Jinekolojik Tümörler ve Paraneoplastik Sendromlar
Özet
Jinekolojik maligniteler, paraneoplastik sendrom vakalarının %1'inden azını oluştursa da bu sendromlar kanser teşhisinden çok önce ortaya çıkabilmekte ve kansere bağlı en sık ikinci doğrudan ölüm nedenini oluşturmaktadır. Bu sendromlar hematolojik, oftalmolojik, nefrolojik, endokrinolojik, romatolojik, dermatolojik ve nörolojik olmak üzere pek çok sistemi etkiler. Hematolojik bozukluklar arasında eritrositoz, trombositoz, lökomoid reaksiyon ve trousseau sendromu gibi durumlar yer alırken; endokrin bozukluklarda hiperkalsemi ve hipertiroidizm dikkat çeker. Oftalmolojik alanda kanser ilişkili retinopati ve bilateral diffüz uveal melanositik proliferasyon görme kayıplarına yol açabilir. Romatolojik ve dermatolojik olarak dermatomyozit, akantosis nigrikans ve Sweet sendromu gibi tablolar malignitelere sekonder gelişebilir. Nörolojik paraneoplastik hastalıklar ise antitümör antikorların nöral dokuyu hedef almasıyla oluşur ve subakut serebellar dejenerasyon, limbik ensefalit ve NMDAR ensefaliti gibi ciddi durumlara yol açar. Bu sendromların tedavisinde temel yaklaşım altta yatan primer tümörün ortadan kaldırılması olmakla birlikte, semptomların hafifletilmesi için steroidler, immunsüpresif ajanlar ve plazmaferez gibi palyatif yöntemlerden de geniş ölçüde faydalanılmaktadır.
Although gynecological malignancies account for less than 1% of paraneoplastic syndrome cases, these syndromes can manifest long before cancer detection and represent the second most common direct cause of cancer-related mortality. These syndromes affect numerous bodily systems, including hematological, ophthalmological, nephrological, endocrinological, rheumatological, dermatological, and neurological systems. Hematological disturbances encompass conditions such as erythrocytosis, thrombocytosis, leukemoid reaction, and Trousseau syndrome, while hypercalcemia and hyperthyroidism stand out among endocrine disorders. In the ophthalmological field, cancer-associated retinopathy and bilateral diffuse uveal melanocytic proliferation can lead to severe vision loss. Rheumatological and dermatological manifestations, including dermatomyositis, acanthosis nigricans, and Sweet syndrome, can develop secondary to these malignancies. Neurological paraneoplastic disorders occur when antitumor antibodies target neural tissues, causing severe conditions like subacute cerebellar degeneration, limbic encephalitis, and NMDAR encephalitis. The primary approach in managing these syndromes is the treatment of the underlying primary tumor, though palliative methods such as steroids, immunosuppressive agents, and plasmapheresis are extensively utilized to alleviate symptoms.
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