Kista Ovarium
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Kista Ovarium
Oleh:Meyke Liechandra
Pembimbing: dr. Merlin Margreth Maelissa
Supervisor: dr. Johnsen Mailoa, Sp.OG
DIBAWAKAN DALAM RANGKA TUGAS KEPANITERAAN KLINIKPADA BAGIAN OBSTETRI DAN GINEKOLOGI
FAKULTAS KEDOKTERANUNIVERSITAS HASANUDDIN
MAKASSAR2014
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Pendahuluan
- Kebanyakan kista bersifat jinak, tidak berbahaya, menghilang dengan sendirinya, dan tidak membutuhkan pengobatan. - Di seluruh dunia, sekitar 27% wanita memiliki kista ovarium.
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Definisi
Kista ovarium adalah kantung dalam ovarium yang mengandung cairan atau materi semisolid.
McCann, JAS. Reproductive system. Dalam: McCann, JAS. Professional guide to pathophysiology, Third edition. Lippincott Williams & Wilkins.
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Anatomi
Sloane E. Sistem reproduksi, kehamilan, dan perkembangan. Dalam: Sloane E. Anatomi dan fisiologi untuk pemula. Penerbit Buku Kedokteran EGC.
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Etiologi
Kongenital
Perubahan hormon
InfeksiEndometriosis
Gaya hidup
Tryniszewski C. Ovarian cysts. Dalam: Tryniszewski C. Mosby’s handbook of diseases, Third edition. Mosby.
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Klasifikasi
Sifat•Sederhana•Kompleks
Jenis•Neoplasma kistik ovarium•Kista fungsional
Dizon DS, Abu-Rustum NR. 100 questions & answers about ovarian cancer, Second edition. Jones and Bartlett Publishers.
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Kista Ovarium Sederhana
Dinding tipis
Cairan berisi kandungan protein hingga darah
Pada umumnya jinak
Dizon DS, Abu-Rustum NR. 100 questions & answers about ovarian cancer, Second edition. Jones and Bartlett Publishers.
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Kista Ovarium Kompleks
Multikompartemen
Echogenik
Penonjolan dalam kavitas
Bisa ada perbedaan ketebalan dari dinding pembungkus
Dizon DS, Abu-Rustum NR. 100 questions & answers about ovarian cancer, Second edition. Jones and Bartlett Publishers.
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Neoplasma Kistik Ovarium
Kista dermoid
Endometrioma
Kistadenoma
Ashby KL. Ovarian cyst. In: Loue S, Sajatovic M. Encyclopedia of women’s health. Kluwer Academic.
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Kista DermoidBerisi berbagai
macam jaringanUmumnya jinakRasa tidak
nyaman pada perut
Memiliki distribusi umur luas
Gailard F. Mature cystic teratoma of the ovary. Radiopaedia.
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EndometriomaBiasa muncul
pada endometriosis
Nyeri panggulDismenoreDispareuniaInfertilBiasanya
berukuran 4 – 5 inci
Malpani A, Malpani A. Endometriosis-the silent invader. Dalam: Malpani A, Malpani A. How to have a baby: overcoming infertility. Infertility Books.
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KistadenomaMuncul dari
jaringan ovariumBanyak terjadi pada
wanita usia reproduktif
Ukuran 3 – 10 cmOval hingga bulatPermukaan halus
berkilauWarna jernih hingga
kuning pucat
Dixon A. Ovarian mucinous cystadenoma macroscopic pathology specimen. Radiopaedia.
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Kista FungsionalKista folikuler
Kista korpus luteum
Kista teka lutein
Polikistik kista
Luteoma kehamilan
Ashby KL. Ovarian cyst. In: Loue S, Sajatovic M. Encyclopedia of women’s health. Kluwer Academic.
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Kista FolikulerGangguan
pelepasan gonadotropin hipofise → ovulasi gagal → folikel berlanjut
Umumnya pada usia reproduktif
McCann, JAS. Reproductive system. Dalam: McCann, JAS. Professional guide to pathophysiology, Third edition. Lippincott Williams & Wilkins.
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Kista Korpus LuteumTerjadi akibat
penumpukan cairan yang berasal dari perubahan korpus hemoragikum menjadi korpus luteum.
Nyeri hebat di panggul
AmenoreGhofrani M, Islam S, Sforza C. Ovary nontumor. Pathology Outlines
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Kista Teka LuteinTerjadi akibat
stimulasi dari abnormalnya beta HCG yang tinggi
Ukuran besarBilateral
Peterson CM. Theca lutein cysts.
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Polikistik KistaKetidaknormalan
siklus FSH dan LH → elevasi yang persisten
Ovarium lebih besar
OligomenorrheaAmenorrheaMandulBerjerawat
Ghofrani M, Islam S, Sforza C. Ovary nontumor. Pathology Outlines
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Luteoma KehamilanParenkim ovarium
→ proliferasi luteinized stronal cells
Terjadi saat kehamilan
BilateralBerwujud halus,
gemuk, berbatas, nodul kuning/orens, berdarah
Ghofrani M, Islam S, Sforza C. Ovary nontumor. Pathology Outlines
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Manifestasi Klinis
Anamnesis•Gejala bervariasi•Umur•Riwayat keluarga•Menstruasi awal•Siklus menstruasi•Infertilitas•Pola hidup•Lingkungan
Pemeriksaan fisis
•Inspeksi•Palpasi•Perkusi•Auskultasi•Vaginal Touche
Candra S, Andarini S, Hariyanti LR. Faktor resiko yang mempengaruhi terjadinya kista ovarium di RSUD dr saiful anwar malang. Fakultas Kedokteran Universitas Brawijaya.
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Keluhan UmumSiklus menstruasi tidak
teratur
Dismenore
Konstipasi
Disuria
Distensi
Rasa nyeri panggul
DispareuniaMcCann, JAS. Reproductive system. Dalam: McCann, JAS. Professional guide to pathophysiology, Third edition. Lippincott Williams & Wilkins.
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Pemeriksaan Penunjang
Radiologi
•Foto polos abdomen•USG•CT Scan•MRI
Laboratorium
•Pertanda tumor CA-125•Kadar HCG
Histologi
•Sesuai karakteristik masing-masing kista
Laparoskopi
•Untuk menilai kista dan apakah kista tersebut ganas atau tidak.
McCann, JAS. Reproductive system. Dalam: McCann, JAS. Professional guide to pathophysiology, Third edition. Lippincott Williams & Wilkins.
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USG
Gambaran ultrasonogram dari kista ovarium kompleks
Dizon DS, Abu-Rustum NR. 100 questions & answers about ovarian cancer, Second edition. Jones and Bartlett Publishers.
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CT Scan
Gambaran massa adneksa bilateral terpisah dan kalsifikasi hiperdens
Boulay RM, Podczaski E. Bilateral ovarian dermoid cysts. Massachusetts Medical Society. Massachusetts. The New England Journal of Medicine.
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MRI
MRI kista teka lutein bilateral
Zhang H. Bilateral theca-lutein cysts in one pregnant woman at MRI. International Journal of Clinical & Medical Imaging.
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Histologi
Kista korpus luteum dengan perdarahan menggunakan pewarnaan hematoksilin dan eosin; terdiri dari sel granulosa di luar dan jaringan ikat di dalam.Ghofrani M, Islam S, Sforza C. Ovary nontumor. Pathology Outlines.
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Histologi
Kista folikuler: Kista dibatasi oleh sel granulosa dengan di atasnya adalah sel teka
Ghofrani M, Islam S, Sforza C. Ovary nontumor. Pathology Outlines.
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Histologi
Polikistik kista: Korteks luar terdiri dari beberapa kista folikel tersusun di bawahnya
Ghofrani M, Islam S, Sforza C. Ovary nontumor. Pathology Outlines.
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Histologi
Luteoma kehamilan: Sitoplasma berlimpah
Ghofrani M, Islam S, Sforza C. Ovary nontumor. Pathology Outlines.
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Histologi
Endometrioma: Dinding kista endometrium mengandung sel pseudoxantoma diisi dengan pigmen hemofusin
Ghofrani M, Islam S, Sforza C. Ovary nontumor. Pathology Outlines.
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Histologi
Ghofrani M, Islam S, Sforza C. Ovary nontumor. Pathology Outlines.
Kistadenoma serosa raksasa dari ovarium
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Histologi
Kista dermoid mengandung epitel skuamous keratin
Sesterhenn IA, Davis CJ. Pathology of germ cell tumors of the testis. Cancer Control. Journal of the Moffitt Cancer Center.
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Penatalaksanaan
Konservatif
•Farmakoterapi
Operatif
•Kistektomi•Salfingo-ooforektomi
Cowperthwaite AC. A textbook of gynecology with homoeopathic therapeutics. B Jain Publishers.
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Penatalaksanaan
Ross EK, Kebria M. Incidental ovarian cysts: when to reassure, when to reassess, when to refer. Cleveland Clinic Journal of Medicine
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Penatalaksanaan
Ross EK, Kebria M. Incidental ovarian cysts: when to reassure, when to reassess, when to refer. Cleveland Clinic Journal of Medicine
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PrognosisKista pada perempuan yang
belum menstruasi → 50% ke arah ganas
Kista pada perempuan menopause → biasa ganas
Kista jinak →baik
Yatim F. Kista indung telur. Dalam: Yatim F. Penyakit kandungan myoma, kanker rahim/leher rahim dan indung telur, kista, serta gangguan lainnya. Pustaka Populer Obor.
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PenutupKista ovarium adalah kantung dalam
ovarium yang mengandung cairan atau materi semisolid.
Berdasarkan sifatnya → kista sederhana dan kompleks
Berdasarkan jenisnya → neoplasma kistik ovarium dan kista fungsional
Manifestasi klinis bervariasi.Penanganan → konservatif maupun
operatif.Perlu deteksi dini.
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Terima Kasih