Midenin Poliplerinde ve Mezenkimal Tümörlerinde Patoloji
Özet
Midenin polipleri, epitelyal lezyonlar (fundik gland polipleri, hiperplastik polipler, pilorik gland adenomları) ve hamartomatöz yapılar olarak sınıflandırılmakta olup, bu lezyonların histopatolojik özellikleri ile displazi/adenokarsinom riskleri değişkenlik göstermektedir. Gastrik displaziler, adenokarsinom gelişiminde kritik risk faktörleri olup Padova ve Vienna gibi uluslararası sistemlere göre low-grade ve high-grade olarak derecelendirilmektedir. Midenin mezenkimal tümörleri arasında ise nadir görülen leiomyom, leiomyosarkom ve schwannom gibi benign veya malign düz kas ve sinir kılıfı tümörleri yer almaktadır. Epitelyal olmayan primer mide tümörlerinin en büyük kısmını oluşturan gastrointestinal stromal tümörler (GİST) ise Cajal'ın interstisyel hücrelerinden köken almakta ve çoğunlukla iğsi veya epiteloid morfoloji sergilemektedir. GİST tanısında KIT (CD117), CD34 ve DOG1 immünohistokimyasal belirteçleri temel rol oynarken; tümör boyutu, mitotik oran ve anatomik lokalizasyon, hastalığın ilerleme ve metastaz riskini belirleyen en önemli prognostik parametrelerdir.
Gastric polyps are classified as epithelial lesions (fundic gland polyps, hyperplastic polyps, pyloric gland adenomas) and hamartomatous structures, with histopathological features and risk of dysplasia/adenocarcinoma varying across types. Gastric dysplasias represent critical risk factors for adenocarcinoma development and are graded as low-grade or high-grade according to international systems like Padova and Vienna. Mesenchymal tumors of the stomach include rare benign or malignant smooth muscle and nerve sheath tumors, such as leiomyomas, leiomyosarcomas, and schwannomas. Gastrointestinal stromal tumors (GISTs), constituting the majority of non-epithelial primary gastric tumors, originate from the interstitial cells of Cajal and mostly exhibit spindle or epithelioid morphology. While KIT (CD117), CD34, and DOG1 immunohistochemical markers play a fundamental role in GIST diagnosis; tumor size, mitotic rate, and anatomical localization are the most crucial prognostic parameters determining progressive disease and metastasis risk.
Referanslar
Montgomery E.A., Voltaggio L. Gastrointestinal traktüs mukoza biyopsilerinin yorumu cilt2 (Çetin S.E, Çev. Ed.) 2.baskı İstanbul: Nobel tıp kitabevi; 2018. P.67-118
Martin FC, Chenevix-Trench G, Yeomans ND. Systematic review with meta-analysis: fundic gland polyps and proton pump inhibitors. Aliment Pharmacol Ther. 2016 Nov;44(9):915-925. doi: 10.1111/apt.13800. Epub 2016 Sep 15. PMID: 27634363.
Genta RM, Schuler CM, Robiou CI, et al. No association between gastric fundic gland polyps and gastrointestinal neoplazi in a study of over 100,000 patients. Clin Gatroenterol Hepatol. 2009;7:849-854
WHO Classification of Tumours Editorial Board. WHO Classification of Tumours. Digestive System Tumours. 5th edition. Lyon, France: International Agency for Research on Cancer (IARC); 2019: 64-109.
Vieth M, Kushima R, Borchard F, Stolte M. Pyloric gland adenoma: a clinico-pathological analysis of 90 cases. Virchows Arch. 2003;442(4):317-321
Chen Z-M, Scudiere JR, Abraham SC, Montgomery E. Pyloric gland adenoma: an entity distinct from gastric foveolar type adenoma. Am J Surg Pathol. 2009;33(2):186-193.
Zea-Iriarte WL, Sekine I, Itsuno M, et al. Carcinoma in gastric hyperplastic polyps. A phenotypic study. Dig Dis Sci. 1996 Feb;41(2):377-86.
Albuquerque A, Rios E, Carneiro F, Macedo G. Evaluation of clinico-pathological features and Helicobacter pylori infection in gastric inflammatory fibroid polyps. Virchows Arch. 2014;465(6):643-647
Hasegawa T, Yang P, Kagawa N, et al. CD34 expression by inflammatory fibroid polyps of the stomach. Mod Pathol. 1997;10(5): 451-456
Burke AP, Sobin LH.The pathology of Cronkhite- Canada polyps. A comparison to juvenile polyposis. Am J Surg Pathol. 1989;13:940-946
Rugge M, Correa P, Dixon MF, et al. Gastric dysplasia: the Padova International classification. Am J Surg Pathol. 2000 Feb;24(2):167-76
Schiemper RJ, Riddel RH, Kato Y, et al. The Vienna classification of gastrointestinal epithelial neoplazi. Gut. 2000 Aug; 47(2):251-5.
Abraham SC, Montgomery EEA, Singh VK, et al. Gastric adenomas: intestinal-type and gastric –type adenomas differ in the risk of adenocarcinoma and presence of background mucosal pathology. Am J Surg Pathol. 2002 Oct;26(10)1276-85
Wood LD, Salaria SN, Cruise MW, et al. Upper GI tract lesions in familial adenomatous polyposis (FAP): enrichment of pyloric gland adenomas and other gastric and duodenal neoplasms. Am J Surg Pathol. 2014 Mar;38(3).389-93.
Weisenberg E. Leiomyoma. PathologyOutlines.com(04/09/2021 tarihinde)https://www.pathologyoutlines.com/topic/stomachleiomyoma.html. Accessed September 4th, 2021.
Sato, T., Akahoshi, K., Tomoeda, N. et al. Leiomyosarcoma of the stomach treated by endoscopic submucosal dissection. Clin J Gastroenterol 11, 291–296 (2018).
Singh A, Mittal A, Garg B et al. Schwannoma of the stomach: a case report. J Med Case Rep. 2016; 10: 4. Published online 2016 Jan 15. doi: 10.1186/s13256-015-0788-0 PMCID: PMC4714491
Patil DT, Rubin BP. Gastrointestinal stromal tumor: advances in diagnosis and management. Arch Pathol Lab Med. 2011;135(10):1298-1310.
Rossi S, Miceli R, Messerini L, et al. Natural history of imatinib-naive GISTs. A retrospective analysis of 929 cases with long-term follow-up and development of a survival nomogram based on mitotic index and size as continuous variables. Am j Surg Pathol. 2011 Nov;35(11):1646-56
Rosai J, Ackerman LV. Stomach. Rosai and Ackerman's Surgical Pathology. 11th Edition. Philadelphia: Elsevier; 2018. 527-567
Miettinen M, Sobin LH, Lasota J. Gastrointestinal stromal tumors of the stomach : a clinicopathologic, immunohistochemical, and moleculer genetic study of 1765 cases with long-term follow-up. Am J Surg Pathol. 2005 Jan;29(1)52-68.z
Miettinen M, Lasota J. Gastrointestinal stromal tmuors: pathology and prognosis at different sites. Semin Diagn Pathol. 2006 May;23(2):70-83.
