presentasi prof djamhoer ed

7/27/2019 Presentasi Prof Djamhoer Ed

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INVASIVE MOLE, IN

BANDUNG TROPHOBLASTIC

CENTERAli Budi Harsono

Djamhoer Martaadisoebrata

Division of Gynecology Oncology

Department of Obstetrics and Gynecology

School of Medicine, University of Padjadjaran

Bandung, Indonesia



2

Introduction

Hasan Sadikin Hospital

(Trophoblastic Center for the

West Java ) the same problems

Invasive mole is rather unique.

Our prior studied indicated

that latent period from mole

to IM was shorter than CC

Trophoblastic Disease

(GTD) is still important

for Indonesia

{incident >,

spread >,

the risk factors > ,

prognosis <}



3

Malignant transformation after mole, without

histological findings (PTG,GTN )

Is it necessary to differentiate IM and CC before

treatment?

Sasaki S4 had

tried to make a

diagnosis of

Clinical IM and

Clinical CC

This paper is to share our

experience of IM cases,

demographic and also the

diagnostic and treatment

procedures



4

Materials and methods

Cross sectional retrospective study (1995 -

2004), conducted in the Department of

Obstetrics and Gynecology, Hasan Sadikin

Hospital, Bandung

During that period 27 cases of I

M,

conformed by histological.



5

Results

70,00%

18,50%

11,20%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Complete Hydatidiform Mole (CHM),

Partial Hydatidiform Mole (PHM)

Doubtful

19

5

3

Of those 27 cases of IM



6

The average values of age were 34,4 years,

parity 4.4 pregnancy , transformation(latent) period 2.6 months and uterine

size 14.3 weeks



7

45%

40%

10%

5,00%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

IM ChCa CMH doubtful

Based on USG examination (20 cases)

9

8

2

1



8

Two cases caused by perforation to

parametrium, and one to abdominalcavity

Perforation occurred in 18 cases (66.7%),

61.1% to abdominal cavity, 5.5% to uterinecavity, 5.5% to uterine and parametrium, 11.1

% to abdominal abdominal and uterine cavity

and 16.7% to abdominal cavity and

parametrium.



9

There were 2 cases with metastases

(7.4%).

One to the vagina and one to the lungs.

Both of them survived



10

There were three dead cases (11.1 %), all ofthem due

to perforation

In 25 (92.6%) cases

ATH were performed, 1 (3.7% explorative laparotomy

and one 3.7%) chemotherapy.



11

Discussion

The transformation or latent period ranges

from zero to 5.5 months, with the average

value : 2.6 months.

When one says that the latent period is zero, it

means that both CHM and IM occur in the same

time. How do we explain it ? ( 2 Cases)



12

The average age and parity

value : 34.4 years (17 -48 years)

and 4.4 pregnancy (112).

Five occurred in young nullipara, and 2 withonly one living child.

All of them deprived of their future fertility, a

rather costly sacrifice to survive



13

Detection of IM is much earlier than ChCa, based on

short latent period and small uterine size

It ranges from 6 to 24 weeks, with an average value of

14.3 weeks

The size is smaller because it perforates earlier



14

The most common

route is to abdominal

cavity, causing

abdominal

hemorrhage

The other two routes are

to parametrium or back to

the uterine cavity.

These two types of

perforation do not cause

acute clinical signs



15

The transformation process (Pathogenesis)

from HM to IM, ??!!

1. When the patients harbor HM, some of its chorionic

villous have already invaded the myometrium.

2. When we evacuate the mole tissues, the chorionic

villous remain in situ

3. Generally, the chorionic villous will be absorbed by the

body, and the patient recover completely.



16

4. In a small portion of cases, by some unknown mechanism,

the chorionic villous will grow into grapelike vesicles.

5. Since there is only a limited space in the myometrium, the

growing vesicles must look for more spacious place

Perforation, is not the only complication

in IM (Hyperthyroid, severe anemia,

shock)



17

Could IM be diagnosed without

histological findings ?

From Our data

Clinical, laboratory as well as

imaging,

Show that there are similarity, in

most of IM cases

Mose JC

claimed that there is a different ultrasound

appearance between IM and ChCa



18

Sasaki Classified Persistent Trophoblastic Disease :

1) post molar persistent hCG

2) invasive or metastatic mole and

3) choriocarcinoma.

{Diagnostic Score }



19

Surgical intervention had been performed in

26 cases

But not all of

them

hysterectomy

Based on the fact that IM is similar toHM, it is our policy not give

chemotherapy in IM cases, as long as

there is no distortion in BhCG curve, and

there is not signs of metastasis.



20

Conclusions and Suggestions

IM should be suspected in middle aged women, high parity,

with hystory HM, bleeding, sub involution of the uterus,

short transformation period and increase level of BhCG

Although it has a low grade of malignancy but it can be fatal



21

The role of USG as a diagnostic procedure is promising,

but it still further prospective study. It will be a great advantage to the management and

prognosis" if IM can be diagnosed in a non invasive

manner



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18TH WORLD CONGRESS OF ISSTD

BANDUNG

2015

presentasi prof djamhoer ed

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