Plevranın Malign Tümörleri ve Cerrahi Tedavisi
Özet
Plevranın malign tümörleri nadir görülmekte olup, bu grupta yaklaşık yüzde 90 oranla en sık saptanan patoloji malign plevral mezotelyomadır. Asbest ve eriyonit maruziyetiyle doğrudan ilişkili olan mezotelyoma, Türkiye'de özellikle ak toprağın ısı yalıtımı amacıyla konutlarda kullanıldığı bölgelerde sık yaşanmaktadır. Hastalarda en belirgin klinik bulgular masif plevral efüzyona bağlı dispne ve şiddetli göğüs ağrısıdır. Tanılama sürecinde bilgisayarlı tomografi ve PET-BT önemli rol oynarken, kesin teşhiste video yardımlı torakoskopi altın standart invaziv yöntem kabul edilir. Tedavi yaklaşımı multidisipliner olup, evre bir ve üç intervalindeki uygun hastalara cerrahi tedavi önerilmektedir. Maksimal tümör sitoredüksiyonunu hedefleyen cerrahide ekstraplevral pnömonektomi ve genişletilmiş plörektomi dekoltasyon olmak üzere iki temel radikal yöntem uygulanır. Mezotelyoma dışındaki plevral maligniteler ise sinovyal sarkom, anjiosarkom, leiyomyosarkom ve primer plevral lenfoma gibi literatürde genellikle olgu sunumu düzeyinde paylaşılan, oldukça agresif seyirli ve kısıtlı prognoza sahip nadir plevral antitelerden oluşmaktadır.
Malignant tumors of the pleura are considerably rare, with malignant pleural mesothelioma constituting approximately ninety percent of these diagnosed cases. Closely associated with asbestos and erionite exposure, mesothelioma shows higher incidence in specific Turkish regions due to the traditional environmental use of white soil for house insulation. The primary clinical presentations include progressive dyspnea triggered by massive pleural effusion and severe localized chest pain. While computed tomography and PET-CT represent critical radiological modalities, video-assisted thoracoscopy remains the definitive gold standard for obtaining accurate histopathological confirmation. Management requires a multidisciplinary framework, where surgical intervention is strongly recommended for eligible patients within clinical stages one to three. Surgical strategies aiming for maximal cytoreduction involve two main radical procedures: extrapleural pneumonectomy and extended pleurectomy/decortication. Non-mesothelioma pleural malignancies encompass exceedingly rare, highly aggressive pathologies such as synovial sarcoma, angiosarcoma, leiomyosarcoma, and primary pleural lymphoma, which are mostly documented as isolated case reports with low survival outcomes.
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