Gestasyonel Trofoblastik Hastalıklar Tanı ve Tedavi
Özet
Gestasyonel trofoblastik hastalıklar (GTH), plasentadan kaynaklanan ve lokal invazyon ile metastaz yeteneği olan komplet ve parsiyel hidatiform mol, invaziv mol, koryokarsinom, plasental site trofoblastik tümör (PSTT) ve epiteloid trofoblastik tümörü (ETT) içeren bir hastalık grubudur. Gebelik trofoblastlarının anormal aşırı proliferasyonu sonucu gelişen bu hastalıkların en önemli tümör belirteci insan koryonik gonadotropinidir (hCG). Hastalıkların en yaygın risk faktörleri arasında uç anne yaşları (≤15 ve >35), geçirilmiş molar gebelik öyküsü, yetersiz hayvansal besin ve karoten tüketimi ile bazı genetik mutasyonlar yer almaktadır. Tanı sürecinde klinik semptomların (en sık vajinal kanama, aşırı uterin büyüme, hiperemezis gravidarum, preeklampsi) takibinin yanı sıra laboratuvar testleri, ultrasonografi, Doppler ve MRG yöntemlerinden yararlanılmakta, kesin tanı ise histopatolojik incelemeyle konulmaktadır. Tedavide doğurganlığını korumak isteyen hastalarda öncelikle vakum küretaj, çocuk istemini tamamlamış hastalarda ise histerektomi tercih edilmektedir. Kötü huylu gestasyonel trofoblastik neoplazi (GTN) vakaları ise FIGO evrelemesi ve Dünya Sağlık Örgütü risk skorlama sistemine göre sınıflandırılarak tek ajanlı (metotreksat veya aktinomisin D) ya da kombine kemoterapi protokolleri (EMA-CO) ile başarıyla tedavi edilebilmektedir.
Gestational trophoblastic diseases (GTD) are a spectrum of disorders originating from the placenta that possess the capacity for local invasion and metastasis, encompassing complete and partial hydatidiform moles, invasive moles, choriocarcinoma, placental site trophoblastic tumor (PSTT), and epithelioid trophoblastic tumor (ETT). Human chorionic gonadotropin (hCG) serves as the most critical tumor marker for these diseases, which develop as a result of the abnormal over-proliferation of pregnancy trophoblasts. The most prominent risk factors for the development of these disorders include extreme maternal ages (≤15 and >35), a history of molar pregnancy, low dietary intake of animal protein and carotene, and certain genetic mutations. In the diagnostic phase, along with monitoring clinical symptoms such as vaginal bleeding, excessive uterine enlargement, hyperemesis gravidarum, and preeclampsia, laboratory tests, ultrasonography, Doppler, and MRI methods are utilized, while the definitive diagnosis is established through histopathological examination. Treatment primarily involves vacuum curettage for patients wishing to preserve fertility, whereas hysterectomy is preferred for those who have completed childbearing. Malignant gestational trophoblastic neoplasia (GTN) cases are classified according to the FIGO staging and World Health Organization risk scoring systems and are successfully managed using single-agent (methotrexate or actinomycin D) or combination chemotherapy protocols (EMA-CO)
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