Role of immunoexpression of cyclin D1, D3, retinoblastoma (Rb) mutant and clinical risk factors on complete mole as risk factors of persistent mole

Abstract

<p>Introduction: Changes in complete hydatidiform mole (CHM) that become persistent are difficult to handle because the malignant pathogenesis of CHM is still unclear. The growth of abnormal cells in CHM is thought to be caused by cell cycle abnormalities. Some components that play a role in this phase include cyclin D and retinoblastoma (Rb). The aim of our study was to determine the role of clinical risk factors, as well as cyclin D1, cyclin D3 and Rb-protein, in the occurrence of persistent moles. Materials and Method: This study involves 68 CHM cases at Dr. Hasan Sadikin Hospital from 2007–2011. The protein expression of cyclin D1, cyclin D3, and Rb were determined by immunohistochemistry. The results were analyzed by comparing the two groups of CHM that became persistent to those that returned to normal, as determined by a Mochizuki regression curve assessment. Results: 20 cases (29%) of CHM became persistent and that 48 cases (71%) returned to normal. Significant clinical variables were age (p <0.05), histopathology (p <0.00) and βhCG (p <0.05). The immunoexpression of cyclin D1 (1.42), cyclin D3 (1.41) and mutant Rb (1.77) in the CHM cases that became persistent was higher than the CHM cases that returned to normal. The statistical analysis showed a significant difference in the immunoexpression of cyclin D1 (p ≤0.05) and Rb (p ≤0.05), whereas cyclin D3 immunoexpression were not significant (p >0.05). Conclusion: There is a strong relationship between clinical risk factors of age, excessive proliferation histopathology, serum βhCG levels ≥100,000 mU/mL, cyclin D1 and Rb mutations with the incidence of persistent moles after the evacuation of the CHM. We proposed a model to predict the risks of persistent moles with a cut-off point of 2.384, which can be used as a reference for patients with CHM.</p>