HYDATIDIFORM MOLE : ETIOLOGY AND PREVENTION POSTMOLE MALIGNANCY

ANDRIJONODIVISION OF ONCOLOGY, DEPT OBSTETRIC AND GYNECOLOGY

FACULTY OF MEDICINE UNIVERSITY OF INDONESIA

PROLIFERATION OF TROPHOBLASTIC CELL----------------------------

CTB, STB, ITB

HYDATIDIRFORM MOLE

CYTOTROPHOBLAST (PROLIFERATION) 2

SYNSITIOTROPHOBLAST (HORMONAL)INTERMEDIATE TROPHOBLAST (INVASIVE)

(1) Trabeti EGR, et al. Mol and Cell Proc. 1993;7:325-29. (2) Kurman RJ. Human Pathology. 1991;22(9):847-55. (3) Shih IM, et al. Placenta.2003;23:20-31(4) Andrijono, et al. MJI.1997;6:153-7.

DEFINITION AND ETIOLOGY

VITAMIN A 3

DEFICIENCYOR: 6,9-7

NORMAL FERTILISATIONANDROGENIZATION FERTILISATION

PREGNANCY

BLIGHTED OVUM 1

TROPHOBLASTIC CELL

NORMAL PREG

PARTIAL MOLE

COMPLETE MOLE

CK 20 (-) (+) (++)

DIAGNOSIS

CLINICAL DIAGNOSIS

CLINICAL SIGN

ULTRASOUND

MOLAR PREGNANCY

PROLIFERATION OF TROPHOBLASTIC CELL

MALIGNANT TROPHOBLASTIC DISEASES

PROLIFERATION

SPONTANEOUS REGRESSION

APOPTOSISCHMS-1, hDab-2pRb

TELOMERASE EGF, VEGF,PDGFp53,Bcl2, Mdm2,JNK,CYCLIN,CDK4,JAK/STATSURVIVINCDKI p27

1

(1) Dumur Ci, et all. Int J of Oncol 2001;19:1161-7, (2) Gang W, et all. Chinese Med J 2000;113:1046-8, (3) Bae SN, et all. Am J Obstet Gynecol 1999;180:328-33, (4) Shih Ie-M. Curr Mol Med 2002;2:1-12, (5) Fong PY, et all. Cancer 2005;103:268-76, (6) Gruslin A, et all. Biol Reprod 2001;64:1264-72

2

3

4

5

6

MOLECULER STUDY

SERUM LEVEL OF VITAMIN A

MOLAHIDATIDOSA

MOLAR PREGNANCY

MALIGNANT TROPHOBLASTIC DISEASESSPONTANEOUS REGRESSION

(1). Sutoto, Tesis , (2) Uberti EMH, et al. Gynecol Oncol 2006;102:325-32. , (3). Andrijono, Tesis 2007.

PREVENTION OF POSTMOLEMALIGNANCY

BCG2,34p= 0.0679

ACTINOMYCIN D

6,9 % VS 29%

VITAMIN A 200 000 IU

6.25% VS 28.57% (p:0.029)

RETINOAT + RAR

APOPTOSIS CELL CYCLEG1

S

G2

M

CASPASE-7 CASPASE-9

(+)(+)

CRABP

Apaf-1

(+)

(+) (+)

Bcl-2

(-)

(+)

(-)

SIKLIN-D1,A, E

P53

(+)

(-)(+)

(-)

P21

(+)

(-)

P27

E2F

pRb-E2F

+

(-)

(-)

(+)

(+)

SIKLIN D3

(-)

Cmyc,Cjun

(+)

(-)

GATA6 dab2(+)

(+)

(+)

EXPRESSION OF RETINOL RECEPTORIN TROPHOBLASTIC CELL

CYTOGRAME CONTROL, ATRA 50, 150, 200

DEPOSIT RETINOL 71,43%

SERUM RETINOL< N

HIDATIDIFORM MOLE

MALIGNANT TROPHOBLASTIC DISEASE28,57 % VS 6,25%

PROLIFERATION RECEPTOR RETINOL MOLAR TROPHOBLASTIC CELL

THERAPY WITH VITAMIN A

SERUM RETINOL >

APOPTOSIS 60,64% VS 94,83%

RETINOAT

CONCLUSION

PREVENTION OF POSTMOLE MALIGNANCY

BCGACTINOMYCIN DHIGH DOSE VITAMIN A