Blok 2.

3
Angkt.2013

BREAST AND
FEMALE GENITAL
TRACT PATHOLOGY
dr. Aswiyanti Asri,M.Si.Med,SpPA

BREAST
PATHOLOGY

INFLAMASI/INFEKSI
NEOPLASMA NON
EPITHELIAL
MALE BREAST LESION

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

NST dan karsinoma invasif lainnya.

Modified Elston & Ellis.

> 75%; 1075%; <10%

Small, regular, uniform;

Moderate;
Marked variation

Nuclear
plemorphism

Tubule and
gland formation

Tergantung
microscope field
area (mm)

Mitotic counts

Pemeriksaan Patologi Anatomi

Breast Lesion

FNAB

Mastektomi

FS/VC

Neoplasm/Non
Neoplasm
Core
Biopsy

Biopsi
Eksisi

Modified radical mastectomy

Mastectomy and level 1
axilliary clearance
Dimensions
65 x 45 to 35mm
Weighing 210g
Ellipse of skin measuring
65 x 20 mm
Nipple-areola (normal)
dimensions
80 x 45mm
Level 1 axillary lymph
nodes present
Suture indicates superior
1. Orientation and description of specimen
1. Orientation

Lesion identification
Slice the specimen from
deep to superficial at
5-10 mm intervals, using the
skin to hold the specimen
together
Palpate the slices for the
lesion
Draw a diagram of the slices,
noting down any remarkable
findings for each slice

4. Lesion identification
1. Orientation

2. Inking

3. Slicing

4. Lesion ID

Specimen slicing and lesion ID

Slices 9 and 10
contain lesion
Lesion 15 mm
diameter
Located in the
mid-portion of
the specimen
28 mm from the
medial margin
5 mm from the
superior margin
4 mm from the
interior margin
25 mm from the
lateral margin
15 mm from the
deep margin

4 & 5. Specimen slicing and lesion identification

1. Orientation

2. Fixation

3. Inking

4. Slicing

5. Lesion ID

A. KONFIRMASI
GANAS/TIDAK
B. MARGIN TUMOR

HER2 IHC scoring criteria in breast

cancer
Score

Staining pattern

IHC 0
(negative)

No reactivity or membrane staining <10% of invasive tumour cells

IHC 1+
(negative)

Faint/barely perceptible membrane staining in >10% of tumour cells;

cells only stained in part of membrane

IHC 2+
(equivocal)

Weak-to-moderate complete membrane staining in >10% of invasive

tumour cells

IHC 3+
(positive)

Strong complete membrane staining in >10%1/30%2 of invasive

tumour cells
HER2-positivity defined as either IHC 3+
and/or ISH+ in breast cancer

1. Wolff AC et al. J Clin Oncol 2007;25:118145. 2. Dako. HercepTest Interpretation Manual. 2002; Images courtesy of Dako.

Pathologic and Molecular

Pathologic
Lymph-node status
LVI (lymphovascular invasion)
Ditemukannya sel karsinoma
dalam pembuluh darah kecil
diluar massa tumor, t.u di
perifer
Prognostik faktor
independent untuk rekurensi
lokal dan jauh
Molecular
ER, PR, HER2

FEMALE
GENITAL
TRACT

PATOLOGI
Uterus

Vagina
Vulva

FGT

Cervix

Ovarium
Tuba Fallopii

Trophoblastic Disease

Cervical Cancer

Squamous cell carcinoma cervix

Adenocarcinoma endometrium

Ovarian tumor

Indonesia : urutan ke-3

Penyebab kematian tertinggi
Faktor risiko : nullipara, mutasi BRCA1/2
Etiologi : belum pasti; diduga trauma
berulang pada epitel permukaan
Tatanama berdasarkan asal sel
Kistik/solid/campuran
Gejala dini tidak jelas; lanjut ; akibat
penekanan massa tumor

Estimated age-standardised incidence and mortality rates: women

BRK 2010
- Payudara
- Serviks
- Ovarium

Globocan, 2012

Cystadenoma ovarii (serosum vs mucinosum)

Cystadenoma ovarii borderline

(serosum vs 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

12/18/2014

copyright (your
organization) 2003

44

Germ cell tumor : dysgerminoma vs

embryonal carcinoma

Germ cell tumor : yolk sac tumor vs

choriocarcinoma

Germ cell tumor : Immature teratoma

Mola Hidatidosa

Pemeriksaan Patologi Anatomi

Lesi FGT

Pap
Smear

HSV/HT/
HTSOB

FS/VC

Neoplasma/Prekanker/
Non Neoplasma
Biopsi

Kuretase

Cairan asites
Omentum

Cervical Cancer Screening

Guidelines
First screen 3 years after first intercourse or by

age 21
Screen annually with regular Paps or every 2
years with liquid-based tests
After three normal tests, can go to every three
years
Stop at 65-70 years with history of negative
tests
Still need annual check-ups

Cervical Cytology Screening. ACOG Practice Bulletin No. 45. 2003; 102:417-27.

52

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)

Lesi prekanker cervix

Makroskopik tidak jelas

tumor
Seluruh bagian cervix
dijadikan slide
Diamati dengan
cermat satu persatu
untuk mendeteksi
epitel cervix