Otopsilerde tiroid papiller karsinom prevalansı

Abstract

Papiller karsinom tiroid kanserlerinin en yaygın türüdür ve çoğu insidental olarak saptanmaktadır. Papiller karsinom prevalansı bölgesel farklılık, çevresel ve genetik faktörlere göre değişkenlik göstermektedir. Otopsi çalışmalarında birbirinden farklı oranlarda ( %0,45- 35) papiller mikrokarsinom prevalansı bildirilmiştir. Ülkemizde yapılan otopsi serilerinde papiller mikrokarsinom prevalansı %1,6-3,7 oranında tespit edilmiştir.Çalışmamızda Trakya Üniversitesi Tıp Fakültesi Tıbbi Patoloji Anabilim Dalı?nda 1995-2011 yılları arasında yapılmış adli/medikal otopsilere ait toplam 438 tiroid materyali iki grupta incelendi. Birinci grupta 388 olguya ait tiroid dokusunda makroskobik olarak görülen lezyonların tümü örneklendi, lezyon görülmeyen tiroidlerden en az 5 blok hazırlandı. İkinci grupta ise 50 olguya ait tiroid dokusunun tamamı takibe alındı. Tiroid dokuları histopatolojik olarak incelendi ve her iki grupta tiroid bezi patolojileri araştırıldı.İncelenen 438 olgunun 357?si erkek, 81?i kadındı ve ortalama yaş 44?tü. Olguların %59,4?ü normal histomorfolojik görünüme sahipti, %40,6?sında histopatolojik değişiklik saptandı. Histopatolojik olarak %24,2 oranında basit diffüz veya nodüler hiperplazi, %18,2 neoplazi ve %8,4 olguda tiroidit saptandı. Olguların 57 (%13)?sinde papiller karsinom tespit edildi ve bunlardan 43 (%11)?ü 1. grupta, 14 (%28)?ü ise 2. gruptaydı (p=0,04). Papiller karsinomların 19 (%33)?u multifokaldi ve tümör çapı 0,2- 20 mm idi.Tümör dışı tiroid dokusunda fokal nonspesifik lenfositik tiroidit birinci grupta %30,2, ikinci grupta ise %78,6 oranında saptandı (p=0,001). Papiller karsinomların %42,1 (24/57)?inde tümör dışı tiroid dokusunda fokal nonspesifik lenfositik tiroidit görülmesi istatistiksel olarak anlamlı bulundu (p=0,000). Solid hücre adası toplam 55 (%12,5) olguda görüldü. Elliyedi papiller karsinom vakasının 10 (%17,5)?unda solid hücre adası vardı ve bunların 3?ü birinci grupta, 7?si ikinci gruptaydı (p=0,001).Sonuç olarak; bu çalışmada tiroid dokusunun tamamının örneklenmesiyle olgularda tiroid papiller karsinom oranının yanı sıra diğer histopatolojik tanılar ve solid hücre adası izlenme oranının arttığı gösterilmiştir.

Papillary carcinoma is the most common type of thyroid cancer and is usually diagnosed incidentally. The prevalence of papillary carcinoma shows geographic differences and varies according to the environmental and genetic factors. In autopsy studies which were carried out in several countries different proportions (0.45-35%) of papillary microcarcinoma prevalence are reported. In series of autopsies performed in our country, papillary microcarcinoma prevalence was detected as 1.6-3.7%.In our study, in the Department of Pathology of Trakya University Medical Faculty, a total of 438 thyroid specimens were examined in two groups from forensic/medical autopsies which were carried out between 1995-2011. In the first group of 388 cases, the lesions in the thyroid tissues were sampled totally in which lesions could be detected macroscopically, and thyroid tissues in which there were no macroscopically detectable lesion, at least 5 tissue blocks were obtained and samples were embedded into paraffin. In the second group all of the 50 thyroid tissues were processed. Thyroid tissues were examined histopathologically and thyroid gland pathologies were investigated in both groups. From the studied 438 cases, 357 were male, 81 were female and average age was 44. Fiftynine point four percent of cases had normal histology whereas in 40.6%, histopathological changes were observed (in 24.4% simple and diffuse hyperplasia, in 18.2% neoplasia, in 8.4% thyroiditis). Papillary carcinoma was detected in 57 (13%) cases, and 43 (11%) of them were in the first group, whereas 14 (28%) of them were in the second group (p=0,04). Nineteen (33.3%) papillary carcinomas were multifocal. Tumor size ranged from 0.2 to 20 mm.In the first group, Focal nonspesific lymphocytic thyroiditis in the tumor-free thyroid tissues was 30.2%, whereas in the second group its rate was established as 78.6% (p=0,001). Focal nonspesific lymphocytic thyroiditis which was observed in the tumor-free regions of papillary carcinoma cases was 42.1% (24/57) and it was found statistically significant (p=0,000). Solid cell nests were observed in a total of 55 (12.5%) cases. In 10 (17.5%) of 57 papillary carcinoma patients, there were solid cell nests and three of them were in the first group and 7 of them were in the second group (p=0.001).As a result; in this study, by sampling thyroid tissue totally, it is shown that the incidence of histopathologic diagnosis of papillary carcinoma and solid cell nest cases were increased.