İstmoselde Gelişen Atipik Plasental Site Nodül: Olgu Sunumu ve Literatür Derlemesi

Abstract

42 yaş kadın hasta, doğumdan 20 ay sonra kronik pelvik ağrı ve oligomenore şikayetleri ile başvurdu. MRG’de, sezaryen skarı ile uyumlu alanda tam kat miyometrial defekte yol açan büyük bir istmosel tespit edildi. Yapılan cerrahi onarım sonrası istmosel kesesinin histopatolojik incelemesinde hastamızda GATA3, P63 ve PLAP pozitifliği, hPL ve MCAM negatifliği saptandı ve Ki-67 indeksi %5–10 olarak bulundu. Hastaya, Ki-67 indeksinin PSN’den daha yüksek, PSST/ETT’den ise daha düşük olması ve tümör boyutunun daha büyük olması nedeniyle APSN tanısı konuldu. Bu vaka, gebelik sonrası kronik pelvik ağrı ve oligomenorenin ayırıcı tanısında APSN’nin göz önünde bulundurulması gerektiğini vurgulamakta olup, erken tanı ve uygun tedavinin, plasental site trofoblastik tümörü (PSTT) veya epiteloid trofoblastik tümör (ETT) gibi daha agresif trofoblastik tümörlere ilerlemeyi önlemedeki kritik rolüne dikkat çekmektedir.

Keywords

• Atipik Plasental Site Nodül
• intermediate trofoblastik tümör
• İstmosel
• Sezaryen skarı

Atypical Placental Site Nodule Arising in an Isthmocele: Case Report and Review of the Literature

Abstract

A 42-year-old woman presented with chronic pelvic pain and oligomenorrhea 20 months after her last pregnancy. MRI revealed a cesarean section scar and a large isthmocele causing a complete myometrial defect. Subsequent isthmocele repair and histopathological examination our patient had GATA3, P 63, and PLAP positivity, HPL, and MCAM negativity, and the Ki-67 index was 5-10%. She was diagnosed with APSN because her Ki-67 index was higher than PSN and lower than PSST / ETT and larger tumor size.This case underscores the importance of considering APSN in the differential diagnosis of chronic pelvic pain and oligomenorrhea post pregnancy, highlighting the need for early recognition and appropriate management to prevent progression to more severe trophoblastic tumors such as placental site trophoblastic tumor (PSTT) or epithelioid trophoblastic tumor (ETT).

Keywords

• Atypical Placental Site Nodule
• Cesarean section scar
• Intermediate trophoblastic tumor
• Isthmocele

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