Midenin Malign Epitelyal Tümörlerinde ve Mide Lenfomasında Patoloji
Özet
Mide kanserleri, dünya çapında kansere bağlı ölümlerin ikinci en sık nedeni olup tedavi stratejilerinin belirlenmesi ve prognoz tahmini açısından doğru tiplendirilmeye ihtiyaç duyar. Gastrik mukoza kaynaklı malign epitelyal tümörler olan mide adenokarsinomları; Lauren ve Dünya Sağlık Örgütü (WHO) 2019 standartlarına göre intestinal, diffüz, tübüler, papiller, müsinöz ve zayıf koheziv gibi alt tiplere ayrılarak makroskopik ve mikroskopik özellikleri bazında karşılaştırılmaktadır. Ayrıca, nadir görülen lenfoepitelyoma benzeri, hepatoid ve mikropapiller karsinom varyantları da mevcuttur. Midenin nöroendokrin neoplazmları (NET ve NEC), mitotik aktivite ile Ki67 proliferasyon indekslerine göre derecelendirilmekte ve hem nöroendokrin hem de non-nöroendokrin bileşenler barındıran MiNEN yapıları olarak incelenmektedir. Son bölümde ise, H. pylori enfeksiyonuyla yakından ilişkili olan MALT lenfoma ile sindirim sisteminde sık görülen diffüz büyük B hücreli lenfoma (DLBCL) yapıları, morfolojik ve immünohistokimyasal belirteçleri doğrultusunda ele alınmaktadır. Sonuç olarak, tümörlerin kesin histopatolojik ayrımı, hastalara doğru klinik yaklaşımın uygulanması açısından elzemdir.
Gastric cancers are the second leading cause of cancer-related deaths worldwide and require accurate typing to determine treatment strategies and predict patient prognosis. Gastric adenocarcinomas, which are malignant epithelial tumors originating from the gastric mucosa, are compared based on their macroscopic and microscopic features, categorized into subtypes such as intestinal, diffuse, tubular, papillary, mucinous, and poorly cohesive according to Lauren and WHO 2019 standards. Additionally, rare variants like lymphoepithelioma-like, hepatoid, and micropapillary adenocarcinomas are present. Neuroendocrine neoplasms of the stomach (NETs and NECs) are graded based on mitotic activity and Ki67 proliferation indices, and MiNEN structures containing both neuroendocrine and non-neuroendocrine components are analyzed. The final section examines MALT lymphoma, which is closely associated with H. pylori infection, and diffuse large B-cell lymphoma (DLBCL), commonly found in the digestive tract, regarding their morphological and immunohistochemical markers. In conclusion, precise histopathological differentiation of these tumors remains essential for implementing correct clinical management.
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