GESTASYONEL TROFOBLASTİK HASTALIKLAR VE NEOPLAZİLER

Gestational trophoblastic diseases (GTD) encompass a spectrum of premalignant and malignant lesions originating from trophoblastic cells of the placenta, closely linked with pregnancy. These conditions secrete elevated human chorionic gonadotropin (hCG) levels and characterize by their invasive behavior, particularly towards maternal tissues. GTD classification includes premalignant forms such as complete and partial hydatidiform mole, and atypical placental site nodules, and malignant forms like invasive mole, gestational choriocarcinoma, placental site trophoblastic tumor (PSTT), and epithelioid trophoblastic tumor (ETT). Epidemiological patterns reveal higher prevalence in Asia and Africa compared to Western countries, with risk factors including maternal age over 35, previous molar pregnancies, genetic predispositions, and nutritional deficiencies. Clinical manifestations consist of abnormal vaginal bleeding, disproportionate uterine size, hyperemesis gravidarum and hyperthyroidism. Diagnosis relies on ultrasound and serum hCG levels, confirmed histopathologically. Standard treatment involves surgical evacuation followed by chemotherapy if required. Rare cases involve coexisting complete hydatidiform mole with a normal fetus (CHMCF), managed expectantly under close supervision. Monitoring is conducted by serial serum hCG measurements. Gestational trophoblastic neoplasia (GTN) denotes the malignant spectrum with metastatic potential, staged via FIGO system. Treatment is stratified by risk scores with single-agent chemotherapy for low-risk, multiple-agent for high-risk cases, and immunotherapy emerging for refractory patients. PSTT and ETT have distinct biology, primarily treated surgically. Despite aggressive disease, chemotherapy preserves fertility in most women, with recommendations for contraception during follow-up. GTD is a highly curable malignancy with modern multidisciplinary care, combining oncologic efficacy and fertility preservation.