KOLIZIJA PRIMARNOG ADENOKARCINOMA PLUĆA SA METASTAZOM ADENOKARCINOMA DEBELOG CREVA: PRIKAZ SLUČAJA

Dzemila  Alic; Marina Markovic; Slobodanka  Mitrovic; Milena Ilic; Ajtana Bajrovic; Jelena  Savic; Dalibor Vukoslav Jovanovic

doi:10.5937/afmnai41-46238

Dzemila Alic General Hospital of Novi Pazar, Serbia, Department of Pneumophthisiology
Marina Markovic University of Kragujevac, Serbia, Faculty of Medical Sciences, Department of Internal Medicine
Slobodanka Mitrovic University of Kragujevac, Serbia, Faculty of Medical Sciences, Department of Pathology
Milena Ilic University of Kragujevac, Serbia, Faculty of Medical Sciences, Department of Pathology
Ajtana Bajrovic University of Kragujevac, Serbia, Faculty of Medical Sciences.
Jelena Savic University of Kragujevac, Serbia, Faculty of Medical Sciences.
Dalibor Vukoslav Jovanovic University of Kragujevac, Serbia, Faculty of Medical Sciences, Department of Pathology https://orcid.org/0000-0001-8224-5914

DOI: https://doi.org/10.5937/afmnai41-46238

Ključne reči: Kolizioni tumori; adenokarcinom pluća; Tireoidni transkriptorni factor 1 (TTF-1); CDX2 transkriptorni faktor

Sažetak

Uvod: Kolizioni tumori predstavljaju istovremenu pojavu dva tumora različitog histološkog porekla na istoj lokalizaciji. Tumori mogu biti kombinacija sarkoma i karcinoma, karcinoma i limfoma i drugo. Kolizioni tumori u plućima su ređi u odnosu na pojavu kolizionih tumora u drugim organima.

Prikaz slučaja: 65-godišnja žena sa ličnom anamnezom o postojanju adenokarcinoma kolona koji je hirurški i hemioterapijski tretiran, javlja se na redovan radiografski pregled pluća. Na kontrolnom snimku otkrivene su dve ovalne promene u desnom plućnom krilu, kasnije verifikovane i kompjuterizovanom tomografijom. Patohistološkom i imunohistohemijskom obradom jedna promena identifikovana je kao primarni adenokarcinom pluća, a druga promena predstavlja metastazu adenokarcinoma kolona. Određivanje ekspresije pojedinih markera je glavni metod prilikom dijagnostikovanja lezija histološki različitog porekla. Adenokarcinom pluća eksprimuje u 90% slučajeva TTF-1, dok 99% metastaza koje vode poreklo od adenokarcinoma kolona pokazuje ekspresiju CDX2 markera.

Zaključak: Postoje brojne teorije kojima se pokušava objasniti nastanak kolizionih tumora. Prvom hipotezom se smatra da je nastanak kolizionih tumora slučajan. Druga hipoteza zagovara promenu okruženja pod uticajem karcinogenih stimulusa, a zatim rast dva tumora istovremno u takvoj izmenjenoj sredini. Poslednja hipoteza smatra da jedan tumor menja mikrookruženje unutar organa, samim tim povećava mogućnost naseljavanja metastaza u blizini. Za pravilan tretman kolizionih tumora neophodna je tačna i precizna dijagnoza, kao i poznavanje karakteristika tumora.

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