Blok 3.

1
Tahun 2018

Breast and Urogenital

Tract Tumors
dr. Aswiyanti Asri,M.Si.Med,SpPA
 Fibroadenoma mammae
 Tumor jinak, ok estrogen , 20-35 th
 Diameter 3 – 10 cm, “berkapsul semu”, putih, ke
abu-abuan, nekrosis (-)
 Soliter, multipel
 Jenis : Perikanalikular, Intrakanalikular, both
 Complex FAM
 Mikroskopik : Jaringan ikat , sel epitel kelenjar
Fibroadenoma mammae peri et intrakanalikulare

perikanalikulare

intrakanalikulare
 Intraductal proliferative lesions

• Usual Ductal Hyperplasia

(UDH)
• Atypical Ductal Hyperplasia
(ADH)
Atypical Ductal Hyperplasia

Ducts are filled with

markedly atypical
cells
1 dari 9 wanita
0.5% pada laki-laki
Prognosis tergantung stadium
90% pada tumor terlokalisir, 77% bila disertai
metastasis KGB
50-70 tahun
Peringkat pertama di Sumbar.
diet, faktor reproduktif, hormon, western lifestyle
BRCA1 dan BRCA2
 Genetic Predisposition

• Positive Family history

• 5-10% of cancers related to specific inherited
gene mutations
• BRCA1 and BRCA2 gene mutations
• Li Fraumeni syndrome –germline mutation
of TP53
• Cowden syndrome -germline mutation in
PTEN.
 Carcinoma of Breast
Carcinoma in situ (15-30%)

Ductal carcinoma in situ

( including Paget’s disease of the nipple)

Lobular carcinoma in situ

Ductal carcinoma in situ
 Lobular carcinoma in situ

Neoplastic cells filling the acini are small and uniform

 Invasive carcinoma of No Special
Type (NST)

• Dulu : Invasive ductal carcinoma

• Terbanyak
• 1 cm – 10 cm
• Tumor iregular, keras, pinggir tidak tegas
• Tidak memenuhi kriteria mikroskopik
subtipe lainnya
Invasive carcinoma of NST
IDC/invasive NST vs ILC/invasive lobular Ca
NST dan karsinoma invasif lainnya.
Modified Elston & Ellis.
> 75%; 10-
75%; <10%

Small, regular, uniform; Tergantung

Moderate; microscope field
Marked variation area (mm)
Carcinoma of breast : Prognostic factors

Lymph node status/ Size /Grade (NPI)

Histologic type
Hormone receptor status
Lymphovascular invasion
Proliferative rate/ DNA content
Oncogene expression eg HER2 NEU
Gene expression profiling
 Prognostic markers
Estrogen Reseptor/ER Nuclear staining,
Proporsi : < 20% 20 - 50 % 50 - 80 % > 80%Intensitas :
Kuat Sedang Lemah Intensitas : bisa dibandingkan dengan
kontrol eksternal atau kontrol internal (Kontrol internal dari kelenjar
payudara normal pada slaid yang sama)

Progesteron Reseptor/PR Nuclear staining,

Proporsi : < 20% 20 - 50 % 50 - 80 % > 80%Intensitas :
Kuat Sedang Lemah Intensitas : bisa dibandingkan dengan
kontrol eksternal atau kontrol internal (Kontrol internal dari kelenjar
payudara normal pada slaid yang sama)

HER2/CerbB2 Membran cell staining> 0 : no staining atau < 10%+ 1 : > 10%,
incomplete+ 2 : > 10% incomplete staining, sedang/lemah; atau
< 10% tapi complete+ 3 : > 10%, complete, kuat

Ki-67 Nuclear staining< 20%> 20%

Topoisomerase Nuclear staining, Persentase sel yang terwarnai

Phylodes tumor
Malignant phylodes tumor
FNAB pada breast cancer
A. KONFIRMASI
GANAS/TIDAK
B. MARGIN TUMOR
 GENE EXPRESSION PROFILE :
-genetic classification-
5 distinct patterns of gene expression which define “intrinsic” molecular subtypes
1. Luminal A – low grade, ER + high level
2. Luminal B – high grade, ER + low level, (some HER2+)
3. Basal type – high grade, ER-, HER2 -, CK5/6,14 and 17+, EGFR+ TNBC
(triple negative breast cancer)
4. HER2 + type – HER2+, ER -
5. (Normal Breast type)

Perou, Sorlie 2000, 2001

ALLPPT.com _ Free PowerPoint Templates, Diagrams and Charts
Cervical Cancer
Squamous cell carcinoma cervix
 Endometrial carcinoma

Endometrioid carcinoma, villoglandular Papillary serous adenocarcinoma

variant (tipe I) (tipe II)
 Leiomyoma uteri
• most common
uterine neoplasm
• asymptomatic -
menometrorrhagia
• intramural,
submucosal,
subserosal
• fundus >>
Ovarian tumor
• Indonesia : urutan ke-3
• Penyebab kematian tertinggi
• Faktor risiko : nullipara, mutasi BRCA1/2
• Etiologi : belum pasti; diduga trauma berulang pada
epitel permukaan
• usia bervariasi (remaja - dewasa tua)
• Tatanama berdasarkan asal sel
• Kistik/solid/campuran
• Gejala dini tidak jelas; lanjut ; akibat penekanan
massa tumor
• terbanyak : epithelial ovarian tumors/EOT
• EOT terbanyak : serous tumors
Estimated age-standardised incidence and mortality rates: women

BRK 2010
- Payudara
- Serviks
- Ovarium

Globocan, 2012
5-Year Relative Survival
 New highlight in
2014 WHO Classification in
Ovary tumour

• What is the benefit with this newer

classification :
– Simplicity

– Straight rules to categorize 

Semi quantitative criteria :
• Micro invasion
• Expansile pattern

• Scope of today presentation :

– Epithelial type of ovarian tumour
related with limited time and most
of the common cases in ovary
tumour
Klasifikasi EOT

• WHO 2003 • WHO 2003

• serous tumors
• mucinous tumors
• Squamous cell tumors
• clear cells tumors
• transitional tumors
• undifferentiated Ca
• endometrioid tumors
• mixed epithelial tumor
• serous tumors
• mucinous tumors
• seromucinous tumors
• clear cells tumors
• brenner tumors
• undifferentiated Ca
• endometrioid tumors

benign - borderline -
malignant : t.u tipe I
Pathogenesis
• Historically, almost all serous cancer involving ovarium,
considered to arise primarily in the ovary.
• Traditional model of ovarian carcinogenesis :
– Metaplastic change of surface mesothelium
– Repeated trauma due to ovulation
– Mutational event
• New finding in research to women with BRCA mutation,
underwent “risk reducing salpingo-oophorectomy
procedure” :
•  Tuba origin as source of high grade serous carcinoma
 EOC Grading histologik

Fakultas Kedokteran Universitas Andalas

Skor Arsitektur Atipia Mitosis/10
Sitologik HPF
1 Glandular Ringan 0–9

2 Papillary Sedang 10 – 24

3 Solid Berat ≥ 25

Skor total 3 – 5 = grade 1; 6 – 7 = grade 2; 8 – 9 = grade 3

Gambaran mitosis dinilai dari bagian yang paling aktif, field area = 0,345 mm2

Silverberg grading system

Serous tumors

• Benign - borderline - malignant : tipe I

• malignant : LGSC (tipe I) dan HGSC
(tipe II)
• mutasi p53
• EOC terbanyak
• 60% bilateral
• > 80% stadium lanjut
Pathogenesis
Serous carcinoma ovary
Imunohistokimia pada Ca ov.serosum
Mucinous tumors

• benign -borderline - malignant

• unilateral
• usia reproduktif (rata-rata 45 tahun)
• prognosis (malignant) tergantung
stadium dan invasi stroma
• kemoresisten
Cystadenoma ov.mucinosum
borderline malignancy

Cystadenocarcinoma
ov.mucinosum
 Germ cell tumor
• Usia muda
• Behaviour bervariasi (low-high
malignant)
• Yolk sac : prognosis lebih buruk dari
epithelial
• Bisa subtipe campuran : slide diambil
dari banyak tempat
2018/11/5 copyright (your 60
organization) 2003
Germ cell tumor : yolk sac tumor vs
choriocarcinoma
Schiller duvall body : yolk sac
tumor

2018/11/5
Mola Hidatidosa

2018/11/5
2018/11/5
Bethesda system

2018/11/5
Operatif

• Dugaan keganasan ovarium

• HTSOB + cairan + omentum
• Subtipe, diferensiasi
• Borderline : stromal invasion
• Harus dipastikan adakah infiltrasi sel tumor
ke setiap organ/jaringan (uterus, cervix etc)
• Endometrium : kedalaman invasi (untuk
stadium)
Hiperplasia prostat
• Hormonal
• Urinary obstruction
• Hiperplasia diikuti hipertrofi prostat
• Pertambahan kelenjar dan stroma
prostat
• Kadang disertai prostatitis
• PIN (low dan high grade) : risiko
prostat cancer
Adenocarcinoma prostat
• Tumor ganas paling banyak pada laki-
laki (> 50 tahun)
• Androgen
• Lobus posterior
• PIN
• Gleason score system
• Tumor marker (PSA) untuk follow up
paska operasi
Other tumors ?

• Sangat banyak
• Primer dan Sekunder
• Sarkoma, limfoma malignum di
breast
• Uterus : leiomiosarkoma, MMMT
• Renal carcinoma, nefrobblastoma,
urothelial tumors, seminoma, SCC
penis
Other pathology ?

• Sangat banyak
• Galaktokel, ginekomastia
• Hiperplasia endometrium, polip
(cervix, endometrium)
• Trophoblastic diseases
• Kista fungsional
• Pielonefritis, glomerulonefritis, ATN
• Hidrokel, TB
Thank You