Malign Pankreas Lezyonlarında Histopatoloji
Özet
Pankreasın malign lezyonları temel olarak ekzokrin ve endokrin tümörler olmak üzere iki ana başlık altında sınıflandırılmakta olup, tüm olguların %85-90'ını en ölümcül türlerden biri olan pankreatik duktal adenokarsinom (PDAK) oluşturmaktadır. Belirtilerin geç ortaya çıkması nedeniyle genellikle ileri evrede tanı konulan bu agresif malignitelerin 5 yıllık sağkalım oranı yaklaşık %6 seviyesindedir. En önemli predispozan faktör tütün kullanımıyken; obezite, alkol, diyabet, kronik pankreatit ve BRCA2 ile CDKN2A gibi genetik mutasyonlar da riski ciddi oranda artırmaktadır. Tümörlerin %60-70'i pankreas başına yerleşmekte ve histopatolojik olarak belirgin desmoplastik stroma ile müsin üretimi içeren infiltratif karakter sergilemektedir. Pankreatik intraepitelyal neoplazi (PanIN) en kritik öncü lezyon olarak kabul edilirken, asiner hücreli karsinom, pankreatoblastom ve solid psödopapiller neoplaziler daha nadir görülen diğer malignitelerdir. Erken evrelerde küratif şans sunan Whipple operasyonu gibi cerrahi rezeksiyonlar uygulanabilirken, ileri evre ve metastatik olgularda gemsitabin bazlı kemoterapötik protokoller standart tedavi seçeneği olarak öne çıkmaktadır.
Malignant lesions of the pancreas are classified into exocrine and endocrine tumors, with pancreatic ductal adenocarcinoma (PDAC) accounting for 85-90% of all cases as one of the most lethal types. Due to the late onset of symptoms, these aggressive malignancies are generally diagnosed at an advanced stage, resulting in a 5-year survival rate of approximately 6%. Tobacco use is identified as the most significant risk factor, while obesity, alcohol, diabetes, chronic pancreatitis, and genetic mutations such as BRCA2 and CDKN2A also substantially increase the risk. Histopathologically, 60-70% of tumors are localized in the pancreatic head and exhibit an infiltrative pattern characterized by a prominent desmoplastic stroma and mucin production. While pancreatic intraepithelial neoplasia (PanIN) is considered the most critical precursor lesion, acinar cell carcinoma, pancreatoblastoma, and solid pseudopapillary neoplasms represent rarer variants. Surgical rezeksion, such as the Whipple procedure, offers curative potential in early stages, whereas gemcitabine-based chemotherapeutic regimens remain the standard treatment for advanced and metastatic diseases.
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