Gestasyonel Trofoblastik Neoplazi
Özet
Gestasyonel trofoblastik neoplazi (GTN), mol hidatiform, koryokarsinom, invaziv mol, plasental bölge trofoblastik tümörü (PSTT) ve epiteloid trofoblastik tümör (ETT) gibi plasental trofoblast hücrelerinden köken alan benign ve malign hastalıklar grubunu kapsar. Bu tümörler, normal trofoblast dokusunun endometriuma invazyonunu kontrol eden düzenleyici mekanizmaların bozulması sonucu oldukça invaziv, vasküler ve metastatik bir karakter kazanır. Hastalığın klinik takibi ve tanısı, mol hidatiform boşaltılmasından sonra plato çizen veya yükselen serum hCG seviyelerine dayanır. En sık akciğerler ve alt genital sisteme metastaz yapan GTN’nin prognozu ve tedavi protokolü, FIGO tarafından revize edilen DSÖ prognostik skorlama sistemine göre belirlenir. Düşük riskli (skor ≤6) ve metastatik olmayan olgularda tek ajanlı kemoterapi (metotreksat veya aktinomisin D) ile %100'e yakın tam iyileşme sağlanırken, yüksek riskli (skor >6) veya yaygın metastatik olgularda çok ajanlı agresif kemoterapi rejimleri ve duruma göre cerrahi rezeksiyon uygulanır.
Gestational trophoblastic neoplasia (GTN) encompasses a spectrum of benign and malignant disorders originating from placental trophoblastic cells, including hydatidiform mole, choriocarcinoma, invasive mole, placental site trophoblastic tumor (PSTT), and epithelioid trophoblastic tumor (ETT). These tumors acquire a highly invasive, vascular, and metastatic character because the regulatory mechanisms controlling the endometrial invasion of normal trophoblastic tissue become dysfunctional. Clinical surveillance and diagnosis of the disease rely on serum hCG levels that either plateau or rise following the evacuation of a hydatidiform mole. Most frequently metastasizing to the lungs and lower genital tract, the prognosis and treatment protocols of GTN are determined by the WHO prognostic scoring system revised by FIGO. While low-risk (score ≤6) and non-metastatic cases achieve a cure rate near 100% with single-agent chemotherapy (methotrexate or actinomycin D), high-risk (score >6) or advanced metastatic cases are treated with multi-agent aggressive chemotherapy regimens and tailored surgical resections.
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