Plevranın Benign Tümörleri ve Cerrahi Tedavisi
Özet
Plevral benign tümörler, diğer neoplazmlara kıyasla oldukça nadir görülen ve plevranın kollajen, elastik lifler, lenfatikler ile kan damarlarından oluşan bileşenlerinden köken alan yapılardır. Plevranın tüm neoplazmlarının %90'ını malign mezotelyoma oluştururken, soliter fibröz tümörler (SFT) %5'lik bir oranla mezotelyomadan sonra en sık görülen primer plevral tümör ve benign formların çoğunluğu olarak kabul edilir. SFT'ler genellikle asemptomatik seyredip rastlantısal olarak saptansa da, büyüdüklerinde dispne, öksürük ve hipoglisemi gibi paraneoplastik sendromlara yol açabilirler. Tedavilerinde temel dayanak tam cerrahi rezeksiyondur. Plevrada SFT dışında adenomatoid tümörler, kalsifiye fibröz tümörler, plevral lipomlar, sklerozan hemanjiyomlar (pnömositoma) ve plevral schwannomalar gibi diğer nadir benign tümör türleri de izlenir. Bu nadir tümörler genellikle yavaş büyüyen, iyi sınırlı ve başka nedenlerle yapılan radyolojik görüntülemelerde tesadüfen saptanan lezyonlardır. Çoğunlukla cerrahi rezeksiyon ile küratif olarak tedavi edilirler. Ayırıcı tanıda malign plevral metastazlar, mezotelyoma veya liposarkom gibi malign durumlardan ayırt edilmeleri kritik önem taşır, çünkü histopatolojik ve immünohistokimyasal incelemeler kesin tanıyı sağlar.
Pleural benign tumors are extremely rare compared to other neoplasms and originate from pleural components including collagen, elastic fibers, lymphatics, and blood vessels. While malignant mesothelioma accounts for 90% of all pleural neoplasms, solitary fibrous tumors (SFT) represent 5% and are considered the most common primary pleural tumor after mesothelioma, forming the majority of benign cases. SFTs are generally asymptomatic and detected incidentally; however, large tumors can cause dyspnea, cough, and paraneoplastic syndromes such as hypoglycemia. Complete surgical resection is the mainstay of treatment. Apart from SFT, other rare benign pleural tumors include adenomatoid tumors, calcifying fibrous tumors, pleural lipomas, sclerosing hemangiomas (pneumocytoma), and pleural schwannomas. These rare tumors are usually slow-growing, well-circumscribed lesions discovered incidentally during radiological imaging performed for other reasons. They are mostly treated curatively through surgical resection. In differential diagnosis, distinguishing them from malignant conditions like malignant pleural metastases, mesothelioma, or liposarcoma is critical, and definitive diagnosis is achieved through histopathological and immunohistochemical examinations.
Referanslar
McNamee CJ, DaSilva MC, Adams AS, Wolf AS, Sugarbaker DJ. Pleural Tumors. In: Kuzdzal J, Asamura H, Detterbeck F, Goldstraw P, Lerut A, Thomas P, Treasure T, ESTS Textbook of thoracic surgery, Medycyna Praktyczna, Cracow 2014; 233-252.
Cardillo G, Lococo F, Carleo F, et al. Solitary fibrous tumours of the pleura. Current Opinion in Pulmonary Medicine. 2012; 18:339-346.
England DM, Hochholzer L, McCarthy MJ. Localized benign and malignant fibrous tumors of the pleura: A clinicopathologic review of 223 cases. Am J Surg pathol. 1989; 13:640–658.
De Perrot M, Kurt AM, Robert JH, et al. Clinical behavior of solitary fibrous tumors of the pleura. Ann Thorac Surg. 1999; 67:1456–1459.
Bosman FTJE, Lakhani SR, Ohgaki H. WHO Classification of Tumours of the Lung, Pleura, Thymus and Heart. Lyons, France, International Agency for Research on Cancer (IARC), 2015.
Robinson LA. Solitary fibrous tumor of the pleura. Cancer Control 2006; 13: 264-9.
Bini A, Brandolini J, Davoli F, et al. Solitary fibrous tumor of the pleura: surgery and clinical course in 18 cases. Asian Cardiovasc Thorac Ann 2009; 17: 378-81.
Liu CC, Wang HW, Li FY, et al. Solitary fibrous tumors of the pleura: clinicopathological characteristics, immunohistochemical profiles, and surgical outcomes with long-term follow-up. Thorac Cardiovasc Surg 2008; 56: 291-7.
Lu C, Ji Y, Shan F, et al. Solitary fibrous tumor of the pleura: an analysis of 13 cases. World J Surg 2008; 32: 1663-8.
Usami N, Iwano S, Yokoi K. Solitary fibrous tumor of the pleura: evaluation of the origin with 3D CT angiography. J Thorac Oncol 2007; 2: 1124-5.
Cardillo G, Carbone L, Carleo F, et al. Solitary fibrous tumors of the pleura: an analysis of 110 patients treated in a single institution. Ann Thorac Surg 2009; 88: 1632-7.
Weynand B, Collard P, Galant C. Cytopathological features of solitary fibrous tumour of the pleura: A study of 5 cases. Diagnostic Cytopathology. 1998; 18:118-124
Rena O, Filosso PL, Papalia E, et al. Solitary fibrous tumour of the pleura: Surgical treatment. European Journal of CardioThoracic Surgery. 2001; 19:185-189
Magdaleinat P, Alifano M, Petino A, et al. Solitary fibrous tumour of the pleura: Clinical characteristics, surgical treatment and outcome. European Journal of Cardio-Thoracic Surgery. 2002; 21:1087-1093
Nogales FF, Issac MA, Hardisson D, et al. Adenomatoid tumors of the uterus: an analysis of 60 cases. Int J Gynecol Pathol 2002; 21:34–40.
Kaplan MA, Tazelaar H, Hayashi T, et al. Adenomatoid tumors of the pleura. Am J Surg Pathol 1996; 20(10):1219–23.
Plaza JA, Dominguez F, Suster S. Cystic adenomatoid tumor of the mediastinum. Am J Surg Pathol 2004;28(1):132–8.
Minato H, Nojima T, Kurose N, et al. Adenomatoid tumor of the pleura. Pathol Int 2009;59(8):567–71.
Isaka M, Nakagawa K, Maniwa T, et al. Disseminated calcifying tumor of the pleura: review of the literature and a case report with immunohistochemical study of its histogenesis. Gen Thorac Cardiovasc Surg 2011;59(8):579–82
Suh JH, Shin OR, Kim YH. Multiple calcifying fibrous pseudotumor of the pleura. J Thorac Oncol 2008;3(11):1356–8.
Mito K, Kashima K, Daa T, et al. Multiple calcifying fibrous tumors of the pleura. Virchows Arch 2005; 446(1):78–81
Travis WD, Colby TV, Corrin B, et al. In Collaboration with Sobin LH and Pathologists from 14 Countries. World Health Organization International Histological Classification of Tumours. Histological Typing of Lung and Pleural Tumours. 3rd edition. Springer-Verlag; 1999.
Politis J, Funahashi A, Gehlsen JA, DeCock D, Stengel BF, Choi H. Intrathoracic lipomas: Report of three cases and review of literature with emphasis on endobronchial lipoma. J Thorac Cardiovasc Surg. 1979; 77:550–6.
Gaerte SC, Meyer CA, Winer-Muram HT, Tarver RD, Conces DJ., Jr Fat-containing lesions of the chest. Radiographics. 2002; 22:S 61–78.
Salahudeen HM, Hoey ET, Robertson RJ, Darby MJ. CT appearances of pleural tumors. Clin Radiol. 2009; 64:918–30.
Devouassoux-Shisheboran M, Hayashi T, Linnoila RI, et al. A clinicopathologic study of 100 cases of pulmonary sclerosing hemangioma with immunohistochemical studies: TTF-1 is expressed in both round and surface cells, suggesting an origin from primitive respiratory epithelium. Am J Surg Pathol 2000;24(7): 906–16.
Boland JM, Colby TV, Folpe AL. Intrathoracic peripheral nerve sheath tumors-a clinicopathological study of 75 cases. Hum Pathol 2015; 46:419–425.
