Akciğer Nöroendokrin Tümörleri
Özet
Nöroendokrin tümörler başta gastrointestinal sistem ve akciğer olmak üzere tüm vücutta görülebilen nadir tümörlerdir. Akciğer nöroendokrin tümörleri akciğer maligniteleri arasında heterojen bir grubu oluşturur. Günümüzde akciğerin nöroendokrin tümörleri iyi diferansiye düşük dereceli tipik karsinoid, orta dereceli atipik karsinoid, kötü diferansiye büyük hücreli nöroendokrin karsinom ve küçük hücreli akciğer karsinomu olmak üzere dört ana kategoriye ayrılır. Malign potansiyelleri tümör çapı, mitoz oranı, ki-67 proliferasyon indeksi ve vasküler invazyona bakılarak belirlenir. Karsinoid tümörlerin prognozu ve tedavisi küçük hücreli ve büyük hücreli nöroendokrin karsinomlardan oldukça farklıdır. Tipik karsinoidler rekürrens sıklığı az, düşük dereceli, yaşam süresi beklentisi uzun iyi prognozlu tümörlerdir.
Büyük hücreli nöroendokrin karsinomlar ve küçük hücreli akciğer karsinomları kötü seyirli olmakla birlikte sigara içenlerde ve erkeklerde daha çok görülmektedir. Hastalığın karmaşıklığı düşünüldüğünde multidisipliner bir tedavi yaklaşımı önerilmekle birlikte tedavinin temelini tümör büyümesini ve nöroendokrin hücrelerin salgı düzenini kontrol etmek oluşturur.
Neuroendocrine tumors are rare tumors that can be seen throughout the body, especially in the gastrointestinal system and lungs. Lung neuroendocrine tumors are a heterogenous group among the lung tumors. Currently lung neuroendocrine tumors consist of four main groups which are well differentiated low grade typical carcinoid, intermediate grade atypical carcinoid, poorly differentiated large cell neuroendocrine carcinoma and small cell lung carcinoma. Their malignant potential is determined by looking at tumor diameter, mitosis rate, ki-67 proliferation index, and vascular invasion. Prognosis and treatment of carcinoid tumors are quite different from small cell and large cell lung neuroendocrine carcinomas. Typical carcinoids have good prognosis with low recurrence, low grade and long life expectancy. Large cell neuroendocrine carcinomas and small cell lung carcinomas have a poor prognosis and are more common in smokers and men. Considering the complexity of the disease, a multidisciplinary treatment approach is recommended, but the basis of treatment is to control tumor growth and the secretory pattern of neuroendocrine cells.
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