Edit Cytopathology and Histopathology PIT (14!9!2013)

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Curriculum Vitae

• Nama: Dr. dr. Junita Indarti, SpOG• Tempat/Tanggal Lahir : Jakarta, 13 Juni 1959• Jabatan:

– epala !i"i#i $inek%l%gi &pe#iali#tik

!epartemen 'b#tetri ( $inek%l%gi )*+ – &C- – epala *nit .%liklinik ebianan

!epartemen 'b#tetri ( $inek%l%gi )*+ – &C-

– etua Clu#ter 0%men# 2ealth Center &C- encana !epartemen 'b#tetri ( $inek%l%gi )*+ – &C-

• +n#tan#i: – )akulta# e%kteran *ni"er#ita# +n%ne#ia/

&*.N r Cipt% -angunku#um%, Jakarta

• .eniikan: – &1 : )*+, lulu# tahun 1943 – &p1 : )*+, lulu# tahun 1993 – &3 : &3 e%kteran )*+, lulu# tahun 669

• .eniikan Tambahan: – ur#u# &it%pat%l%gi, tahun 1993

!epartemen 'bgin )*+ – &C- 73 bulan8 – Ct%path%l%g an C%lp%#c%p C%ur#e, tahun 199

&ne, ;u#tralia 73 bulan8


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Cytopathology and HistopathologyCytopathology and Histopathology

of Pre-Cancerous Lesionof Pre-Cancerous Lesion

Dr.dr. Junita Indarti, SpOG

Departeen O!stetri " Gine#ologi

$a#ultas %edo#teran &ni'ersitas Indonesia

(S&P) dr. Cipto *angun#usuo

Ja#arta


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Ct%path%l%gCt%path%l%g

%< .re=Cancer%u# Le#i%n%< .re=Cancer%u# Le#i%n


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+S S%(I)I)G LSI P( %)%(+S S%(I)I)G LSI P( %)%(

S%(I)I)G SI+OLOGI+es Pap %on'ensional+es Pap +hin Prep

+es Pap )et

S%(I)I)G )O) SI+OLOGI +e#ni# isual

- I

- Ser'i#ografi

- Spe#ulos#opi

+e#ni# )on isual - +es D) HP

- Polar pro!e /+ruescan0


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.erkembangan Termin%l%gi 2a#il Te# .ap.erkembangan Termin%l%gi 2a#il Te# .ap

1234 Papanicolaou

1254 Displasia - %arsinoa Insitu /(eagan0

1267 Neoplasia Intraepitel Serviks (Richart RM)

1288 The Bethesda System

1229 *odifi#asi )eoplasia Intraepitel Ser'i#s

1229 :ritish Society for Clinical Cytology

1221 The Bethesda System

;991 The Bethesda System


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$a#tor (esi#o

)oral Pra#an#er

Sitologi/tes Pap0tiologi

%an#er

ser'i#s


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&it%l%gi &er"ik# N%rmal

• !itemukan paa te# .ap ari apu#an #er"ik#

• &el mengalami ek#


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&el epitel #kuam%#a #er"ik#• &el primiti< atau reserve cells

• &el ba#al an #el paraba#al• &el intermeiet

• &el #uper


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Sitologi noral

Sel superfisial

• :er!entu# poligonal < dari sel

interediet• uran sel ;599-3599 ;

• uran inti sangat #ecil 19-;5 ; dan #ondensasi /pi#noti#0

• Sitoplasa !er=arna eosinofilli#

• +ida# !er#elopo#, !iasanya flat


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Sitologi )oral

Sel Interediet

• uran inti ;5-;7 ;

uran sel 1;99-4999 ;

/)>C (atio rendah0

• Inti 'esi#uler, #roatin halus

• :entu# sel poligonal,

• Sitoplasa sianofili#

• +epi sitoplasa dapat

enggulung


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Sitologi )oral

Sel para!asal

• Sel !er!entu# !undar dan

o'al ? 195-1;99 ; • uran inti 35-29 ;

• %roatin halus• Diteu#an pada =anita usia

tua atau pada =anita uda

dengan inflaasi atau

defisiensi estrogen


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Sitologi )oral

Sel ndoser'i#s

• Inti !ulat, u#uran ;5-35 ;

• uran sel 159-4999 ;

• %roatin halus dengan 1-;

nu#leoli• Sitoplasa terdapat 'a#uola

halus>#asar • Pada #eadaan inflaasi?

sel ultinu#leolus

endoser'i#s


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SL *+PLSISL *+PLSI


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Sitologi !noralSitologi !noral


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.aanan Termin%l%gi Te# .ap

Cla## + Cla## ++ Cla## +++ Cla## +V Cla## V

N%rmal +n


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Sel S#uaosaSel S#uaosa

- typical s@uaous cell of undeterine significance- typical s@uaous cell of undeterine significance

/SC&S0/SC&S0

- Lesi intraepitelial s#uaosa deraAat rendah- Lesi intraepitelial s#uaosa deraAat rendahHPHP

)IS 1 > Displasia ringan)IS 1 > Displasia ringan

- Lesi intraepitelial s#uaosa deraAat tinggi- Lesi intraepitelial s#uaosa deraAat tinggi

)IS ; > Displasia sedang)IS ; > Displasia sedang

)IS 4 > Displasia !erat)IS 4 > Displasia !erat

)IS 4 > %arsinoa in situ)IS 4 > %arsinoa in situ

- %arsinoa Sel S#uaosa- %arsinoa Sel S#uaosa

SI+OLOGI :)O(*LSI+OLOGI :)O(*L


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Sitologi !noral

SC&S

• Sitoplasa irip dengan sel

Interediet

• )u#leus ;-4B u#uran sel

Interediet• )oro#roatin sapai

hiper#roatin ringan

• )u#leus !ulat tanpa atau dengan

inial iregularitas

• +ida# ada efe# HP• :iasanya sel terisolasi /#ecuali

pada atypical repair)


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Criteria for the diagnosis of LGSIL

Cells accur singly or in sheets Cells deonstrate cytoplasic aturation =ith

distinct !orders

)uclei are 3-6 ties the sie of noral interediate

cell nuclei*oderate 'ariation in nuclear sie :inucleation ay !e present*ild hyperchroasia of nuclei*ild nuclear en'elope irregularities

&niforly distri!uted, usually finely granularchroatin

!sent nucleoli Huan papilloa'irus cytopathic effect often

proinent


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LGSIL > HP

Sel %oilosit Dis#eratosis


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LGSIL > )IS 1LGSIL > )IS 1


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Criteria for the diagnosis of HGSIL

Cells arraged singly or in syncytiu-li#earrageents /carcinoa in situ0

Saller cells =ith cytoplas rese!ling that of

iature s@uaous etaplastic cells orpleioorphic #eratinied cells

Decreased nuclear sie, !ut ar#edly increasednuclear-to cytoplasic ratio

Increased hyperchroasia Increased nuclear en'elope irregularities

Increased chroatin cluping

)ucleoli a!sent

HGSILHGSIL


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HGSILHGSIL


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ar#in%ma #el #kuam%#a #er"ik#


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&@L $L;N!*L@

• ;tipik 7N'&8 : &el en%#er"ik#, en%metrium,glanuler

• ;tipik 7favor neoplastic 8 : &el en%#er"ik#, glanuler • ;en%kar#in%ma in#itu #er"ik# 7;+&8

• ;en%kar#in%ma : @n%#er"ik#, en%metrium,

ek#trauterin, N'&

SITOLOGI ABNORMALSITOLOGI ABNORMAL


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Atypical Glandular Cells


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;!@N';&+N'-;+N&+T* &@V+&


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;en%kar#in%ma #er"ik#


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2i#t%path%l%g2i#t%path%l%g

%< .re=Cancer%u# Le#i%n%< .re=Cancer%u# Le#i%n


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Lesi Pra %an#er Lesi Pra %an#er %an#er %an#er

Infe#si Displasia Displasia Displasia %IS %arsinoa HP ringan sedang !erat

4 tahun

3 - 20 th

NATURAL HISTORY KANKER SERVIKS


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N@'.L;&+; +NT;@.+T@L+;L &@V+& 7N+&8

N+&.r%li


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= -atura#i paa ua pertigabagian ata#

= &el #uper


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!+&.L;&+; &@!;N$ / N+&

= -atura#i #etengah bagian ata#

= ;tipia inti Aela#

= -it%#i# terbata# ua pertiga ba#al= -it%#i# abn%rmal 7B8


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!+&.L;&+; ?@;T / N+& 3

= Tiak terapat matura#i atau

terbata# #epertiga ata#

= ;tipia inti Aela#

= -it%#i# bi#a banak an paa#eluruh lapi#an

= -it%#i# abn%rmal #ering itemukan


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+N)@&+ 2.V


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;!@N';&+N'-; +N&+T* &@V+&


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%(SI)O* SL S%&*OS S(I%S

&it l i l k i 2i t t l i


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Patologi natoi%lini#us>%olpos#opi

Sitologi

&it%l%gi = %lp%#k%pi = 2i#t%pat%l%gi


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e#impulan

• .emahaman ha#il pemerik#aan #it%l%gi

7pap #mear8 an hi#t%pat%l%gi penting

alam penatalak#anaan le#i pra kanker

#er"ik#

• 2a#il hi#t%pat%l%gi #ebagai a#ar

tinakan/ peng%batan paa le#i pra

kanker #er"ik#


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erima Kasih

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