İbrahim ALANBAY, Hakan ÇOKSUER, Mutlu ERCAN, Emre KARAŞAHİN, Salih DEVECİ, Murat DEDE, Mufit C.YENEN

Ultrasonografi Eşliğinde Biopsi ile Tanı Konulan, İntramural Yerleşimli Atipik Trofoblastik Tümör

Amaç: Ultrasonografi eşliğinde biopsi ile tanı konulan, atipik trofoblastik tümör olgusunun sunulmasıdır. Olgu: 31 yaşında, Gravidesi 3, Paritesi 1 olan olguya dış merkezde incomplet abortus tanısıyla, D/C işlemi uygulanmıştır. ‚- hCG kontrollerinde yükselme saptanması üzerine kliniğimize refere edilmiştir. Kliniğimizde hCG düzeyleri plato çizmesi nedeniyle metotreksat uygulanmıştır. Metotreksat tedavisine yanıt alınmadığından ve hCG değerlerinin yükselmesinden dolayı, ultrasonografi eşliğinde uterin lezyona girilerek yapılan biopsi sonucunda epiteloid trofoblastik tip tümör saptanmıştır. Olguya histerektomi uygulanmıştır. Hastanın operasyon sonrası yapılan takiplerinde şu ana kadar herhangi bir problem ile karşılaşılmamıştır. Sonuç: Gestasyonel trofoblastik hastalık düşünülen bir hastada hCG değerleri düşük ve kemoterapiye cevap yoksa, ileri histolojik inceleme yapılarak epiteloid trofoblastik tip tümör mutlaka akılda tutulmalıdır.

Anahtar Kelimeler:

epiteloid trofoblastik tip tümör, metotreksat, biopsi

Intramural Atypical Trophoblastic Tumor Diagnosed by Ultrasound Guided Biopsy

Objective: To present an intramural atypical trophoblastic tumor case diagnosed by ultrasound guided biopsy. Case: A 31 years old patient gravidity 3, parity 1 referred to our tertiary center with the diagnosis of an incomplete abortion who had been performed dilatation and curretage in another healthcare unit. Her referrel reason was the plateau and elevation of ‚- hCG levels in her check-ups. When we repeated the tests the patients ‚- hCG values were decreased and we planned methotrexate therapy. Unfortunately the patient did not respond to methotrexate treatment and her ‚- hCG levels started to elevate. We decided to perform an ultrasound guided biopsy direct to the lesion. An epithelioid trophoblastic type tumor diagnose was confirmed by hystopathological examination. Then hysterectomy was performed and she discharged without any complication. She was free of disease in her follow-up period. Conclusions: Epithelioid trophoblastic type tumors should be kept in mind for the patients with a diagnosis of gestational trophoblastic disease and has low ‚- hCG levels who do not respond to chemotherapy.

Keywords:

epithelioid trophoblastic type tumor, methotrexate, biopsy,

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