INVASIVE MOLE, IN BANDUNG TROPHOBLASTIC CENTER

Ali Budi Harsono Djamhoer Martaadisoebrata

Division of Gynecology Oncology Department of Obstetrics and Gynecology School of Medicine, University of Padjadjaran Bandung, Indonesia

Introduction
Trophoblastic Disease

(GTD) is still important

for Indonesia {incident >, spread >, the risk factors > , prognosis <}

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
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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
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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 IM,

conformed by histological.

Results
80%

70%

70,00%

Of those 27 cases of IM

19
60%

50%

40%

30%

20%

18,50%

5
10%

11,20%

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Complete Hydatidiform Mole (CHM), Partial Hydatidiform Mole (PHM) Doubtful
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0%

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

Based on USG examination (20 cases)

50%
45% 40% 35% 30% 25% 20% 15% 10% 5% 0% IM ChCa CMH doubtful
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45%

40%

10%

5,00%

Perforation occurred in 18 cases (66.7%), 61.1% to abdominal cavity, 5.5% to uterine cavity, 5.5% to uterine and parametrium, 11.1 % to abdominal abdominal and uterine cavity and 16.7% to abdominal cavity and parametrium.

Two cases caused by perforation to parametrium, and one to abdominal cavity

There were 2 cases with metastases

(7.4%).
One to the vagina and one to the lungs. Both of them survived

In 25 (92.6%) cases ATH were performed, 1 (3.7% explorative laparotomy and one 3.7%) chemotherapy.

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

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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)
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The average age and parity value : 34.4 years (17 -48 years) and 4.4 pregnancy (112).

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

All of them deprived of their future fertility, a rather costly sacrifice to survive
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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

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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

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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.

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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)

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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
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Sasaki Classified Persistent Trophoblastic Disease : 1) post molar persistent hCG

2) invasive or metastatic mole and

3) choriocarcinoma.

{Diagnostic Score }

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Surgical intervention had been performed in 26 cases

But not all of them hysterectomy

Based on the fact that IM is similar to HM, 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.

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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

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 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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SEE YOU IN NEXT 18TH WORLD CONGRESS OF ISSTD BANDUNG 2015