Kompozit kolonik adenom-mikrokarsinoid tümör, gerçekten tesadüf mü? Olgu sunumu

Mikst adenonöroendokrin kanserler nadir rastlanan tümörlerdir. Kolonik tübüler adenomlar ile mikrokarsinoid tümörlerin birlikteliği ise literatürde son derece ender bildirilmiştir. Bilindiği üzere, bu tümörlerdeki nöroendokrin bileşen glandüler patern, iğsi hücreli patern, skuamöz-osteoid metaplazi veya pleomorfizm gibi belirgin hitopatolojik değişkenlik gösteren geniş bir yelpaze sergiler. Nadiren çok az farklılaşmış olabilir ve undiferansiye karsinom ya da lenfomaya benzeyebilirler. Bununla beraber, karsinoid veya Zollinger-Ellison gibi birtakım sendromlarla ilişkili karsinoid tümörlerin immünohistokimyasal analizinde, bir amin veya peptit baskın olabileceği gibi çoğunun mültihormonal olduğu gösterilmiştir ve primer tümördeki aminler ve peptidler, üstte bulunan endokrin hücrelerde normal olarak bulunanlarla çoğu zaman eşleşmez. Ayrıca son zamanlarda, neoplastik endokrin ve endokrin dışı epitel hücrelerinin karışımlarını içeren artan sayıda tümör tarif edilmiştir. Dahası, endokrin ve epitel hücresi özelliklerinin aynı hücre içinde gözlendiği farklı tümör türleri de mevcuttur. Bütün bu literatür bilgileri ile benzer olarak, olgumuzda izlenen morfolojik ve immünhistokimyasal bulgular iki neoplastik bileşenin ortak bir öncü hücreden kaynaklandığını göstermektedir.

Anahtar Kelimeler:

Kompozit adenom, mikrokarsinoid, tübüler

Compozite colonic adenoma-microcarcinoid tumor, is really a coincidence? Case report

Mixed adenoneuroendocrine cancers are rare tumors. The association of colonic tubulary adenomas with microcarcinoid tumors has been reported very rarely in the literature. As known, the neuroendocrine component in these tumors display a broad spectrum with marked variability in histopathology properties; such as glandular pattern, spindle cell pattern, squamous-osteoid metaplasia or pleomorphism. Rarely, they may be very poorly differentiated and may resemble undifferentiated carcinoma or lymphoma. In addition, immunohistochemical analysis of carcinoid tumors associated with some syndromes such as Zollinger-Ellison and carcinoid has shown that, most are multihormonal as well as one amine or peptide may predominate and the amines and peptides in the primary tumor do not often match to those normally found in the overlying endocrine cells. However, an increasing number of tumors have recently been described including mixtures of neoplastic endocrine and non-endocrine epithelial cells. Furthermore, there are different types of tumors in which endocrine and epithelial cell characteristics are observed in the same cell. Similar to all this literature information, morphological and immunohistochemical findings in our case show that, the two neoplastic components originate from a common precursor cell.

Keywords:

Compozite adenoma, microcarcinoid, tubulary,

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