Mola Hidantidosa

&
Gestational Trophoblastic
Neoplasma
Klasifikasi
 PATHOGENESIS

Complete mole

Partial mole

HETEROZYGOTE
complete partial
Risk Factor

• The 2 established risk factors that have emerged are extremes of maternal
age and prior molar pregnancy
• the risk of complete mole is 1.9 times higher for women both > 35 years
and 21 years as well as 7.5 times higher for women > 40 years.
• spontaneous abortion, giving women a 2- to 3-fold increased risk of a
molar pregnancy compared to women without a history of miscarriage.
• Environmental etiologies for complete mole have been studied, the only
consistent association has been an inverse relationship between -carotene
and animal fat dietary intake and the incidence of molar pregnancy.
• Risk of repeat molar pregnancy after 1 mole is about 1%
Etiopatologi
GTN atau Mola persisten
When is postmolar GTN Diagnosed ?
• The diagnosis of GTN is made on the basis of elevated hCG levels
supported, if possible, by histologic or radiologic evidence. The agreed
criteria to diagnose GTN include:
1. At least 4 values of persistently elevated hCG plateau (hCG +- 10% days 1, 7, 14,
and 21) or longer, or sequential rise of hCG for 2 weeks (days 1, 7, 14) or longer.
The actual values of hCG are left to the discretion of individual physicians.
2. Lung metastases are diagnosed by chest X-ray.
3. Rise of serum hCG > 10 % during 3 weekly consecutive measurements or longer
for 2 weeks (days 1, 7, 14)
4. The serum hCGlevels remains detectable for >= 6 months*
5. Histopatological criteria for choriocarcinoma*
* FIGO Oncology Committee, 2002
Treatment
PSTT : Placenta site trophoblastic Tumor
Kemoterapi
TRIAS Acosta Sison
• “HBSL”
• History : post mola hidatinosa
• Post abortus : Postpartum
• Bleeding : Terjadi perdarahan berkelanjutan
• Softness : perlunakan rahim
• Enlargement : Pembesaran uterus

DIDUGA KEGANASAN
Tes Klasik
• Hanifa Test  sondase ke intrauterin putar 360 , tidak ada tahanan
• Acosta sison Test  masukkan sonde ke uterus, tidak ada tahanan,
sonde diputar setelah ditarik sedikit, bila tetap tidak ada tahanan
mungkin mola
• Hogben test  injeksi 2 cc urin wanita hamil ke kodok betina (lihat
telur kodoknya muncul setelah 12-24 jam)
• Galli Mainini test  injeksi 5 cc urin wanita hamil ke bawah kulit
perut kodok jantan (Lihat sperma di air kemih kodok setelah 3 jam
post injeksi)
Tahap perkembangan payudara
• Mamogenesis  puncak pada kehamilan (B Hcg, esterogen dan
progesteron plasenta)
• Laktogenesis  menurun hormon esterogen dan progesteron
plasenta berakhir mulai trimester ke 3 berakhir setelah kala 3
(plasenta lepas) , reseptor prolaktin , asi keluar
• Galaktopoesis  fase mempertahankan asi (stimulasi dengan isapan
putting)