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Year 2013, Volume: 26 Issue: 1, 43 - 46, 30.09.2015

İşın Üreyen Günsu Kimyon , Alper Karalök Ömer Tapısız Reyhan Öcalan Taner Turan Nurettin Boran Gökhan Tolunay

Abstract

A patient who had gestational trophoblastic neoplasia (GTN) with vaginal metastasis resistant to sequential methotrexatefolinic acid (MTX-FA) treatment is presented. She was 25 years old and presented with vaginal bleeding. A curettage was performed and the pathology revealed a partial hydatidiform mole. There was a rise in β-hCG, a 2 cm metastatic lesion on the middle third of the right wall of the vagina, and there were nodular implants up to a size of 12 mm in both lungs. Therefore, she was diagnosed as having a GTN. She was considered as having low risk metastatic GTN, as

Keywords

Gestational trophoblastic neoplasia Vaginal metastasis Methotrexate Actinoycin-D

References

  • 1. Hoffman B. Gestational trophoblastic disease. In: Schorge J, Schaffer J, Halvorson L, et al editors. Williams Gynecology, Ch. 37. Ed. 23. Texas: McGraw-Hill Companies, 2010: 756-8.
  • 2. May T, Goldstein DP, Berkowitz RS. Current chemotherapeutic management of patients with gestational trophoblastic neoplasia. Chemother Res Pract 2011;2011:806256. doi: 10.1155/2011/806256
  • 3. Berkowitz RS, Goldstein DP. Chorionic tumors, New Eng J Med 1996; 335: 1740-8. doi:10.1056/NEJM199612053352306
  • 4. Lurain JR, Gestational trophoblastic disease II: Classification and management of gestational trophoblastic neoplasia. Am J Obstet Gynecol 2010; 204: 11-8. doi:10.1016/j.ajog.2010.06.073
  • 5. Newlands ES. The management of recurrent and drug resistant gestational trophoblastic neoplasia (GTN). Best Pract Res Clin Obstet Gynecol 2003; 17: 905-23. doi:10.1016/S1521-6934(03)00092-0
  • 6. Ghaemmaghami F, Behtash N, Soleimani KH, Hanjani P. Management of patients with metastatic gestational trophoblastic tumor. Gynecol Oncol 2004; 94: 187-90. doi:10.1016/j.ygyno.2004.04.006
  • 7. Ghaemmaghami F, Behroozi S, Mousavi A, et al. Assessment of the response to chemotherapy in gestational trophoblastic neoplasia with vaginal metastases. Arch Gynecol Obstet 2008; 278: 315-8.
  • 8. Yingna S, Yang X, Xiuyu Y, Hongzhao S. Clinical characteristics and treatment of gestational trophoblastic tumor with vaginal metastasis. Gynecol Oncol 2002; 84: 416-9. doi:10.1006/gyno.2001.6540
  • 9. Ross SB, Donald PG. Gestational trophoblastic neoplasia In: Berek JS, editor. Novak’s Gynecology, Ch. 39. Edition 15. California: Lippincott Williams & Wilkins, 2003: 1458–75.
  • 10. Chapman-Davis E, Hoekstra AV, Rademaker AW, Schink JC, Lurain JR. Treatment of non-metastatic and metastatic low-risk gestational trophoblastic neoplasia: factors associated with resistance to singleagent methotrexate chemotherapy. Gynecol Oncol 2012; 125: 572-5. doi:10.1016/j.ygyno.2012.03.039
  • 11. Lurain JR, Elfstrand EP. Single-agent methotrexate chemotherapy for the treatment of nonmetastatic gestational trophoblastic tumors. Am J Obstet Gynecol 1995; 172: 574-9. doi:10.1016/0002-9378(95)90575-8
  • 12. Wong LC, Ngan HY, Collins RJ, Ma HK. Vaginal metastases in gestational trophoblastic disease. Asia-Oceania J Obstet Gynaecol 1990; 16: 123-6. doi:10.1111/j.1447-0756.1990.tb00013.x
  • 13. Ngan HYS, Gestational trophoblastic disease. Curr Obstet Gynaecol 2003; 13:95-101. doi:10.1054/cuog.2002.0316
  • 14. Vardar MA, Altintas A, Demir SC. Gestational trophoblastic disease: The significance of vaginal metastasis. Eur J Gynaecol Oncol 2000; 21:184-6.
  • 15. Goldberg GL, Yon DA, Bloch B, Levin W. Gestational trophoblastic disease; the significance of vaginal metastasis. Gynecol Oncol 1989; 24:155-61.

Vajinal metastazı olan gestasyonel trofoblastik neoplazinin yönetimi

Year 2013, Volume: 26 Issue: 1, 43 - 46, 30.09.2015

İşın Üreyen Günsu Kimyon , Alper Karalök Ömer Tapısız Reyhan Öcalan Taner Turan Nurettin Boran Gökhan Tolunay

Abstract

Vajinal metastazı olan ve ardışık metotreksat-folinik asit (MTXFA) tedavisine dirençli gestasyonel trofoblastik neoplazi (GTN) olgusu sunuldu. 25 yaşında ve vajinal kanama şikâyetiyle başvuran hastaya yapılan teropatik kürtaj sonrası patoloji sonucu parsiyel mol hidatidiform olarak rapor edildi. β-hCG değerlerinde yükselme, her iki akciğerde büyüğü 12 mm olan nodüler tarzda implantların varlığı ve vajina sağ yan duvar orta 1/3’lük kısmında 2 cm boyutunda metastatik lezyon saptanması üzerine hasta GTN olarak kabul edildi. Modifiye WHO sistemine göre skoru 3 olan hasta düşük riskli metastatik GTN olarak değerlendirildi ve ardışık MTX-FA kemoterapisinin başlanmasına karar verildi. 7. kür sonrasında β-hCG değerlerinin plato çizmesi üzerine hasta ardışık MTX-FA tedavisine dirençli kabul edilip aktinomisin-D tedavisine geçilmesine karar verildi. 2 kür aktinomisin-D tedavisi sonrası β-hCG değeri normal sınırlara inen hastaya 2 kür daha tedavi verilip kemoterapi sonlandırıldı. Düşük riskli olmasına rağmen vajinal yayılımı olan GTN olgularında MTX-FA tek ajan kemoterapisine direnç oluşabileceği göz önünde bulundurulmalı ve bu hastalarda aktinomisin-D ile kür sağlanabileceği unutulmamalıdır.

Keywords

Gestasyonel trofoblastik neoplazi Vajinal metastaz Metotreksat Aktinomisin-D

References

  • 1. Hoffman B. Gestational trophoblastic disease. In: Schorge J, Schaffer J, Halvorson L, et al editors. Williams Gynecology, Ch. 37. Ed. 23. Texas: McGraw-Hill Companies, 2010: 756-8.
  • 2. May T, Goldstein DP, Berkowitz RS. Current chemotherapeutic management of patients with gestational trophoblastic neoplasia. Chemother Res Pract 2011;2011:806256. doi: 10.1155/2011/806256
  • 3. Berkowitz RS, Goldstein DP. Chorionic tumors, New Eng J Med 1996; 335: 1740-8. doi:10.1056/NEJM199612053352306
  • 4. Lurain JR, Gestational trophoblastic disease II: Classification and management of gestational trophoblastic neoplasia. Am J Obstet Gynecol 2010; 204: 11-8. doi:10.1016/j.ajog.2010.06.073
  • 5. Newlands ES. The management of recurrent and drug resistant gestational trophoblastic neoplasia (GTN). Best Pract Res Clin Obstet Gynecol 2003; 17: 905-23. doi:10.1016/S1521-6934(03)00092-0
  • 6. Ghaemmaghami F, Behtash N, Soleimani KH, Hanjani P. Management of patients with metastatic gestational trophoblastic tumor. Gynecol Oncol 2004; 94: 187-90. doi:10.1016/j.ygyno.2004.04.006
  • 7. Ghaemmaghami F, Behroozi S, Mousavi A, et al. Assessment of the response to chemotherapy in gestational trophoblastic neoplasia with vaginal metastases. Arch Gynecol Obstet 2008; 278: 315-8.
  • 8. Yingna S, Yang X, Xiuyu Y, Hongzhao S. Clinical characteristics and treatment of gestational trophoblastic tumor with vaginal metastasis. Gynecol Oncol 2002; 84: 416-9. doi:10.1006/gyno.2001.6540
  • 9. Ross SB, Donald PG. Gestational trophoblastic neoplasia In: Berek JS, editor. Novak’s Gynecology, Ch. 39. Edition 15. California: Lippincott Williams & Wilkins, 2003: 1458–75.
  • 10. Chapman-Davis E, Hoekstra AV, Rademaker AW, Schink JC, Lurain JR. Treatment of non-metastatic and metastatic low-risk gestational trophoblastic neoplasia: factors associated with resistance to singleagent methotrexate chemotherapy. Gynecol Oncol 2012; 125: 572-5. doi:10.1016/j.ygyno.2012.03.039
  • 11. Lurain JR, Elfstrand EP. Single-agent methotrexate chemotherapy for the treatment of nonmetastatic gestational trophoblastic tumors. Am J Obstet Gynecol 1995; 172: 574-9. doi:10.1016/0002-9378(95)90575-8
  • 12. Wong LC, Ngan HY, Collins RJ, Ma HK. Vaginal metastases in gestational trophoblastic disease. Asia-Oceania J Obstet Gynaecol 1990; 16: 123-6. doi:10.1111/j.1447-0756.1990.tb00013.x
  • 13. Ngan HYS, Gestational trophoblastic disease. Curr Obstet Gynaecol 2003; 13:95-101. doi:10.1054/cuog.2002.0316
  • 14. Vardar MA, Altintas A, Demir SC. Gestational trophoblastic disease: The significance of vaginal metastasis. Eur J Gynaecol Oncol 2000; 21:184-6.
  • 15. Goldberg GL, Yon DA, Bloch B, Levin W. Gestational trophoblastic disease; the significance of vaginal metastasis. Gynecol Oncol 1989; 24:155-61.
There are 15 citations in total.

Details

Primary Language Turkish
Journal Section Case Reports
Authors

İşın Üreyen This is me

Günsu Kimyon

Alper Karalök This is me

Ömer Tapısız This is me

Reyhan Öcalan This is me

Taner Turan This is me

Nurettin Boran This is me

Gökhan Tolunay This is me

Publication Date September 30, 2015
Published in Issue Year 2013 Volume: 26 Issue: 1

Cite

APA Üreyen, İ., Kimyon, G., Karalök, A., Tapısız, Ö., et al. (2015). Vajinal metastazı olan gestasyonel trofoblastik neoplazinin yönetimi. Marmara Medical Journal, 26(1), 43-46.
AMA Üreyen İ, Kimyon G, Karalök A, Tapısız Ö, Öcalan R, Turan T, Boran N, Tolunay G. Vajinal metastazı olan gestasyonel trofoblastik neoplazinin yönetimi. Marmara Med J. October 2015;26(1):43-46.
Chicago Üreyen, İşın, Günsu Kimyon, Alper Karalök, Ömer Tapısız, Reyhan Öcalan, Taner Turan, Nurettin Boran, and Gökhan Tolunay. “Vajinal Metastazı Olan Gestasyonel Trofoblastik Neoplazinin yönetimi”. Marmara Medical Journal 26, no. 1 (October 2015): 43-46.
EndNote Üreyen İ, Kimyon G, Karalök A, Tapısız Ö, Öcalan R, Turan T, Boran N, Tolunay G (October 1, 2015) Vajinal metastazı olan gestasyonel trofoblastik neoplazinin yönetimi. Marmara Medical Journal 26 1 43–46.
IEEE İ. Üreyen, G. Kimyon, A. Karalök, Ö. Tapısız, R. Öcalan, T. Turan, N. Boran, and G. Tolunay, “Vajinal metastazı olan gestasyonel trofoblastik neoplazinin yönetimi”, Marmara Med J, vol. 26, no. 1, pp. 43–46, 2015.
ISNAD Üreyen, İşın et al. “Vajinal Metastazı Olan Gestasyonel Trofoblastik Neoplazinin yönetimi”. Marmara Medical Journal 26/1 (October 2015), 43-46.
JAMA Üreyen İ, Kimyon G, Karalök A, Tapısız Ö, Öcalan R, Turan T, Boran N, Tolunay G. Vajinal metastazı olan gestasyonel trofoblastik neoplazinin yönetimi. Marmara Med J. 2015;26:43–46.
MLA Üreyen, İşın et al. “Vajinal Metastazı Olan Gestasyonel Trofoblastik Neoplazinin yönetimi”. Marmara Medical Journal, vol. 26, no. 1, 2015, pp. 43-46.
Vancouver Üreyen İ, Kimyon G, Karalök A, Tapısız Ö, Öcalan R, Turan T, Boran N, Tolunay G. Vajinal metastazı olan gestasyonel trofoblastik neoplazinin yönetimi. Marmara Med J. 2015;26(1):43-6.