BACKGROUND Gestational trophoblastic disease (GTD) encompasses a group of disorders that arise from abnormal growth of trophoblastic tissue. The spectrum of GTD includes 2 major groups: benign and malignant. The benign form is a hydatidiform mole, either complete or partial; the malignant forms, referred to as gestational trophoblastic neoplasia (GTN), consist of invasive moles, choriocarcinomas, placental site trophoblastic tumors, and epithelioid trophoblastic tumors. Most patients who undergo evacuation of a hydatidiform mole by curettage have a disease-free period before a new tumor develops that can be considered malignant. In rare cases, metastasis occurs rapidly and manifests coincidentally before the hydatidiform mole can be evacuated. CASE REPORT A 19-year-old woman in Bandung City, West Java, Indonesia, was diagnosed with a molar pregnancy with early evidence of a mass in her vagina that was suspicious for stage II GTN. The early emergence of a vaginal mass was a rare case of early transformation of a molar pregnancy into GTN. CONCLUSIONS Careful evaluation is warranted of patients with characteristics typical of an intrauterine molar pregnancy who have an early presentation of a vaginal mass because of the possibility that the diagnosis could be GTN.
Objective: To evaluate the ability of pulsatility index (PI), resistance index (RI), and hypoxia inducible factor-1α (HIF-1α) expression in predicting the clinical response after radiation in patients with cervical cancer. Methods: A prospective cohort was carried on in Department of Obstetric and Gynecology Dr. Hasan Sadikin Hospital/ Faculty of Medicine, Padjadjaran University, during the period of July 2017 to March 2018 which include 51 samples with stage IIB to IVA cervical cancer. Tumor perfusion and oxygenation were evaluated using color Doppler ultrasound indices (pulsatility index and resistance index) and the expression of hypoxia inducible factor-1α (HIF-1α). The clinical response was assessed 2 months after external radiation. Result: Among 51 patients, 31 patients demonstrated good response and 20 patients demonstrated poor response to radiation. The mean value of PI was significantly lower in patients who demonstrated good response as compared to patients with poor response (0.84±0.916 vs. 1.70±1.260, p = 0.004). The mean value of RI did not differ significantly (0.29±0.112 vs. to 0.36±0.189 p =0.173). HIF-1α expression was significantly lower in patients who demonstrated good response as compared to patients with poor response (1.83±1.529 vs. 6.55±2.625, p = 0.0001). In multivariate model, PI and HIF-1α expression both predicted the clinical response after radiation. Conclusion: PI and HIF-1α expression predict the clinical response after radiation in patients with cervical cancer.
This study was conducted to evaluate the effect of Calcitriol on cellular death in HeLa cells via autophagy and turn over due to mitochondria homeostasis.HeLa cell lines were grown in 24-well plates and treated with Calcitriol at varying doses (0.013 μM-0.325 μM) for varying time periods (2, 6, 12, and 18 h). Cell proteins were extracted with scrapers and lysed using RIPA buffer. Western blots were performed for proteins involved with autophagy (Lc3, p62), signaling (mTOR, PI3K, HIF1α), mitochondria (PGC1α, COX4, and Tom 20), and apoptosis (Caspase 3, Caspase 9, and PARP). Protein carbonyl levels were determined by measuring the indirect ROS level. An inhibition study using L-mimosine was performed to analyze the significance of HIF1α.Calcitriol treatment induced cytotoxicity in a dose- and time-dependent manner and caused growth arrest in HeLa cells. The PI3K-AKT-mTOR pathway was activated, leading to inhibition of autophagy and alterations in mitochondria biogenesis homeostasis. Treatment with Calcitriol produced protein carbonyl levels similar to those in the cisplatin-treated and control groups. Increased ROS levels may cause toxicity and induce cell death specifically in cancer cells but not in normal cells. The inhibition of HIF1α partially rescued the HeLa cells from the toxic effects of Calcitriol treatment.We suggest that Calcitriol may shut down mitochondrial homeostasis in HeLa cells by inducing the PI3K-AKT-mTOR pathway and inhibiting autophagy, which leads to cell death.
Tujuan : Mengetahui profil penderita kanker endometrium. Metode : Penelitian metode deskriptif dengan menggunakan data sekunder. Kriteria inklusi penelitian yaitu pasien dengan diagnosis kanker endometrium dilihat berdasarkan hasil histopatologi. Hasil : Distribusi pasien mayoritas berusia >50 tahun (62,0%), berasal dari Kota/Kabupaten Bandung (32,5%), memiliki indeks massa tubuh 18,5-22,9 kg/m2 (27,0%), multipara (36,5%), status postmenopause (59,0%), memiliki usia menarche ≥12 tahun (88,0%), tidak memiliki riwayat diabetes mellitus (66,0%) dan hipertensi (27,0%), terdiagnosis ketika stadium I (47,5%), dengan derajat diferensiasi baik/grade I (31,0%) dan tipe I endometrioid adenocarcinoma (82,5%). Terapi yang paling sering adalah tindakan operasi (50,0%) dengan tipe pembedahan histerektomi total dan salfingooforektomi bilateral (44,21%). Kesimpulan : Pasien kanker endometrium di RSUP Dr. Hasan Sadikin Bandung periode tahun 2017-2020 ditemukan paling banyak berusia >50 tahun, dari Kota/Kabupaten Bandung, indeks massa tubuh normal, multipara, postmenopause, usia menarche ≥12 tahun, tidak ada riwayat DM dan hipertensi, terdiagnosis pada stadium I dengan tipe I endometrioid adenocarcinoma dan derajat diferensiasi baik (grade I), serta dilakukan tindakan operasi dengan tipe pembedahan histerektomi total dan salfingooforektomi bilateral. Profile of Endometrial Cancer Patients in Dr. Hasan Sadikin Central General Hospital Bandung in 2017–2020 Abstract Objective : Identifying the profile of endometrial cancer patients Methods : This research used descriptive method by collecting secondary data. The inclusion criteria was patients with endometrial cancer diagnosis based on the histopathological results. Results : In this research, the majority of patients were aged >50 years (62,0%), came from Bandung City/Regency (32,5%), with body mass index of 18,5-22,9 kg/m2 (27,0%), multiparous (36,5%), postmenopause (59,0%), menarcge age of ≥12 years (88,0%), no history of diabetes mellitus (66,0%) and hypertension (27,0%), diagnosed at stage I (47,5%), with histopathological results well differentiated/grade I (31,0%) and type I endometrioid adenocarcinoma (82,5%). Surgery (50,0%) with the type of total hysterectomy and bilateral salpingoophorectomy (44,21%) was the most common treatment. Conclusion : In 2017-2020, endometrial cancer patient in Dr. Hasan Sadikin Central General Hospital Bandung were mostly found in the aged of >50 years, came from Bandung City/Regency, normal body mass index, multiparous, postmenopause, menarche age of ≥12 years, no history of diabetes mellitus and hypertension, diagnosed at stage I with histopathological result type I endometrioid adenocarcinoma and well differentiated (grade I), and the treatment was surgery with the type of total hysterectomy and bilateral salpingoophorectomy. Key words : Endometrial cancer, profile, risk factor
Tujuan : Penelitian ini bertujuan untuk mengevaluasi dan membandingkan penerapan dua metode diagnostik yang telah digunakan di RSHS, yaitu skor RMI dan Klasifikasi IOTA Rules untuk memprediksi keganasan suatu tumor ovarium selama periode 2017−2018 Metode : Penelitian ini merupakan penelitian komparatif dengan pengambilan data secara retrospektif. Sumber data diperoleh dari rekam medis pasien yang menjalani operasi pengangkatan dan pemeriksaan histopalogis tumor ovarium. Dilakukan pengumpulan informasi mengenai data USG, kadar CA125, skor RMI, klasifikasi IOTA Simple Rules, dan membandingkannya dengan luaran histopatologis. Hasil : 190 kasus tumor ovarium diteliti. 156 kasus (82,1%) memiliki luaran histopatologis ganas dan 34 kasus lainnya (17.9%) jinak. 178 kasus (93,68%) memiliki skor RMI ≥200 dan 12 kasus (6,32%) <200. sebanyak 78 kasus diklasifikasikan sebagai Malignant, 42 kasus Benign, dan 70 kasus lainnya Inconclusive dengan kriteria IOTA Simple Rules. Distribusi CA125 dan Skor RMI pada kedua kelompok luaran histopatologis berbeda secara bermakna (P<0,05). Sensitivitas dan spesifisitas klasifikasi IOTA Simple Rules di RSHS masing-masing 94,23% dan 97,06%, dengan menggabungkan kelompok IOTA inkonklusif dengan kelompok ganas. Penghitungan sensitivitas dan spesifisitas skor RMI memberikan nilai 95,51% dan 14,71% dengan menggunakan cut-off-point skor RMI 200. Kesimpulan : Sensitivitas dan spesifisitas klasifikasi IOTA Simple Rules lebih baik dibandingkan dengan skor RMI dalam memprediksi keganasan suatu tumor ovarium. Predictive Value Comparison of Risk-of-Malignancy Index (RMI) and IOTA Simple Rules in Predicting Ovarian Tumor Malignancy in Dr. Hasan Sadikin Hospital Bandung Abstract Objective : This study was done to evaluate and compare the use of RMI score & IOTA Simple Rule which has been routinely used in Hasan Sadikin Hospital to predict ovarian malignancy in 2017-2018 Method : This is a comparative study that collects data retrospectively. Data was obtained from medical record of patient who underwent ovarian tumor surgery, including USG report, CA125, RMI score, IOTA Simple Rules, and compared it with histopathological outcome. Result : 190 ovarian tumor cases was studied. 156 cases (82.1%) have malignant histopathological result and the other 34 cases (17.9%) were benign. 178 (93.68%) cases have RMI score ≥ 200 and 12 cases (6.32%) <200. As much 78 cases were classified as malignant, 42 cases (22.11%) were classified benign, and the other 70 cases were classified inconclusive using IOTA Simple Rules. CA125 and RMI Score distribution on both histopathological group differs significantly (P<0.05). IOTA Simple Rules shows sensitivity and specificity of 94.23% and 97.06% respectively, when inconclusive and malignant results were grouped together. RMI Score showed sensitivity and specificity of 95.51% and 14.71% respectively using cut-off point of 200. Conclusion : IOTA Simple Rules performs better than RMI in predicting ovarian tumor malignancy. Key words : Ovarian cancer, IOTA, RMI, USG, CA125
Tujuan : Penelitian bertujuan mengetahui faktor risiko kejadian TTG pasca evakuasi, untuk memprediksi penderita molahidatidosa yang berkembang menjadi TTG atau kembali normal. Metode : Menggunakan studi case control retrospektif dalam waktu 1 Agustus 2013 - 1 Agustus 2018. Populasi penelitian, penderita molahidatidosa yang datang dan dirawat pada Obstetri dan Ginekologi RSUP Hasan Sadikin. Hasil : Terdapat 59 pasien high risk, dan 67 pasien low risk. Probabilitas <0,05 terdapat hubungan signifikan antara usia dengan kejadian TTG. Probabilitas 0,031, terdapat hubungan signifikan antara paritas dengan kejadian TTG. Dengan uji Fisher Exact terdapat hubungan bermakna antara kadar βHCG praevakuasi dengan kejadian TTG (p value =<0,001), dan hubungan bermakna antara gambaran PA dengan kejadian TTG (p value =<0,001). Dengan uji Spearman Correlation terdapat hubungan yang bermakna antara kadar βHCG Praevakuasi dengan gambaran PA (p value <0, 001). Kesimpulan : Terdapat hubungan yang bermakna antara usia, paritas, BHCG, Patologi Anatomi, dengan kejadian TTG pasca evakuasi molahidatidosa. Dari analisis multivariat dengan uji regresi logistic didapatkan bahwa BHCG dan PA yang merupakan faktor risiko TTG. Risk Factors Trofoblas Tumor of Post Evacuation Of Hydatidiform Mole in Dr. Hasan Sadikin General Hospital Bandung Period August 2013−August 2018 Period Abstract Objective : This study aims to determine the risk factors for GTT events after HM evacuation, used to predict patients who will develop into GTT or return to normal. Methods : Case control study (retrospective) was conducted from August 1st 2013 −August 1st 2018. Population of this study was all patients with HM who came and treated at the RSHS Obstetrics and Gynecology Department. Result : There are 59 high risk, 67 low risk patients. The probability value is 0.015, (<0.05) there is a significant relation between age and the incidence of GTT. The probability value of 0.031, there is a significant relationship between parity and the incidence of GTT. Fisher Exact test, significant relation between pre-evacuated βHCG levels and GTT events (p value = <0,001), and significant relation between Pathology Anatomy result and GTT events (p value =<0,001) was found. Spearman Correlation test, there was significant relation between levels of βHCG pre-evacuation with Pathology Anatomy result (p value <0, 001). Conclusion : There is a significant relation between age, parity, BHCG, Pathology Anatomic result, and the incidence of GTT after evacuation of HM. From multivariate analysis with logistic regression test, it was found that BHCG and pathology anatomic were risk factors for GTT. Key words : Molahidatidosa, Gestational Trophoblast Tumor.
BACKGROUND: Ovarian cancer is the most dangerous gynecologic cancer and one of the top five causes of cancer death in women. One of the intraoperative strategies to diagnose and manage women with ovarian cancer is by doing intraoperative frozen section examination during surgery, but not all hospitals in Indonesia have this facilities, thus makes it difficult to achieve intraoperative diagnosis, which lead to substandard management of patients with ovarian cancer. AIM: The purpose of this study is to investigate if one can determine whether an ovarian tumor is benign or not based on the gross appearance of the tumor. METHODS: This study is a comparative, analytic, and cross-sectional study to compare the results of operator’s assessment with the results of intraoperative frozen section examination in determining malignancy during surgery. After the tumor was removed, it was assessed by operator based on the gross appearance of the tumor whether the tumor was benign or not, then the tumor underwent frozen section examination, and based on the frozen section examination results, the patient was treated accordingly. Both of the results then compared to the histopathologic (paraffin block) results, as the gold standard of pathologic diagnosis. RESULTS: This study shows that variables ascites, tumor seedings, tumor surface, tumor consistency, tumor lobes, and lymph node enlargement are statistically significant (p < 0.05). The combinations of highly significant variables (p < 0.01) show that a combination of ascites and irregular tumor surface give the suggestions that an ovarian is highly likely a non-benign tumor. CONCLUSION: In the absence of intraoperative frozen section examination in a hospital, operator’s assessment based on gross appearance of the tumor can be used as a substitute for intraoperative frozen section examination to determine the malignancy of an ovarian tumor during surgery.
Background: Clear cell ovarian carcinoma (CCOC) is a type of epithelial ovarian cancer, representing 5-11% of ovarian cancers.CCOCs tend to occur in the fifth to seventh decades of life, with only 10% of cases occurring in the fourth decade.On the other side, papillary thyroid carcinoma is the most common histology type of thyroid carcinoma and is associated with locoregional spread.Herein, we present a rare case of double-primer ovarian and thyroid cancer, which is a clear cell ovarian carcinoma metachronous with papillary thyroid carcinoma.Case Report: A 47-year-old nulliparous woman presented to our Gynecology Oncology facility with an abdominal mass that had progressively increased in size over the last three months.She had a history of papillary thyroid cancer ten years previously and was treated with radioiodine (I-131).Physical examination revealed an immobile abdominal cystic mass measuring 20 × 18 × 15 cm.Ultrasound imaging revealed a cystic mass with a solid part, measured 16.1 × 10.9 × 12.84 cm, with M4 feature of the IOTA simple rule.CA-125 tumor marker levels were 190.1 U/mL.Ovarian cancer was suspected, and surgical staging with total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, frozen sectioning, and adhesiolysis was performed.Histopathological examination revealed a clear cell ovarian carcinoma.Discussion: Papillary thyroid carcinoma tends to be a locoregional metastasis, whereas distant metastases are rare.Distant metastasis often occurs decades after the primary tumor, with the most common metastatic sites being the lungs and bones.This raises an important clinical question concerning the etiology of the ovarian carcinoma: whether it represents a metastasis from the pre-existing thyroid carcinoma or a distinct primary neoplasm.Determining the precise relationship between these malignancies is crucial for guiding treatment strategies and understanding the biological behavior of the tumors involved.In this case, clear cell ovarian carcinoma arose separately from papillary thyroid carcinoma.Conclusion: Double primer cancer of the ovary and thyroid, which is a clear cell ovarian carcinoma metachronous with papillary thyroid carcinoma, is possible.
Tujuan: Kegiatan ini untuk menganalisis pengetahuan kanker payudara dan serviks tenaga kesehatan di faskes pertama kabupaten Bogor.Metode: Pelatihan deteksi dini kanker serviks dan payudara tenaga kesehatan di faskes pertama kabupaten Bogor dilakukan 6 hari melalui kuliah, dry lab, dan praktik lapangan. Dilakukan pre-test dan post-test untuk menilai pengetahuan tenaga kesehatan faskes pertama kabupaten Bogor.Hasil: Dari 75 responden perwakilan dari Puskesmas di kabupaten Bogor, 6,67% melakukan pelayanan deteksi dini kanker payudara dan 4,00% melakukan pelayanan deteksi dini kanker serviks. Pengetahuan responden setelah diklat, 100% responden menjawab benar tanda klinis IVA test negatif, pembacaan hasil IVA test setelah 1 menit, anjuran setelah krioterapi, tidak berhubungan selama 4 minggu setelah krioterapi, langkah pemeriksaan payudara, hal yang dilakukan bila menemukan kelainan pada payudara dan setelah digunakan, spekulum didekontaminasi 10 menit direndam dalam larutan klorin 0,5%. Pengetahuan meningkat signifikan mengenai perubahan leher rahim yang abnormal hampir selalu terjadi pada sambungan skuamo-kolumnar, yaitu naik 42,67% (56,00%pada menjadi 98,67% pada post-test).Kesimpulan: Terdapat peningkatan pengetahuan dan keterampilan setelah pelatihan kanker payudara dan serviks, terutama deteksi dini lesi prakanker serviks dan payudara, sehingga dapat disimpulkan upaya pelatihan penting untuk meningkatkan pengetahuan dan keterampilan deteksi dini kanker payudara dan serviks.Knowledge of Healthcare Providers on Early Detection of Breast Cancer and Precancerous Cervical LesionsAbstractObjective: This community service program aims to analyze the level of knowledge of breast cancer and cervical cancer by providing solutions through training for healthcare providers at primary health facilities in Bogor Regency.Method: Training on early detection of cervical cancer and breast cancer for doctors and midwives at primary health facilities at the Bogor Regency health office. The training was carried out for 6 days and was divided into lecture delivery, dry lab, and fieldwork practice at Padasuka Health Center and Puter Health Center. Pre-tests and post-tests were carried out to assess the level of knowledge of healthcare providers at primary health facilities in Bogor Regency.Results: Out of 75 representative respondents from each health center in Bogor Regency, 6.67% provided early detection of breast cancer, and 4.00% provided early detection of cervical cancer. As for respondents’ knowledge after being given training, as many as 100% of respondents answered correctly about the clinical signs of a negative VIA test reading the VIA test results after 1 minute, recommendations after cryotherapy, not to have sexual intercourse for 4 weeks after cryotherapy, steps for breast examination, what to do if they find abnormalities in the breast and after use, and the speculum that should be decontaminated for 10 minutes by immersion in 0.5% chlorine solution. Respondents’ knowledge significantly increased regarding abnormal cervical changes-dysplasia almost always occurred in the squamous columnar junction, which went up 42.67% (from 56.00% on the pre-test to 98.67% on the post-test).Conclusion: There was an increase in knowledge and skills after being given training on breast cancer and cervical cancer, especially knowledge about early detection of precancerous cervical lesions and breast cancer, so it can be concluded that training efforts are very important to increase knowledge and skills for early detection of breast cancer and cervical cancer.Key words: cervical cancer, breast cancer, VIA test
Abstrak Tujuan : Mengetahui hasil luaran tindakan operatif pada kanker serviks, endometrium dan ovarium di RSUP Dr. Hasan Sadikin. Metode : Jenis penelitian dengan mengevaluasi data pasien kanker serviks, endometrium dan ovarium dengan tindakan operatif dari Bagian Rekam Medik RSUP Dr. Hasan Sadikin, Bandung dari Januari 2015−Desember 2016. Variabel yang dievaluasi berupa usia, BMI, paritas, asal kanker, jenis dan komplikasi tindakan operasi. Hasil : Terdapat 560 kasus yang sesuai dengan kriteria inklusi dari Januari 2015−Desember 2016. Nilai tengah usia pasien 45 tahun, dengan 222 pasien (39,6%) memiliki BMI normal dan 413 pasien (73,8%) dengan kanker ovarium. Perdarahan >2000 cc terdapat pada 141 kasus (25,2%). Durasi operasi terbanyak 3−4 jam pada 208 kasus (37,1%). Komplikasi saluran gastrointestinal sebanyak 40 kasus (7,1 %) dan saluran genitourinaria sebanyak 28 kasus (5%). Nilai tengah length of stay selama 7 hari, dengan 47 pasien (8,4%) memerlukan ICU dan kematian terjadi pada 20 kasus (3,6%). Kesimpulan : komplikasi tersering adalah perdarahan. Tindakan operatif pada kanker serviks lebih berkaitan dengan cedera saluran genitourinaria, sedangkan tindakan operatif pada kanker ovarium lebih berkaitan dengan cedera saluran gastrointestinal. Evaluation of Operative Procedures on Cervical, Endometrial and Ovarian Cancers in Dr. Hasan Sadikin General Hospital Bandung 2015 ̶̶̶ 2016 Abstract Objectives : To evaluate the post-operative outcomes in patients with cervical, endometrial, and ovarian cancers in Dr. Hasan Sadikin General Hospital in 2015−2016. Method : We retrospectively evaluated cross-sectionally the charts of these three cancer patients who underwent operative procedures from January 2015 to December 2016 in Dr. Hasan Sadikin Hospital. The following study variables were noted for evaluation: age, BMI, parity, cancer origin, type of surgery, and operative complications. Results : A total of 560 oncologic surgery from these three cancers was undertaken and met the inclusion criteria from January 2015 to December 2016. Median age was 45 years old, with 222 (39,6%) patients had normal BMI and 413 (73,8%) patients belonged to ovarian cancer. Operative complications such as bleeding >2000cc were reported in 141 (25,2%) cases. The most common length of surgery time was 3−4 hours in 208 (37,1%) patients. A total of 40 (7,1%) gastrointestinal and 28 (5%) genitourinary tract injuries were encountered. Median length of stay was 7 days, post-operative staying at ICU was noted in 47 (8,4%) patients and 20 (3,6%) had intraoperative-related deaths. Conclusion : The most common complication is bleeding.The operative procedure of cervical cancer is more related to injury to the genitourinary tract, while gastrointestinal tract injury mostly occurs in the operative procedure of ovarian cancer Key words : Gynecological oncology, surgery and complication
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