Gestasyonel Trofoblastik Hastalık
Özet
Gestasyonel trofoblastik hastalık (GTH), trofoblastik dokunun anormal çoğalmasıyla ortaya çıkan premalign bir durum olup, invazyon ve metastaz durumunda ise malign nitelikteki Gestasyonel Trofoblastik Neoplaziye (GTN) dönüşmektedir. Jinekolojik onkolojide kür oranları en yüksek hastalık grubunu oluşturan GTH'nın %80'ini komplet ve parsiyel olmak üzere ikiye ayrılan hidatiform mol oluşturur. Komplet mol, boş ovumun haploid sperm ile fertilizasyonu sonucu paternal kökenli oluşurken, parsiyel mol triploid yapıda meydana gelir. Hastalığın tanısı ultrason muayenesi ve belirgin şekilde yüksek olan kantitatif hCG düzeyleri ile konur. Tedavide hem tanı hem tahliye amacıyla dilatasyon ve evekuasyon (D&E) önerilirken, doğurganlığını tamamlamış hastalarda histerektomi alternatif bir seçenektir. Tahliye sonrasında GTN gelişimini erken teşhis etmek amacıyla hastalar seri beta hCG ölçümleri ve kontrasepsiyon eşliğinde yakından takip edilir. Kriterlere göre GTN tanısı alan hastalar, Dünya Sağlık Örgütü (WHO) prognostik risk skorlamasına göre düşük (0-6) veya yüksek (>6) riskli olarak sınıflandırılır. Düşük riskli GTN vakalarında metotreksat veya aktinomisin D gibi tek ajanlı kemoterapiler ile %100 tam kür sağlanabilirken; yüksek riskli metastatik vakalarda EMA-CO gibi çok ajanlı kemoterapiler, gerekli hallerde cerrahi, radyoterapi veya güncel immünoterapiler (pembrolizumab) tercih edilmektedir.
Gestational trophoblastic disease (GTD) is a premalignant condition arising from the abnormal proliferation of trophoblastic tissue, which transforms into malignant Gestational Trophoblastic Neoplasia (GTN) in cases of invasion and metastasis. Forming the disease group with the highest cure rates in gynecologic oncology, 80% of GTD is constituted by hydatidiform mole, which is divided into complete and partial moles. While complete mole is of paternal origin, resulting from the fertilization of an empty ovum by a haploid sperm, partial mole occurs in a triploid structure. Diagnosis of the disease is established through ultrasonography and markedly elevated quantitative hCG levels. For both diagnosis and evacuation, dilatation and evacuation (D&E) is recommended in treatment, whereas hysterectomy is an alternative option for patients who have completed childbearing. Following evacuation, patients are closely monitored with serial beta hCG measurements and mandatory contraception to early detect GTN development. Patients diagnosed with GTN according to the criteria are classified as low-risk (0-6) or high-risk (>6) based on the World Health Organization (WHO) prognostic risk scoring system. While a 100% cure rate can be achieved in low-risk GTN cases with single-agent chemotherapies such as methotrexate or actinomycin D, high-risk metastatic cases require multi-agent chemotherapies like EMA-CO, and when necessary, surgery, radiotherapy, or current immunotherapies (pembrolizumab) are utilized.
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