Hubungan Kadar βHCG Praevakuasi, Gambaran Histopatologi, dan Kista Lutein dengan Performa βHCG pada Penderita Mola Hidatidosa yang Berkembang Menjadi PTG dan Kembali Normal

Abstract

Insidensi penyakit trofoblas di Indonesia maupun negara berkembang masih cukup tinggi dibandingkan dengan negara maju. Hal yang perlu diwaspadai adalah terjadinya penyakit trofoblast gestasional (PTG) pascaevakuasi mola hidatidosa berkisar 10-20%. Beberapa variabel klinis telah diteliti sebagai variabel faktor risiko keganasan seperti kadar β-human chorionic gonadotropin (βHCG) praevakuasi, gambaran histopatologi, dan terdapat kista lutein. Tujuan penelitian ini adalah mengetahui hubungan kadar βHCG praevakuasi, gambaran histopatologi dan kista lutein dengan performa penurunan βHCG pada penderita mola. Metode penelitian yang digunakan adalah case control study pada penderita mola hidatidosa komplet di Rumah Sakit Dr. Hasan Sadikin Bandung selama periode tahun 2007-2011. Hasil penelitian menunjukkan hubungan bermakna kadar βHCG ≥100.000 mIU/mL dengan keganasan pascamola (p<0,05), terdapat hubungan bermakna gambaran histopatologi proliferasi berlebih dengan keganasan pascamola (p<0,05), dan terdapat hubungan bermakna kista lutein positif dengan keganasan pascamola (p<0,05). Simpulan penelitian ini adalah variabel kadar βHCG praevakuasi ≥100.000 mIU/mL, gambaran histopatologi proliferasi berlebih, dan kista lutein positif memiliki korelasi dengan keganasan pascaevakuasi mola. Variabel faktor risiko tersebut  dapat digunakan untuk memilahkan penderita mola hidatidosa komplet risiko tinggi atau risiko rendah untuk kejadian keganasan dan variabel faktor risiko keganasan tersebut berpengaruh pada performa penurunan kurva regresi βHCG.

Kata kunci: Gambaran histopatologi, kadar βHCG, kista lutein, mola hidatidosa komplit, PTG

Relationship between Pre-Evacuation βHCG Level, Histopathologycal View, Lutein Cysts and βHCG Performance in Patients with Hydatidiform Mole which Developed into Gestational Trophoblastic Disease (GTD) and Back to Normal

Abstract

The incidence of trophoblastic diseases in Indonesia and developing countries is relatively high compared to the developed countries. The incidence of gestational trophoblast tumors (GTT) after the evacuation of a hydatidiform mole ranges from 10% to 20%. Several clinical variables have been studied as the risk factors for malignancy, including the pre-evacuation level of beta human chorionic gonadotropin (βHCG), histopathological appearance, and the presence of lutein cysts. The purpose of this study was to determine the relationship between βHCG decline and pre-evacuation βHCG levels, histopathological features, and the lutein cysts status in patients with moles. This study was a case control study of patients with complete hydatidiform mole in Dr. Hasan Sadikin General Hospital during the period of 2007-2011. The results revealed that there was a significant correlation between the level of βHCG ≥100,000 mIU/mL and post-molar malignancy (p<0.05). There was also a significant relationship between the histopathologic feature of excessive post-molar cell proliferation and malignancy (p<0.05) and between the presence of lutein cyst and post-molar malignancy (p<0.05). This study concludes that the pre-evacuation βHCG level ≥100.000 mIU/mL, excessive proliferation, and the presence of lutein cysts are correlated with malignancy after molar evacuation. These risk factors are useful to differentiate whether a complete hydatidiform mole will become malignant or remain benign.

Key words: Beta human chorionic gonadotropin levels, histopathologic features, lutein cysts, complete hydatidiform mole, gestational trophoblast tumors

DOI: 10.15395/mkb.v46n4.345