludwig C, Kayser G, Passlick B. Sclerosing hemangioma of the lung: a benign tumour with potential for malignancy? Ann Thorac Cardiovasc Surg 2006;12:352-4.
3) Devouassoux-Shisheboran M, Hayashi T, Linnoila RI, Koss MN, Travis WD. A clinicopathologic study of 100 cases of pulmonary sclerosing hemangioma with immunohistochemical studies: TTF-1 is expressed in both round and surface cells, suggesting an origin from primitive respiratory epithelium. Am J Surg Pathol 2000;24:906-16.
4) Chan AC, Chan JK. Pulmonary sclerosing hemangioma consistently expresses thyroid transcription factor-1 (TTF-1): a new clue to its histogenesis. Am J Surg Pathol 2000;24:1531-6.
5) Kim GY, Kim J, Choi YS, Kim HJ, Ahn G, Han J. Sixteen cases of sclerosing hemangioma of the lung including unusual presentations. J Korean Med Sci 2004;19:352-8.
6) Sugio K, Yokoyama H, Kaneko S, Ishida T, Sugimachi K. Sclerosing hemangioma of the lung: radiographic and pathological study. Ann Thorac Surg 1992;53:295-300.
7) Nagata N, Dairaku M, Ishida T, Sueishi K, Tanaka K. Sclerosing hemangioma of the lung. Immunohistochemical characterization of its origin as related to surfactant apoprotein. Cancer 1985;55:116-23.
8) Hill GS, Eggleston JC. Electron microscopic study of socalled “pulmonary sclerosing hemangioma”. Report of a case suggesting epithelial origin. Cancer 1972;30:1092-106.
9) Sugio K, Yokoyama H, Kaneko S, Ishida T, Sugimachi K. Sclerosing hemangioma of the lung: radiographic and pathological study. Ann Thorac Surg 1992;53:295-300.
10) Katzenstein AL, Gmelich JT, Carrington CB. Sclerosing hemangioma of the lung: a clinicopathologic study of 51 cases. Am J Surg Pathol 1980;4:343-56.
11) Jungraithmayr W, Eggeling S, Ludwig C, Kayser G, Passlick B. Sclerosing hemangioma of the lung: a benign tumour with potential for malignancy? Ann Thorac Cardiovasc Surg 2006;12:352-4.
12) Katakura H, Sato M, Tanaka F, Sakai H, Bando T, Hasegawa S, et al. Pulmonary sclerosing hemangioma with metastasis to the mediastinal lymph node. Ann Thorac Surg 2005; 80:2351-3.
13) Iyoda A, Hiroshima K, Shiba M, Haga Y, Moriya Y, Sekine Y, et al. Clinicopathological analysis of pulmonary sclerosing hemangioma. Ann Thorac Surg 2004;78:1928-31.
14) Sakamoto K, Okita M, Kumagiri H, Kawamura S, Takeuchi K, Mikami R. Sclerosing hemangioma isolated to the mediastinum. Ann Thorac Surg 2003;75:1021-3.
15) Özlük Y, Güllüoğlu MG, Toker A, Kalaycı G, Yılmazbayhan D. Akciğerin sklerozan hemanjiyomlarının kinikopatolojik ve immunohistokimyasal özellikleri. Türk Patoloji Dergisi 2005;21:11-16.