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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