Kemik Tumorleri Patolojisi

.: PREFACE
ÖN SÖZ
PREFACE
Prof. Dr. Sergülen DERVİŞOĞLU
İstanbul Medipol Üniversitesi Uluslararası Tıp Fakültesi, Tıbbi Patoloji ABD, İstanbul
Article Language: TR
Kemik tümörleri nadir tümörlerdir ve bu konuda deneyim azlığı ve bilgi birikiminin uzun yıllar içinde oluşması, değerlendirmede sorun yaratabilmektedir. Bu kitabın konusu olan kemik tümörleri, tanı koymak açısından bütün patologların korkulu rüyasıdır. Bunun nedeni iskeletin karmaşık yapısının doğal olarak çeşitli hastalıklarına ve tümörlerine de yansımasıdır. Kemik patolojisi konusunda deneyimli uzmanların bile zaman zaman fikir birliğine varamadığı bu tümörlerle uğraşmak, bu özellikleri nedeniyle de ayrıca heyecan verici ve bir o kadar da ürkütücüdür. Kemik tümörlerinin öncelikle genç yaş grubu hastaları tutması ve tanı yanılgılarının uzuv kaybı ile sonuçlanabilmesi patolog için tanı aşamasında zorlayıcı faktörlerdendir. Günümüzde giderek artan yeni teknikler, immünohistokimyasal belirteçler ve moleküler bulgularla patolojinin diğer dalları gibi dinamik bir süreç izleyen bu devinim bilgilerimizin sürekli yenilenmesini ve vakalarla pekişmesini gerekli kılmıştır. Son yıllardaki klinikopatolojik ilişkinin artışı ve etkileşim de dil birliğini artırmış, karşılıklı beklentileri netleştirmiş ve kemik tümörlerinin değerlendirilmesinde multidisipliner yaklaşımlar hedeflenmiştir.

Kemik tümörleri konusunda bizlere ışık tutarak meşale olmuş, bu konuda hepimizin yetişmesinde emeği olan ve bizlere kemiği sevdiren duayen hocamız Prof. Dr. Fikri Öztop'un bu kitaba temel olan ''Kemik ve Eklem Hastalıkları Patolojisi'' kitabımızın girişindeki bizi bu konuda yüreklendiren sözleri ile devam etmek istiyorum:

''İskelet sistemi tümörlerinin, bütün insan tümörleri içerisinde yaklaşık olarak %1 gibi küçük bir paya sahip olmaları nedeniyle kemik lezyonları ile uğraşan bir merkezde çalışmayan hekimlerin bu olgularla karşılaşma olasılığı azdır. Kemik tümörlerinin klinik belirtileri nonspesifiktir, ancak burada da klinisyenlerin imdadına yetişen çok güçlü bir yardımcı vardır; görüntüleme yöntemleri. İskelet sistemi, günümüzdeki bilgisayarlı tomografi, manyetik rezonans ve PET sintigrafi gibi incelikli yöntemlere gerek kalmadan basitçe bir direkt grafi ile bile son derece yararlı bilgiler alınabilen nadir vücut yapılarından birisidir. Tek bir düz röntgen filmi, iyi bir yorumcunun elinde klinisyeni büyük oranda doğru ön tanıya götürür. Kemik tümörlerinin tanısal bakımdan bir iyi yanı da yaş, cinsiyet ve yerleşim yeri gibi özelliklerin yol gösterici olmasıdır. Kırk yıl önce osteosarkom tanısı alan hastaların ancak %20'si, Ewing sarkom tanısı konan hastaların ise %0-5'i beş yıllık sağkalım oranlarına erişebilirken, bugün bu oranlar %60-70'lere ulaşmıştır. Bu başarının altında patoloji teknikleri, sofistike görüntüleme yöntemleri, kemoterapi ve radyoterapi teknikleri ve ekstremite kurtarma operasyonları kadar altı yedi uzmanlık dalının birlikte çalıştığı ''Kemik Tümörleri Konseyleri'' yatmaktadır. Son 30 yılda ülkemizde de multidisipliner kemik konseylerinin sayıları hızla artmıştır. Bu konseylerde görev alan patoloji uzmanları, Türkiye Patoloji Dernekleri Federasyonu şemsiyesi altında ''Kemik ve Yumuşak Doku Patolojisi Çalışma Grubu'nu oluşturarak ülkemizdeki kemik lezyonları ve kemik tümörlerini, birlikte tartışmaya ve değerlendirmeye başlamıştır. Bu ortak çalışmanın zengin birikimi ürünlerini vermektedir. Bu çalışma grubu ve konseylerin ortak çalışmaları, onları dünyanın hatırı sayılır merkezleri arasına sokmuş ve yaptıkları çalışmalar önemli uluslararası dergilerde yayınlanmaya başlamıştır. Elinizde tuttuğunuz bu kitap da, bu grubun ortak ürünlerinden birisidir. Büyük bir emek ve titizlikle hazırlanan bu eserin, kemik hastalıkları ve kemik tümörlerini patoloji uzmanlarının korkulu rüyası olmaktan uzaklaştıracağına inanıyorum ve kendilerini kutluyorum.''

Yılların birikim ve deneyimini süzgeçten geçirerek, kendi vakalarımız üzerinden aktardığımız literatür bilgileriyle harmanlayarak ürettiğimiz Türkiye Klinikleri'nin ''Kemik Tümörleri Patolojisi'' isimli kitabını; bize inanan, yetiştiren, destekleyen, yönlendiren, bizlere ufuk açan ve yol gösteren, yetişmemizde katkısı büyük değerli hocalarımıza ithaf ediyor, Türk tıp ve patoloji eğitimine katkı sağlamasını diliyorum.

Prof. Dr. Sergülen DERVİŞOĞLU
Editör
Bone tumors are rare; therefore, problems are encountered in the evaluation of such rare tumors due to lack of experience, that needs years of hard work to acquire. Bone tumors - the subject of this special edition - are the diagnostic nightmares for the pathologists. The reason is the complex structure of the skeleton and eventually its reflection on various bone diseases and tumors. Dealing with such tumors, on which even the experts sometimes cannot agree, is exciting as well as scary due to these properties. The fact that these tumors primarily affect young age groups and limb loss due to a misdiagnosis cause difficulties for the pathologists to diagnose these tumors. As seen in other fields of pathology, a dynamic process of advances, which lead to the development of new techniques, immunohistochemical markers, and molecular findings necessitates continuous refreshing of our current knowledge and consolidating these with various case studies. In recent years, an increase in the clinicopathologic interaction has enhanced the use of common terminology and clarified reciprocal expectations, thus multidisciplinary approaches were targeted in the evaluation of bone tumors.

I would like to continue with the encouraging statements of Prof. Dr. Fikri Öztop, a doyen in this field and a great teacher, who shed a light for us on the subject of bone tumors and made us fall in love with bones, in the introduction section of ''Kemik ve Eklem Hastalıkları Patolojisi'', the book which formed the basis of this special edition:

''The tumors of the skeletal system consist of approximately 1% of all human tumors. Therefore, physicians not working in centers dealing with these lesions have very little chance of encountering these cases. Symptoms of bone tumors are quite nonspecific; however, a very powerful help is offered to the struggling clinicians; namely imaging methods. The skeletal system is one of the rare body structures where extremely useful information can be obtained simply by direct radiography without the need for highly specific methods like CT scan, magnetic resonance imaging, and PET scintigraphy. One simple radiography can mostly lead the clinician to the correct pre-diagnosis in the hands of a good interpreter. Another clue for the diagnosis of bone tumors is clinical features such as age, gender, and location. While only 20% of the osteosarcoma patients and 0-5% of Ewing sarcoma patients had 5-year survival rates 40 years ago, today these rates have reached up to 70%. This success has been achieved by developments in pathologic techniques, sophisticated imaging techniques, advances in chemotherapy and radiotherapy, and extremity saving operations as well as the efforts of bone tumor councils operated by six-seven different specialty branches. In Turkey, the number of multidisciplinary bone tumor councils has increased rapidly in the last 30 years. The pathologists who participate in these councils established the ''Bone and Soft Tissue Pathology Working Group'' under ''the Confederation of Turkish Pathology Society'' and started to discuss and evaluate bone lesions and tumors in Turkey. The collaborative work of this working group and councils constituted one of the most respectable centers in the world and their studies started to be published in prominent international journals. This bulletin you are holding now is one of the collaborative products of this group. I believe that this work, which had been prepared with meticulous effort, will end the bone diseases and bone tumors from being nightmares of pathologists. Congratulations to those who have contributed.''

I dedicate this book of Türkiye Klinikleri named ''Pathology of Bone Tumors'', which has been compiled by distilling years-long experience and by blending in literature knowledge adapted from unique cases to our highly esteemed professors, who believed in us, supported and guided us, and opened up new horizons for us. I hope this book provides beneficial contributions to medical and pathology education.

Prof. Dr. Sergülen DERVİŞOĞLU
Editor

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