Uloga ekspresije c-MYC u dijagnozi i kliničkoj potvrdi angiosarkoma izazvanog zračenjem

  • Luka Jovanović Univerzitet u Beogradu, Medicinski fakultet
  • Predrag Filipović Klinika za radijacionu onkologiju i dijagnostiku, Institut za onkologiju i radiologiju Srbije
  • Jelena Dedović Stojaković Klinika za radijacionu onkologiju i dijagnostiku, Institut za onkologiju i radiologiju Srbije
  • Zorka Milovanović Institute for Oncology and Radiology of Serbia, Department of Pathology, Belgrade, Serbia
  • Milica Labudović Borović University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Jasminka Tanasijević General Hospital Studenica, Kraljevo, Serbia
  • Predrag Patrašinović Institute for Oncology and Radiology of Serbia, Department of Radiation Oncology, University of Belgrade, Faculty of Medicine, Belgrade, Serbia;
  • Tamara Marinković Institute for Oncology and Radiology of Serbia, Department of Radiation Oncology, University of Belgrade, Faculty of Medicine, Belgrade, Serbia;
  • Vesna Plešinac Karapandžić Institute for Oncology and Radiology of Serbia, Department of Radiation Oncology, University of Belgrade, Faculty of Medicine, Belgrade, Serbia;
DOI: https://doi.org/10.2298/VSP201207028J
Ključne reči: adenokarcinom;, genetika;, imunohistohemija;, neoplazme, radijacijom uzrokovane;, radioterapija, adjuvantna;, rizik, procena;, sarkomi;, preživljavanje.

Sažetak


Uvod. Angiosarkomi (AS) koji nastaju iz vaskularnog tkiva, čine 3,3% svih sarkoma i imaju lošu prognozu. Zračenjem indukovani AS su retka kasna komplikacija lečenja radioterapijom (RT), a karakterišu se posebnim profilom genske ekspresije, poput amplifikacije c-MYC onkogena, pomoću kojeg možemo razlikovati primarni od sekundarno indukovanog tumora. Prikaz bolesnika. Bolesnici staroj 77 godina, sa adenokarcinomom endometrijuma u ranom stadijumu, inicijalno je urađena radikalna histerektomija sa bilateralnom adneksektomijom. Prema patohistološkim faktorima rizika, indikovana je postoperativna konformalna RT (CRT) karlice, uz brahiterapiju. Šest godina nakon tretmana na prednjem trbušnom zidu, u regiji postoperativnog ožiljka i zračnog polja, histološki je potvrđen infiltrativni AS kože i potkožnog masnog tkiva. Bolesnica je primila šest ciklusa hemioterapije mono-adriamicinom, sa verifikovanom delimičnom regresijom. Dodatna imunohistohemijska analiza (IHH) ekspresije c-MYC, Ki67 i CD34 pokazala je visok proliferativni indeks (Ki67 oko 60%) i pozitivnost c-MYC što je ukazivalo na molekulski obrazac AS izazvanog zračenjem. Visoki proliferativni indeks mogao je objasniti dobar odgovor na hemioterapiju. Zaključak. Nove tehnike RT omogućavaju bolje preživljavanje i lokalnu kontrolu bolesnica sa karcinomom endometrijuma visokog rizika. Međutim, produženo preživljavanje tih bolesnica stavlja ih u povišen rizik od razvoja tumora izazvanih radijacijom kao i drugih kasnih efekata RT. Ukoliko su ispunjeni Cahan-ovi kriterijumi, dodatne IHH analize ekspresije c-MYC mogu pomoći u razlikovanju sekundarnih od ostalih AS, kada se procenjuje mogućnost pojave radijaciom indukovanog AS.

Biografija autora

Luka Jovanović, Univerzitet u Beogradu, Medicinski fakultet

Research assistant at Institute for oncology and radiology of Serbia and The Medical Faculty University of Belgrade, Institute for Microbiology and Immunology;

Clinitian at Research assistant at Institute for oncology and radiology of Serbia

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Objavljeno
2022/09/22
Broj časopisa
Vol. 79 Br. 08 (2022): Vojnosanitetski pregled
Rubrika
Prikaz bolesnika