Akciğer kanserini taklit eden organize pnömoni: onyedi olgu tecrübemiz
Küçük Resim Yok
Tarih
2013
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Maltepe Üniversitesi
Erişim Hakkı
Attribution-NonCommercial-NoDerivs 3.0 United States
info:eu-repo/semantics/openAccess
info:eu-repo/semantics/openAccess
Özet
Lokalize organize pnömoniler radyolojik olarak bazen akciğer kanseri ile benzerlik göstermektedir. Operasyon öncesi tanı konulamayan ve tedaviye rağmen gerilemeyen bir çok olgu rezeksiyona kadar gidebilmektedir. Bu seri opere ettiğimiz, final patolojileri organize pnömoni olarak raporlanan 17 hastayla ilgili tecrübelerimizi içermektedir. Kliniğimizde Şubat 2006-Aralık 2011 yılları arasında fokal pulmoner lezyonu olan 1266 hastaya akciğer rezeksiyonu yapıldı. Bu çalışmanın temelini oluşturan 84 hastada rezeksiyon sonrası benign patolojik lezyon saptandı. Bu hastaların 17'sinde operasyon sonrası tanı organize pnömoni olarak raporlandı. Hastaların hepsinde operasyon sırasında kitle örneklenerek frozen section ile değerlendirildi. Bu hastalara cerrahi rezeksiyon olarak, videotorakoskopik veya torakotomi ile wedge (n=6 %35) rezeksiyon ve lobektomi (n=11 %65) uygulandı. Rezeksiyon materyellerinden sürüntü alınarak aerobic ve anaerobic bakteriyel, mantar ile mycobacteriyel kültür alındı. Hastaların kliniği, radyolojik bulgular, kitlenin lokalizasyonu ve boyutu, patolojileri, yapılan tedavi ile takipleri incelendi. Hastaların yaşları 40 ile 79 arasındaydı. En sık saptanan klinik belirti öksürük (%94) ve hemoptizi (%59) idi. Radyolojik olarak, parankim yerleşimli, plevrayı invaze etmeyen, yuvarlak ve ya oval şekilde genelde hava bronkogramları da içeren kitlelerin boyutları 2.1 ila 8.7 cm arasında değişmekteydi. Patolojik bulgular ise inflamasyonun eşlik ettiği basit mikroskopik patern ile nekrotizan pnömonik bulgular arasında değişmekteydi. Sadece 11 (%65) vakada etyolojik ajan mikrobiyolojik olarak üretilebildi. En sık etken patojenler, viridans Streptoccocus, Klebsiella ve Neisseria spp saptandı. Hiçbir hastada mortalite, morbidite gelişmedi ve takiplerinde sorun yaşanmadı. Organize pnömonilerin akciğer neoplazmalarından, ayırıcı tanısında zaman zaman zorluklar yaşanmaktadır. Takiplerde, tedaviye rağmen gerilemeyen, kesin tanısı olmayan pulmoner lezyonlarda cerrahi rezeksiyon gerekebilmektedir.
Localized organizing pneumonia may be confounded with lung cancer radiologically. Despite the preoperative treatment; undiagnosed and persisting cases are candidates for surgery, even resection. This series represents our experience with 17 operated patients whose final pathology was reported as organizing pneumonia. Between February 2006 and December 2011, 1266 patients with focal pulmonary lesions had lung resection in our clinic. Eighty-four of the pathology results were reported as benign pathological lesions which established the basis of this study. Postoperative pathology was reported as organizing pneumonia in 17 of these patients. In all the cases, masses were evaluated with frozen section during operation. Wedge resection with videothoracoscopy or thoracotomy (n=6, 35%) and lobectomy (n=11, 65%) was carried out. Swab sample was taken from resection materials for aerobic and anaerobic bacterial, fungal and mycobacterial culture. Patient's clinic, radiological findings, localization and size of the mass, final pathology, treatment and follow-up period were analysed. Patients aged between 40 and 79. Most frequent symptoms were cough (94%) and hemoptysis (59%). Radiologically, the masses were between 2.1-8.7 cm which were localized in the lung parenchyma; without any invasion to the pleura, round or oval shaped and generally presented with air bronchograms. Pathological findings ranged from simple microscopic pattern with inflammation to necrotizing pneumonia. Etiological cause was found in only 11 (65%) cases microbiologically. Most common pathogens were Streptococcus viridians, Klebsiella and Neisseria spp. No mortality or morbidity was detected and none of the patients had a complication during follow up. Differential diagnosis of organizing pneumonia from lung neoplasms may present a challenge occasionally. Surgical resection can be necessary in patients with undiagnosed persisting pulmonary lesions despite the treatment and follow-up.
Localized organizing pneumonia may be confounded with lung cancer radiologically. Despite the preoperative treatment; undiagnosed and persisting cases are candidates for surgery, even resection. This series represents our experience with 17 operated patients whose final pathology was reported as organizing pneumonia. Between February 2006 and December 2011, 1266 patients with focal pulmonary lesions had lung resection in our clinic. Eighty-four of the pathology results were reported as benign pathological lesions which established the basis of this study. Postoperative pathology was reported as organizing pneumonia in 17 of these patients. In all the cases, masses were evaluated with frozen section during operation. Wedge resection with videothoracoscopy or thoracotomy (n=6, 35%) and lobectomy (n=11, 65%) was carried out. Swab sample was taken from resection materials for aerobic and anaerobic bacterial, fungal and mycobacterial culture. Patient's clinic, radiological findings, localization and size of the mass, final pathology, treatment and follow-up period were analysed. Patients aged between 40 and 79. Most frequent symptoms were cough (94%) and hemoptysis (59%). Radiologically, the masses were between 2.1-8.7 cm which were localized in the lung parenchyma; without any invasion to the pleura, round or oval shaped and generally presented with air bronchograms. Pathological findings ranged from simple microscopic pattern with inflammation to necrotizing pneumonia. Etiological cause was found in only 11 (65%) cases microbiologically. Most common pathogens were Streptococcus viridians, Klebsiella and Neisseria spp. No mortality or morbidity was detected and none of the patients had a complication during follow up. Differential diagnosis of organizing pneumonia from lung neoplasms may present a challenge occasionally. Surgical resection can be necessary in patients with undiagnosed persisting pulmonary lesions despite the treatment and follow-up.
Açıklama
Anahtar Kelimeler
organize pnömoni, akciğer kanseri cerrahisi, pulmoner kitle, organising pneumonia, lung cancer surgery, pulmonary mass
Kaynak
Maltepe Tıp Dergisi
WoS Q Değeri
Scopus Q Değeri
Cilt
5
Sayı
1
Künye
Kanbur, S., Alpay, L., Atinkaya, C., Mısırlıoğlu, A., Demir, M., Doğruyol, T., Baysungur, V. ve Yalçınkaya, İ. (2013). Akciğer kanserini taklit eden organize pnömoni: onyedi olgu tecrübemiz / Organising pneumonia mimicking lung cancer : experience of 17 patients. Maltepe Tıp Dergisi. 5(1), s. 26-30.
