GESTASYONEL TROFOBLASTİK HASTALIKLARA GÜNCEL YAKLAŞIM CONTEMPORARY

Öz

Gestasyonel trofoblastik hastalık (GTH), değişken derecede lokal invazyon ve metastaz gösterebilen komplet ve parsiyel hidatiform mol, invaziv mol, koryokarsinom, plasental site trofoblastik tümör (PSTT) ve epiteloid trofoblastik tümörü içeren birbiriyle ilişkili tümör grubudur. Gestasyonel trofoblastik neoplazi (GTN) invazyon ve metastaz gösterebilen tedavi edilmezse ölümcül olabilen bir hastalıktır. Bu grupta invazif mol, koryokarsinom ve PSTT bulunur. Bu derlemede amacımız güncel literatür ışığında GTH’ın tanı, yönetimi ve takibini tartışmaktır.

Anahtar Kelimeler

• Gestasyonel trofoblastik hastalık,gestasyonel trofoblastik neoplazi,komplet hidatiform mol ve parsiyel hidatiform mol.

TREATMENT OF GESTATİONAL TROPHOBLASTİC DİSEASE

Öz

Gestational trophoblastic disease (GTD) includes a spectrum of interrelated tumors, including complete and partial hydatidiform mole, invasive mole, choriocarcinoma, placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor that have varying propensities for local invasion and metastasis. Futhermore, invasive mole, choriocarcinoma and PSTT are classified as gestational trophoblastic neoplasia, which can progress, invade, metastasize, and lead to death if left untreated. In this review, our aim is to discuss diagnosis, management and follow-up of the GTD in light of the current literature. 

Anahtar Kelimeler

• Gestational trophoblastic disease,gestational trophoblastic neoplasia,complete hydatidiform mole and partial hydatidiform mole

Kaynakça

1. 1. Seckl MJ, Sebire NJ, Berkowitz RS. Gestational trophoblastic disease. Lancet. 2010 Aug 28;376:717-29
2. 2. Lurain JR. Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole. Am J Obstet Gynecol. 2010 Dec;203(6):531-9.
3. 3. Dhanda S, Ramani S, Th akur M. Gestational trophoblastic disease: a multimodality imaging approach with impact on diagnosis and management. Radiol Res Pract. 2014;2014:842751.
4. 4. Tse KY, Chan KK, Tam FK, Ngan YH. Current management of gestational trophoblastic disease. Obstetrics, Gynaecology and Reproductive Medicine 2014; 25:1, 12-21.
5. 5. Mangili G, Lorusso D, Brown J, Pfisterer J, Massuger L, Vaughan M et al. Trophoblastic disease review for diagnosis and management: a joint report from the International Society for the Study of Trophoblastic Disease, European Organisation for the Treatment of Trophoblastic Disease, and the Gynecologic Cancer InterGroup. Int J Gynecol Cancer. 2014 Nov;24:109-16.
6. 6. Parazzini F, La Vecchia C, Pampallona S. Parental age and risk of complete and partial hydatiform mole. Br J Obstet Gynaecol 1986;93:582-85.
7. 7. Parazinni F, La Vecchia C, Mangili G, Caminiti C, Negri E, Cecchetti G et al. Dietary factors and risk of trophoblastic disease. Am J Obstet Gynecol 1988;158:93.
8. 8. Ulker V, Gurkan H, Tozkir H, Karaman V, Ozgur H, Numanoglu C et al. Novel NLRP7 mutations in familial recurrent hydatidiform mole: are NLRP7 mutations a risk for recurrent reproductive wastage? Eur J Obstet Gynecol Reprod Biol. 2013;170: 88–192.

9. 9. Parazzini F, Cipriani S, Mangili G, Garavaglia E, Guarnerio P, Ricci E et al. Oral contraceptives and risk of gestational trophoblastic disease. Contraception. 2002;65(6):425-7.
10. 10. Froeling FE, Seckl MJ. Gestational trophoblastic tumours: an update for 2014. Curr Oncol Rep. 2014 Nov;16(11):408.
11. 11. Loukovaara M, Pukkala E, Lehtovirta P, Leminen A. Epidemiology of hydatidiform mole in Finland, 1975 to 2001. Eur J Gynaecol Oncol 2005;26(2):207–8.
12. 12. Garner EI, Goldstein DP, Feltmate CM, Berkowitz RS. Gestational trophoblastic disease. Clin Obstet Gynecol 2007;50(1):112–22.
13. 13. Berkowitz RS, Goldstein DP. Current management of gestational trophoblastic diseases. Gynecol Oncol 2009 Mar;112(3):654-62.
14. 14. Ozalp S, Telli E, Oge T, Tulunay G, Boran N, Turan T. Multicenter Analysis of Gestational Trophoblastic Neoplasia in Turkey. Asian Pac J Cancer Prev 2014;15:3625-28.
15. 15. Berkowitz RS, Goldstein. Gestational trophoblastic disease. In: Berek JS, Hacker NF. Gynaecology Oncology. 5th ed. Philadelphia: Williams and Wilkins; 2014.
16. 16. Mangili G, Giorgione V, Gentile C, Bergamini A, Pella F, Almirante G, Candiani M. Hydatidiform mole: age-related clinical presentation and high rate of severe complications in older women. Acta Obstet Gynecol Scand. 2014;93(5):503-7.
17. 17. Sun SY, Melamed A, Goldstein DP, Bernstein MR, Horowitz NS, Moron AF et al. Changing presentation of complete hydatidiform mole at the New England Trophoblastic Disease Center over the past three decades: does early diagnosis alter risk for gestational trophoblastic neoplasia? Gynecol Oncol. 2015 Jul;138(1):46-9.
18. 18. Elias K, Shoni M, Bernstein M, Goldstein D, Berkowitz R. Complete hydatidiform mole in women aged 40 to 49 years. J Reprod Med. 2012 May-Jun;57(5-6):254-8.
19. 19. Alhamdan D, Bignardi T, Condous G. Recognising gestational trophoblastic disease. Best Pract Res Clin Obstet Gynaecol 2009;23:565–573.
20. 20. Taylor KJW, Schwartz PE, Kohorn EI. Gestational trophoblastic neoplasia: diagnosis with Doppler US. Radiology 1987;165:445–448.
21. 21. Shimamoto K, Sakuma S, Ishigaki T. Intratumoral blood fl ow: evaluation with color Doppler echography. Radiology 1987;165 683–685.
22. 22. Desai RK, Desberg AL. Diagnosis of gestational trophoblastic disease: value of endovaginal color fl ow Doppler sonography. Case report. Am J Radiol October 1991;157:787–788.
23. 23. Shanbhogue AK, Lalwani N, Menias CO. Gestational trophoblastic disease. Radiol Clin North Am. 2013 Nov;51(6):1023-34
24. 24. Bolze PA, Attia J, Massardier J, Seckl MJ, Massuger L, van Trommel N et al. Formalised consensus of the European Organisation for Treatment of Trophoblastic Diseaseson management of gestational trophoblastic diseases. Eur J Cancer. 2015 Jun 16. pii: S0959-8049(15)00494-3.