Evaluation of Cases Diagnosed with Gestational Trophoblastic Disease

Yıl 2022, , 349 - 354, 30.09.2022

Tuğba Alemdar , Selim Gülücü

https://doi.org/10.34087/cbusbed.1015255

Öz

Objective: The aim of our study is to discuss the incidence, demographic characteristics, complications, follow-up and treatment approaches of our patients diagnosed with gestational trophoblastic disease (GTH) with current literature.
Materials and Methods: 134 patients who were diagnosed with GTD histopathologically in our clinic between 2005 and 2020 were included in the study retrospectively. Application complaints, demographic data, laboratory tests, treatments, presence of other comorbidities, histological subtype of GTD, transfusion and chemotherapy needs of these patients were evaluated. Partial and complete molar hydatiform pregnancies were compared with each other.
Results: The mean age of the patients was 29.9±7.49 years. According to the histopathological results, 91 patients (67.9%) with partial mole and 37 (27.6%) patients with complete mole were found. Invasive mole was detected in one patient (0.7%), choriocarcinoma in one patient (0.7%), and placental trophoblastic tumor (PSTT) in one patient (0.7%). The diagnosis of GTD was made at an average of 8 weeks. In GTD patients, A Rh (+) blood group was the most, B Rh (-) and AB Rh (-) blood groups were the least.
Conclusion: Early diagnosis and appropriate follow-up-treatment in GTD, which has a regionally different incidence, play an important role in preventing the morbidity and mortality associated with this disease.

Anahtar Kelimeler

Gestational trophoblastic disease, β-hCG, Hydatiform mole, Invasive mole

Gestasyonel Trofoblastik Hastalık Tanısı Alan Olguların Değerlendirilmesi

Öz

Giriş ve Amaç: Çalışmamızın amacı, gestasyonel trofoblastik hastalık (GTH) tanısı alan hastalarımızın insidansını, demografik özelliklerini, komplikasyonlarını, takip ve tedavi yaklaşımlarını güncel literatür bilgileriyle tartışılmasıdır.
Gereç ve Yöntemler: Kliniğimizde 2005- 2020 tarihleri arasında histopatolojik olarak GTH tanısı alan 134 hasta geriye dönük olarak çalışmaya alındı. Bu hastaların başvuru şikâyetleri, demografik verileri, laboratuvar tahlilleri, uygulanan tedaviler, eşlik eden diğer hastalıkların varlığı, GTH histolojik alt tipi, transfüzyon ve kemoterapi ihtiyaçları değerlendirildi. Parsiyel ve komplet mol hidatiform gebelikler birbirleriyle karşılaştırıldı.
Bulgular: Hastalarda ortalama yaş 29,9±7,49 olarak bulundu. Histopatolojik sonuçlara göre parsiyel mol tanılı 91 hasta (%67,9), komplet mol tanılı 37 hasta (%27,6) bulundu. İnvaziv mol bir hastada (%0,7), koryokarsinom bir hastada (%0,7), plasental yerleşimli trofoblastik tümör (PSTT) bir hastada (%0.7) tespit edildi. GTH tanısı ortalama 8. haftada konuldu. GTH hastalarında en çok A Rh (+) kan grubu, en az B Rh (-) ve AB Rh (-) kan grupları izlendi.
Sonuç: Bölgesel olarak farklı insidans gösteren GTH’de erken teşhis ve uygun takip-tedavinin yapılması bu hastalıkla ilişkili morbidite ve mortalitenin önlenmesinde önemli rol oynamaktadır.

Anahtar Kelimeler

Gestasyonel trofoblastik hastalık, β-hCG, İnvaziv Mol, Mol Hidatiform

Kaynakça

• Bayraktar, D.I, Yılmaz, B, Gestasyonel Trofoblastik Hastalıklar ve Tedavisi, Türkiye Klinikleri Tıbbi Onkoloji-Özel Konular, 2019, 12, 85-89.
• Berkowitz, R.S, Goldstein, D.P, Gestational trophoblastic disease, Cancer, 1995, 76, 2079-2085.
• Garrett, L.A, Garner, E.I, Feltmate, C.M, ve ark. Subsequent pregnancy outcomes in patients with molar pregnancy and persistent gestational trophoblastic neoplasia, Obstetrical & Gynecological Survey, 2008, 63, 704-705.
• Çakmak, B, Toprak, M, Nacar, M.C, ve ark., Incidence of gestational trophoblastic disease in Tokat province, Turkey, Journal of the Turkish German Gynecological Association, 2014, 15, 22.
• Ozalp, S, Yalcin, O, Tanır, H, Hydatidiform mole in Turkey from 1932 to 2000, International Journal of Gynecology & Obstetrics, 2001, 73, 257-258.
• Karateke, A, Kurt, R, Dede, M, ve ark., Kliniğimize Başvuran Mol Gebelik Olgularinin Retrospektif İncelenmesi: 5 Yillik Klinik Deneyim, Mustafa Kemal Üniversitesi Tıp Dergisi, 2014, 5, 18-23.
• Benson, C, Genest, D, Bernstein, M ve ark., Sonographic appearance of first trimester complete hydatidiform moles, Ultrasound in Obstetrics and Gynecology: The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2000, 16, 188-191.
• Zhou, Q, Lei, X-Y, Xie, Q, ve ark., Sonographic and Doppler imaging in the diagnosis and treatment of gestational trophoblastic disease: a 12‐year experience, Journal of Ultrasound in Medicine, 2005, 24, 15-24.
• Schorge, J.O, Gestasyonel Trofoblastik Hastalıklar, Williams Jinekoloji, In: Yıldırım G (Ed). İstanbul, Nobel Tıp Kitabevleri, 2016, 1398.
• Bracken, M.B, Brinton, L.A, Hayashi, K, Epidemiology of hydatidiform mole and choriocarcinoma, Epidemiologic Reviews, 1984, 6, 52-75.
• Matsui, H, Iitsuka, Y, Yamazawa, K, ve ark., Changes in the incidence of molar pregnancies, A population‐based study in Chiba Prefecture and Japan between 1974 and 2000, Human Reproduction, 2003, 18, 172-175.
• Zakaria, A, Hemida, R, Elrefaie, W, ve ark., Incidence and outcome of gestational trophoblastic disease in lower Egypt, African Health Sciences, 2020, 20, 73-82.
• Ozalp, S.S, Telli, E, Oge, T ve ark., Multicenter analysis of gestational trophoblastic neoplasia in Turkey, Asian Pacific Journal of Cancer Prevention, 2014, 15, 3625-3628.
• Gül, T, Yilmaztürk, A, Erden, A.C, A review of trophoblastic diseases at the medical school of Dicle University, European Journal of Obstetrics & Gynecology and Reproductive Biology, 1997, 74, 37-40.
• Barut, M.U, Sak, S, Sak, M.E, Kliniğimize Başvuran Mol Gebelik Olgularının Retrospektif İncelenmesi, Dicle Tıp Dergisi, 2018, 45, 431.
• Budak, M.Ş, Kaya, C, Şentürk, M.B ve ark., Kliniğimizde Tani Alan Parsiyel Ve Komplet Mol Hidatiform Olgularinin Retrospektif Analizi, Haydarpaşa Numune Eğitim Ve Araştirma Hastanesi Tip Dergisi, 2016, 81.
• Berkowitz, R, Goldstein, D, Epidemiology, genetics and molecular biology of gestational trophoblastic disease, Gynecologic Cancer: Controversies in Management, 1st ed Philadelphia, PA: Elsevier Churchill Livingstone, 2004, 545-554.
• Neelakanthi, A, Lokeshchandra, H, Gestational Trophoblastic Disease: A Hospital-Based Prospective Study to Characterize Incidence, Risk Factors, Management and Review of Literature, Indian Journal of Gynecologic Oncology, 2020, 18: 1-8.
• Ngan, H.Y, Wong, L, Ma, H, Reproductive performance of patients with gestational trophoblastic disease in Hong Kong, Acta Obstetricia et Gynecologica Scandinavica, 1988, 67, 11-14.
• Kim, J.H, Park, D.C, Bae, S.N, ve ark., Subsequent reproductive experience after treatment for gestational trophoblastic disease, Gynecologic oncology, 1998, 71, 108-112.
• Uberti, E.M.H, do Carmo Fajardo, M, Ferreira, S.V.V.R, ve ark., Reproductive outcome after discharge of patients with high-risk hydatidiform mole with or without use of one bolus dose of actinomycin D, as prophylactic chemotherapy, during the uterine evacuation of molar pregnancy, Gynecologic Oncology, 2009, 115, 476-481.
• Gul, A, Celebi, H, A review of trophoblastic disease at the Department of Obstetrics and Gynecology medical school, Yuzuncu Yil University, Journal of Gynecology Obstetrics (in english), 2000, 10, 192-195.
• Adali, Y, Eroğlu, H.A, Güvendi, G.F ve ark., Frequency of hydatidiform mole in curettage material between 2014 and 2016 in a university hospital, Medical Sciences, 2018, 13, 66-71.
• Çetin, M, Balta, Ö, Duran, B ve ark., Kliniğimize Başvuran Mol Gebelik Olgularının Retrospektif İncelenmesi, Cumhuriyet Üniversitesi Tıp Fakültesi Dergisi, 2004, 26, 18-22.
• Kurdoglu, M, Kurdoglu, Z, Kucukaydin, Z ve ark., Gestational trophoblastic diseases: Fourteen year experience of our clinic, Journal of Turkish Society of Obstetric Gynecology, 2011, 8, 134-139.
• Kars, B, Taşlıgedik, G, Karşıdağ, Y.K, ve ark., 2005-2009 Yillari Arasinda Molar Gebelik Nedeniyle Tedavi Olan Hastalarin Takibi Ve Değerlendirilmesi, Türk Jinekolojik Onkoloji Dergisi, 14, 26-32.
• Hou, J-L, Wan, X-r, Xiang, Y, ve ark., Changes of clinical features in hydatidiform mole: analysis of 113 cases, The Journal of Reproductive Medicine, 2008, 53, 629-633.
• Sand, P.K, Lurain, J.R, Brewer, J.I, Repeat gestational trophoblastic disease, Obstetrics and Gynecology, 1984, 63, 140-144.
• Özgen, G, Aydin, G.A, Gestasyonel Trofoblastik Hastalıkların Kliniğimizde Retrospektif Olarak Değerlendirilmesi: Orta Dönem Sonuçlarımız, Zeynep Kamil Tıp Bülteni, 2020, 51, 1-4.
• Karaman, E, Çetin, O, Çim, N ve ark., Molar gebelik olgularında tiroid fonksiyonlarının değerlendirilmesi, Van Tıp Dergisi, 2017, 24, 35-39.