Merkez sinir sistemi tümörlerinin intraoperatif tanısında impirint yönteminin önemi

Giriş ve amaç: Smear tekniği, beyin cerrahisinde intraoperatif tanı ve stereotaktik biyopsilerin incelenmesinde önemlidir. Amacımız, merkez sinir sistemi (MSS) lezyonlarında imprint ve “squash” (ezme) preparatları frozen ve parafin kesitlerle karşılaştırmak, sitolojik özelliklerini, intraoperatif tanıya katkılarını, ayrıca imprint preparatlarda DNA içeriği ile AgNOR değerinin yararını araştırmaktır. Gereç ve yöntem: MSS biyopsilerinden frozen yapılan olguların 97’sine imprint, 19’una imprint ve “squash” preparat yapıldı, tümü H+E ve PAP ile, 53’ü gallocyanin chromalum, 28’i de AgNOR ile boyandı. Dizideki olgularımız, 36 glial tümör, 20 meningiom, 6’şar schwannoma ve hipofiz adenomu, 3 kraniofaringiom, 2 hemanjioblastom, 1’er medullablastom, gangliogliom ve lipom, 14 metastatik tümör, 5 non-neoplastik lezyon ve 2 normal beyin içermektedir. Bulgular: DNA içeriği saptanan 53 olgunun kontrol grupları ile karşılaştırılmasında, glial tümörler ile metastatik karsimonlarda kontrol gruplarına göre, istatistiksel olarak, anlamlı bir yükselme izlendi. AgNOR değeri saptanan 28 olgunun, tümör gruplarının kontrollerle karşılaştırılması, istatiksel anlamlı bulunmadı. Sonuç: İmprint yöntemi, özellikle küçük, ödemli, yumuşak dokularda ve dokunun parafin kesitler içinde saklanması gerektiğinde en iyi intraoperatif tanı yöntemidir, sınır lezyonların değerlendirmede yetersizdir. Schwannoma ve kraniofaringiomun imprintleri hiposellüler olduğundan, intraoperatif tanıda, öncelikle frozen kesitle değerlendirme yapılmalıdır. İmpirintlerle birlikte frozen doğru tanı olasılığını arttırır. Ayrıca imprint preparatta DNA içeriği ölçülebilir ve AgNOR değeri saptanabilir

Anahtar Kelimeler:

İmprint preperat, “squash” (ezme) preparat, merkez sinir sistemi tümörleri, intraoperatif tanı, DNA, AgNOR

The significance of touch technique in intraoperative diagnosis of central nervous system tumors

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