Mesanenin Prekanseröz Lezyonlarına Yaklaşım
Özet
Mesane kanseri, dünya genelinde sık görülen bir malignite olup vakaların büyük çoğunluğunu ürotelyal karsinomlar oluşturmaktadır. Mesanenin prekanseröz lezyonlarının (MPL) doğru teşhis edilmesi, hastaları gereksiz girişimsel prosedürlerden korumak açısından kritik öneme sahiptir. MPL'ler düz ve papiller olmak üzere iki ana grupta incelenmektedir. Düz lezyonlar arasında yer alan karsinoma in situ (KİS), kötü prognozu ve yüksek progresyon riski ile bilinmekte, tedavisinde intravezikal BCG uygulaması gerekmektedir. Ürotelyal displazi ise KİS kadar hücresel atipi barındırmayan ancak normal yapısı bozulan ve KİS'e dönüşebilen bir diğer düz lezyondur. Papiller nitelikteki proliferatif lezyonlar (MPNBL) başlığı altında düz, papiller ve atipik papiller ürotelyal hiperplaziler yer almaktadır. Bunlardan papiller ürotelyal hiperplazi sıklıkla ileri yaş erkeklerde hematüri ile ortaya çıkmakta ve atipi barındırmamasıyla papiller karsinomdan ayrılmaktadır. Ayrıca, mesanede nadir görülen benign ürotelyal papillom, kronik irritasyon kaynaklı intestinal metaplazi (sistitis glandularis) ve skuamöz metaplazi gibi lezyonlar da mevcuttur. Non-keratinize skuamöz metaplazinin malignite riski yokken, keratinize türü skuamöz karsinom riskini artırır. Son olarak, radyoterapi sonrası oluşan değişiklikler, Von Brun adaları ve endometriozis gibi lezyonlar da histolojik veya endoskopik olarak karsinomlarla karışabilen diğer önemli prekanseröz veya psödöneoplastik durumlar arasında yer almaktadır.
Bladder cancer is a frequently encountered malignancy worldwide, with the vast majority of cases being urothelial carcinomas. Correctly diagnosing premalignant lesions of the bladder (PLB) is of critical importance in order to protect patients from unnecessary interventional procedures. PLBs are examined in two main groups as flat and papillary; flat lesions include carcinoma in situ (CIS), which is known for its poor prognosis and high risk of progression, requiring intravesical BCG treatment, and urothelial dysplasia, another flat lesion that does not harbor as much cellular atypia as CIS but exhibits a distinctly disrupted cellular structure that can progress to CIS. Proliferative lesions with malignant potential not clearly determined (MPNBL) include flat, papillary, and atypical papillary urothelial hyperplasias. Among these, papillary urothelial hyperplasia frequently presents with hematuria in elderly male patients and is distinguished from papillary carcinoma by the absence of cellular atypia. Additionally, rare benign urothelial papilloma, intestinal metaplasia (cystitis glandularis) caused by chronic irritation, and squamous metaplasia are also present; while non-keratinizing squamous metaplazi carries no risk of malignancy, the keratinizing type increases the risk of squamous carcinoma. Finally, radiation-induced changes, Von Brunn's nests, and endometriosis represent other crucial conditions that can histologically or endoscopically mimic carcinomas.
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