Nonsirotik portal hipertansiyonlu hastalarda hepatoportal ven  trombozu ile malignitelerin birlikteliği
Coincidence of hepatoportal vein thrombosis and malignity in patients with noncirrhotic portal  hypertension
Yazar: İnce, Ali Tüzün; Bölükbaş, Cengiz; Kendir, Tülin; Soylu, Aliye; Dolapçıoğlu, Can; Güveli, Hakan; Dalay, Remzi; Övünç, Oya
Dergi: Akademik Gastroenteroloji Dergisi, Vol. 2 No. 3, 2015
Anahtar kelimeler: Hepatoportal vein thrombosis, malignancies, noncirrhotic  portal hypertension ; Hepatoportal ven trombozu, maligniteler, nonsirotik  portal hipertansiyon

Giriş ve amaç: Maligniteler metastaz, tromboz, viskozite değişiklikleri  ve vaskülit gibi nedenlerle hepatoportal venöz (portal ven ile sağ, sol ve  orta hepatik venler) sistemi etkileyerek nonsirotik portal hipertansiyon  sebebi olabilirler. Bu çalışmanın amacı nonsirotik portal hipertansiyonlu  hastalarda hepatoportal ven trombozlarıyla malignitelerin birlikteliğini  değerlendirmektir. Gereç ve yöntem: Kliniğimize 1995-2000 yılları arası  nda başvuran nonsirotik portal hipertansiyon vakaları arasından malignite  ve hepatoportal ven trombozlu hastalar retrospektif yolla değerlendirilmiştir.  Bulgular: Nonsirotik portal hipertansiyonlu 28 hastanın  36%'sı E [n:10, mean: 46.8, median:37, range:14-76], %64'ü K [n:18,  mean:36.8, median:33, range:20-71]. Hastaların 57%'sinde [n:16, 8 E  (mean:37, medium: 48, range:23-65), 8 K (mean:31, medium:35, range:  23-65)] hepatoportal ven trombozu vardı. Trombozların 1/3'ü hepatik,  2/3'ü portal venlerde lokalizeydi. Trombozların etiolojisinde: 9 hastada  (56,25%) malignite [2 hepatoma, 1 kronik myeloid lösemi, 1 kolanjiokarsinoma,  1 Wilms tümörü, 1 prostat kanseri, 1 pankreas kanseri, 1  nöroendokrin tümör, 1 jinekolojik malignite], 3 hastada (18,75%) düşük  protein S, C ve antitrombin-III seviyeleri, 1 hastada (6,25%) Polistemia  Vera'ya bağlı hiperviskosite sendromu ve 1 hastada (6,25%) pankreatitis  varken 2 hastada (12,5%) etioloji saptanamadı. Sonuç: Hepatoportal  ven trombozu olan nonsirotik portal hipertansiyonlu hastalarda malignite  etioloji olasılığı yüksektir ve bu nedenle mutlaka aranılmalıdır.

Background and aim: Malignancies can cause noncirrhotic portal  hypertension by affecting the hepatoportal vascular (right, left and middle  hepatic veins and portal vein) system with metastasis, thrombosis,  viscosity changes and vasculitis. The aim of this study was to assess the  coincidence of hepatoportal vein thrombosis and malignancies in  patients with noncirrhotic portal hypertension. Material and methods:  Patients admitted to our clinic between 1995-2000 with noncirrhotic portal  hypertension who had malignancy and hepatoportal vein thrombosis  were assessed retrospectively. Results: Sixty-four percent (n:28) of  patients with noncirrhotic portal hypertension were K [n:18, mean:36.8,  median:33, range:20-71], 36% were E [n:10, mean:46.8, median:37,  range:14-76]. Fifty-seven percent of noncirrhotic portal hypertension  patients had hepatoportal vein thrombosis [n:16, 8 E (mean:37, medium:  48, range:23-65), 8 K (mean:31, medium:35, range:23-65)]. Onethird  of thromboses were located in hepatic vein, two-thirds were located  in portal vein. Among the etiologies of thromboses were: 9 patients  (56.25%) with malignancies [2 hepatomas, 1 chronic myeloid leukemia,  1 Wilms tumor, 1 cholangiocarcinoma, 1 prostate cancer, 1 pancreatic  cancer, 1 neuroendocrine tumor, 1 gynecologic malignancy]; 3 patients  (18.75%) with low levels of protein S, C and antithrombin-III, 1 patient  (6.25%) with hyperviscosity syndrome of polycythemia vera, 1 patient  (6.25%) with pancreatitis and 2 patients (12.5%) with no etiology.  Conclusion: Malignancy probability is quite high in patients with  hepatoportal vein thrombosis and noncirrhotic portal hypertension and  thus should be investigated.