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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