Sistem Reproduksi Wanita Dan Mamma (2)

7/23/2019 Sistem Reproduksi Wanita Dan Mamma (2)

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kmr/mamma/05

•FCD – Epithelial hyperplasia



kmr/mamma/05

•FCD – Florid epithelial hyperplasia



kmr/mamma/05

•FCD – Atypical epithelial hyperplasia



kmr/mamma/05

•Benign intraductal papilloma



kmr/mamma/05

•Laktasi



FIBROADENOA AA

!neoplasma "inak tersusun dari "aringan stroma maupun

kelen"ar#

Insidens $ neoplasma "inak paling sering

usia reprodukti%& umumnya '( th

)linis $ tum*uh lam*at& tidak nyeri

single& multiple& unilateral& *ilateral

akhir menstruasi + hamil→

mem*esar

postmenopause→

regresi + hialinisasi + kalsi%ikasi

,erapi $ operasi



akros $

•

- cm – -( cm• -( cm – -. cm $ /iant Fi*roadenoma

Benign cystosarcoma0

phylloidesikros $

1aringan stroma tertekan→

!kapsul#

2troma %i*ro*lastik

Duktus tertekan → menyempit



kmr/mamma/05

•Fi*roadenoma mamma



kmr/mamma/05



CARCINOA AA

Insidens $ - dari 3 0 4 5 di 62A 7 Canada

→

∴

Cam

62A 87 Canada9 $ :(th& :. th;

dekade < $ - dr :':

dekade = $ - dr :4

insidens sta*il +↑

& mortalitas↓

alang& >A F)6B+R22A& :((- $

''' pemeriksaan >A mamma→

'( Cam

termuda $ :: th& tertua $ 3( th



FA),OR RE2I)O $

-; )eluarga + genetik $ gen BrCa - 8Breast Cancer9& BrCa :

:; >enyakit amma >roli%erati% + atypical epith; ?yperplasia

'; asa reproduksi yang lama

<; >aritas $ nullipara multipara

.; 6sia saat melahirkan pertama

@; O*esitas

=; Cam kontralateral 7 Ca Endometrium3; Estrogen eksogen



FA),OR E,IOLO/I 7 >A,?O/ENE2I2 $

-; Faktor /enetik

:; Faktor ?ormonal

'; Faktor Lingkungan

Faktor /enetik $

utasi gen $ BrCa-& BrCa:& p.' dan A, 8ataia 0

telangiectasia mutated9;

≈

tumor0suppressor gene→

mutasi→

supresi 809 +↓

→

pertum*uhan + proli%erasi↑

→

∴

Ca;



Faktor hormonal $

?ormonal im*alance→

ekses estrogen endogenER

>rogresi sel CaEstrogen

>romotorpertum*uhan ,/F0

E/F

F/F



Faktor Lingkungan $

>ola hidup $ Ca di 62A + 5estern < 0 = non05estern

Radiasi $ radioterapi pada keganasan lain

Diet $ Fat;

irus $ mouse mammary tu i;→

retro i; 8Bittner& -4'@9

>estisida organochlorine 89

Distri*usi $

)iri $ )anan --( $ -((

.(G $ upper outer Huadrant

:(G $ central + su*areolar

-(G $ loer outer & upper inner & loer inner Huadrants



Non0inasie Carcinomas o% the Breast

?istologic ,ype FreHuency 8G9 .0year 2urial 8G9

Intraductal Carcinoma ';@ J44

Lo*ular Carcinoma in situ -;@ J44

8LCI29

Intraductal 7 LCI2 (;: J44

>apillary Carcinoma (;< J44

Comedocarcinoma (;' J44



Inasie Carcinomas o% the Breast

?istologic ,ype FreHuency 8G9 .0year 2urial 8G9

In%iltrating Ductal Ca @';@ =4

In%iltrating Lo*ular Ca .;4 3<

In%iltrating Ductal 7 -;@ 3.

Lo*ular Carcinoma



kmr/mamma/05

Atypical ductal epithelial hyperplasia



kmr/mamma/05

Intraductal 0 classic cri*ri%orm



kmr/mamma/05

Intraductal 0 intact *asal mem*rane 7 microcalci%ication



kmr/mamma/05

Intraductal 0 comedo ca



kmr/mamma/05

Intraductal 0 >agetKs Dis



kmr/mamma/05

>agetKs Dis 0 >A2 stain



kmr/mamma/05

Lo*ular Ca in situ



kmr/mamma/05

In%iltrating Lo*ular Ca 0 !indian %ile#



kmr/mamma/05

In%iltrating lo*ular Ca



kmr/mamma/05I;D;Cell Ca



kmr/mamma/05

In%iltrating D; Cell Ca

mikrokalsi%ikasi

dp

dp



kmr/mamma/05

I;D;C;Ca 0 desmoplasia→

kolagenous→

scirrhous



kmr/mamma/05I;D;C;Ca $ edullary Ca



kmr/mamma/05edullary Ca $ nuklei pleomor%ik

nukleoli prominen



kmr/mamma/05

I;D;C;Ca $ sHuamous metaplasia



kmr/mamma/05I;D;C;Ca $ colloid + mucinous Ca



kmr/mamma/05I;D;C;Ca tu*ular Ca $selapis sel ku*oid



kmr/mamma/05

I;D;C;Ca $ sHuamous metaplasia



kmr/mamma/05!In%lammatory Ca;#$ peau dKorange& pene*alan&

kasar



kmr/mamma/05etastase dalam pem*; lim%e



,eknik immunohistokimia 8immunoperoksidase9

deteksi *iomarker + reseptor hormon

untuk , 7 prognosis

Contoh $

Estrogen receptor 8ER9 $↔

, ,amoi%en

>rogesteron recep; 8>R9

?ER: 8C0er* B:9 $↔

, ,rastuMuma*

↔

gradasi intiCathepsin D $ korelasi dg metastase lmn



kmr/mamma/05

ER positi%



kmr/mamma/05

>R positi%



kmr/mamma/05

Cathepsin D $ positi%



kmr/mamma/05

?ER:0neu positi%



/RADIN/ ?I2,O>A,OLO/I

,u*ule Formation 2core

8G o% ca composed o% tu*ular structures9

J=.G -

-(0=.G :

less than -(G '



Nuclear >leomorphism 2core

2mall& uni%orm cells -

oderate increase in siMe and ariation :

arked ariation '



itotic Count 8per -( high poer %ields9 2core

6p to = -

3 to -< :

-. or more '

/rade 2core .02 8G9 =02 8G9

- ' to . 4. 4(

: @ or = =. @.

' 3 or 4 .( <.



,ERA>I $

Bergantung pada stadium dan grading 8dera"at proli%erasi9Indiidual;

-; Operasi $

lumpectomy→

!*reast consering surgey#

mastectomy→

seluruh mamma

radical mastectomy→

mamma kg* ailla

:; Radiasi

'; )hemoterapi



FA),OR / E>EN/AR6?I >RO/NO2A

-; etastase kg*

:; Inasi "aringan sekitar

'; Besar tumor

<; 2u*tipe histologi $

tu*ular + colloid 8mucinous9 $ *aik;.; /rade tumor 8dera"at histopatologi9

@; ER 7 >R

=; Inasi lim%oaskuler

3; >roli%eratie rate

"umlah mitosis 8mitotic rate9

ekspresi protein inti 8ki0@=& >CNA9



4; DNA content

diploid le*ih *aik dp aneuploidi-(; Ekspresi onkogen

?ER:0neu& c0myc& ras

?ilangnya ekpresi tumor0suppressor gene

p.'& N:'

--; Angiogenesis

-:; >rotease

>rotease stromal→

degradasi matri ekstraseluler



>du prognosis le*ih *aik "ika $

,umor : cm

etastase kg* ailla 809

Non0inasie + non0in%iltrating Ca

ER dan >R positi%

,idak ada aneuploidy



kmr/mamma/05



kmr/mamma/05

P0Ray Ca



kmr/mamma/05

ammogra%i I;D;C;Ca



kmr/mamma/05Fine Needle Aspiration Ca



/NECOA2,IA

>athogenesis $hormonal im*alance $ estrogen androgen

>ada $

)line%elter syndrome

,umor sel leydic

Cirrhosis hepatis

O*at $ alkohol& mariyuana& heroin& dll

,erapi $ operasi



kmr/mamma/05

gynecomastia



EERI)2A 2EDINI 6N/)IN )ELAINAN AA

2ADARI + 2ARARI $

>eriksa payudara sendiri

>eriksa *ra sendiri

)apan

6sia su*ur $ teratur& se*ulan - &

- minggu setelah haid

enopause $ teratur& setiap tgl tertentu + *ulan;

>erhatikan $ simetris& peru*ahan kulit& tera*a *en"olan&

nyeri& sekret papilla & dll;



Thankyou

Sistem Reproduksi Wanita Dan Mamma (2)

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