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"Latar Belakang: Karsinoma gaster merupakan tumor ganas yang paling sering di daerah gastrointestinal atas. Menurut data epidemiologi adenokarsinoma gaster menunjukkan perkembangan kanker tipe intestinal dan kanker tipe difus melalui jalur kausa yang berbeda dan juga akhir-akhir ini pengobatan terapi target untuk adenokarsinoma telah diketahui dan dikembangkan. Penelitian ini bertujuan untuk mengetahui hubungan antara ekspresi HER2 dengan tipe histopatologik menurut klasifikasi Lauren dan derajat diferensiasi pada adenokarsinoma gaster.Bahan dan cara kerja: Penelitian dilakukan di Departemen Patologi Anatomik FKUI RSCM Jakarta, dengan melakukan analisis ekspresi HER2 untuk melihat hubungannya dengan tipe histopatologik dan derajat diferensiasi adenokarsinoma gaster yang diperoleh secara reseksi dan biopsi sejak tahun 2007-2011. Penilaian tipe histopatologik dengan menggunakan pulasan Hematoxillin Eosin dan penilaian ekspresi HER2 dengan menggunakan pulasan imunohistokimia HER2.Hasil: Dari tahun 2007-2011 diperoleh 55 kasus (76,4% laki-laki dan 23,6% wanita). Rata-rata umur penderita 50,55 tahun (rentang umur 29-73 tahun). Ekspresi HER2 3+, 2+, dan 1+ didapatkan pada 14,5%, 34,5%, dan 25,5% sampel. Sebanyak 25,5% sampel tidak menunjukkan ekspresi HER2. Ekspresi berlebih HER2 (3+) didapatkan pada 8 kasus (14,5%) adenokarsinoma gaster, yang seluruhnya adalah tipe intestinal .Kesimpulan: Terdapat hubungan yang bermakna antara ekspresi HER2 dengan tipe histopatologik (p= 0,021). Tidak terdapat hubungan yang bermakna antara ekspresi HER2 dengan derajat diferensiasi tumor (p=0,253).

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Background: Gastric carcinoma is the most common malignant tumor in upper gastrointestinal. According to epidemiologic data, gastric adenocarcinoma intestinal type and diffuse type showed different carcinogenesis. Recently, targeting therapy for adenocarcinoma has established. The aim of the study to know the relationship between HER2 expression and histopathologic type according to Lauren's classification and grading of gastric adenocarcinoma.Patient and method: This study has done in Anatomical Pathology department of medicine University Indonesia/ Cipto Mangunkusumo National Hospital, Jakarta. HER2 expression is analyzed to see the relationship with histopathologic type and differentiation of gastric adenocarcinoma. The specimens were from resection and biopsy (2007-2011). Histopathologic type evaluated with Hematoxylin Meyer's staining. HER2 expression evaluated with immunostaining with HER2 antibody.Results: We found 55 cases from 2007 until 2011 (76,4% men and 23,6% women). The mean age is 50,55 years (the range of age 29-73 years). HER2 expression 3+,2+ and 1+ are 14,5%, 34,5%, and 25,5% sampling. 25% sample did not show HER2 expression. We found overexpression HER2 (3+) in 8 cases (14,5%) of adenocarcinoma gastric intestinal type.Conclusion: There is a significant relation between HER2 expression with histopathologic type (p=0,021). There is no significant relation between HER2 with grading (p=0,253)."

"Latar Belakang: HER2 merupakan protoonkogen menjadi dasar pemberian terapi sel target pada adenokarsinoma gaster stadium lanjut. Penelitian hubungan antara gambaran klinis, endoskopi dan histopatologi dengan ekspresi HER2 masih menunjukkan hasil yang berbeda. Penelitian tentang HER2 sebagai prediktor kesintasan juga menunjukkan hasil yang berbeda. Penelitian ini bertujuan untuk mengetahui hubungan gambaran klinis, endoskopi, histopatologi dengan ekspresi HER2 dan hubungan antara ekspresi HER2 dengan kesintasan dua tahun.Metode: Penelitian kohort retrospektif pada subyek adenokarsinoma gaster yang baru terdiagnosis, berusia ³ 18 tahun di 4 rumah sakit di Jakarta, berobat dari 2015-2019, memenuhi kriteria inklusi: memiliki rekam medis yang lengkap, hasil pemeriksaan gastroskopi, blok parafin hasil biopsi. Slide biopsi diwarnai dengan pewarnaan imunohistokimia HER2 dan diinterpretasi dengan kriteria ToGA. Analisis statistik deskriptif dan bivariat dengan menggunakan chi square/tes fisher untuk menilai hubungan antara gambaran klinis, endoskopi, dan histopatologi dengan ekspresi HER2. Analisis kesintasan, bivariat dan multivariat dengan Cox-regresi menentukan pengaruh ekspresi HER2 terhadap kesintasan dua tahun.Hasil: Ekspresi HER2 positif ditemukan pada 12,3% subyek (15 dari 122 subyek). Ekspresi HER2 cenderung lebih tinggi pada metastasis ke hati, klasifikasi Borrman tipe I/II, diferensiasi baik/sedang, tipe intestinal berdasarkan Klasifikasi Lauren memiliki dengan proporsi masing-masing: 17.6% RR(IK95%)=1.726 (0.665-4.480), 16.1% RR(IK95%)=1,768(0,670-4,662), 14.3% RR(IK95%)=1,304(0,505-3,363), 13.9% RR(IK95%)=1,389(0,505-3,817).Ekspresi HER2 positif tidak berhubungan dengan kesintasan dua tahun, HR (IK95%)=1,12(0,609-2,058).Simpulan: Matastasis hati, klasifikasi Borrman, letak tumor, diferensiasi tumor dan klasifikasi Lauren tidak berhubungan bermakna secara statistik terhadap ekspresi HER2. Ekspresi HER2 positif tidak berhubungan dengan kesintasan dua tahun pada adenokarsinoma gaster.

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Background: HER2 is a proto-oncogene which important for administering of target cell therapy in advanced gastric adenocarcinoma. Research on clinical, endoscopic, and histopathological features shown conflicting in association with HER2 expression. Studies on HER2 as a predictor of survival still show different results. This study aims to determine association of the clinical, endoscopic, and histopathological features with HER2 expression and association of HER2 expression with 2-year survival.

Methods: A retrospective cohort study on newly diagnosed gastric adenocarcinoma subjects, aged 18 years old at 4 hospitals in Jakarta, receiving treatment from 2015-2019, meeting the inclusion criteria: having complete medical record, results of gastroscopy examination, and paraffin block tumor biopsy results. The biopsy slides were stained with HER2 immunohistochemical staining and interpreted according to the ToGA criteria. Descriptive and bivariate analysis by using chi-square or fisher's test assessed the relationship between clinical, endoscopic, and histopathological features with HER2 expression. Survival, bivariate and multivariate analysis with cox regression method were used to determine the effect of HER2 expression on 2-year survival.

Results: Positive HER2 expression was found in 12.3% of subjects (15 of 122 subjects). HER2 expression tends to be higher in metastases to the liver, Borrman classification type I/II, good/moderate differentiation, intestinal type based on Lauren's classification has the respective proportions:17.6% RR (95%CI)=1.726 (0.665-4.480), 16.1% RR (95%CI)=1,768 (0,670-4,662), 14.3% RR (95%CI)=1,304 (0,505-3,363), 13.9% RR (95%CI)=1,389 (0,505-3,817). Positive HER2 expression was not associated with 2-year survival with HR (95%CI) =1.12 (0.609-2.058)."

"ABSTRAKLatar belakang: Hiperplasia prostat dan adenokarsinoma prostat keduanyasangat dipengaruhi oleh hormon androgen terutama dihidrotestosteron(DHT) berasal dari konversi testosteron (T) dikatalisator oleh enzim 5α-reduktase (5αR). Terapi hormonal merupakan salah satu modalitas terapikedua penyakit ini dengan menghambat enzim 5αR tipe1dan tipe 2. Tujuanpenelitian ini untuk mengetahui perbedaan ekspresi 5αR1 antaraadenokarsinoma prostat tipe asinar dan hiperplasia prostat, serta melihatekspresi 5αR1 berdasarkan skor Gleason.Metode: Penelitian menggunakan metode potong lintang. Sampel terdiriatas 20 kasus adenokarsinoma prostat tipe asinar dan 20 kasus hiperplasiaprostat. Dilakukan pulasan 5αR1 dan penilaian pulasan denganmenggunakan histoscore.Hasil: Mean area sel tumor sebanyak 11,63% dan sel epitel di hiperplasiaprostat 26,54%. Terdapat perbedaan kadar PSA antara adenokarsinomaprostat dengan hiperplasia prostat (p=0,00). Ekspresi 5αR1 di sitoplasmadan inti didapatkan perbedaan antara adenokarsinoma prostat denganhiperplasia prostat (p=0,00). Ekspresi 5αR1 lemah terbanyak didapatkanpada adenokarsinoma prostat.Kesimpulan: Ekspresi dan total area pulasan intensitas 5αR1 padahiperplasia prostat lebih tinggi. Peningkatan skor Gleason cenderung diikutipenurunan ekspresi 5αR1.

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ABSTRACTBackground: Acinar adenocarcinoma and BPH both are stronglyinfluenced by androgen hormone especially dihydrotestosterone (DHT)from convertion of testosterone (T) catalize by 5α-reductase (5αR) enzyme.Hormonal therapy is one of treatment modality for these condition byinhibiting 5αR type 1 and type 2 enzyme. The aim of this study is to knowdifferential expression of 5αR1 between acinar adenocarcinoma and BPHand also expression 5αR1 based on Gleason score.Method: This was cross-sectional study on 20 cases acinar adenocarcinomaand 20 cases BPH stained with 5αR1 antibody. The appraisal was done withestimating histoscore.Result: Mean area of tumor cells is 11,63% and epithelial cells in BPH26,54%. There was statistically significant levels of PSA between acinaradenocarcinoma and BPH (p=0,00). Cytoplasmic and nuclear expression of5αR1 were statistically significant different between acinar adenocarcinomaand BPH (p=0,00). Low intensity expression of 5αR1 in acinaradenocarcinoma was the most commonly found.Conclusion: Total area of expression 5αR1 in BPH are higher. hiperplasiaprostat lebih tinggi. The higher Gleason score tends followed by decliningexpression of 5αR1.;"

"Latar Belakang: Karsinoma sel hati (KSH) adalah lesi neoplastik ganas pada hati tersering. Transformasi keganasan sel hati normal menjadi KSH melibatkan berbagai faktor seperti inflamasi dan perubahan genetik yang menyebabkan KSH menjadi sangat heterogen pada tingkat histologik dan molekular. Perbedaan fenotipe yang dipengaruhi berbagai perubahan molekular menghasilkan berbagai derajat diferensiasi, subtipe histologik dan gambaran klinik yang berbeda dan sebagian berhubungan dengan prognosis pada KSH. Mutasi pada gen TP53 yang berfungsi menontrol proliferasi sel melalui perbaikan DNA, apoptosis, dan penuaan sel terbukti sebagai salah satu perubahan molekular tersering pada KSH dan sering dikaitkan dengan beberapa faktor risiko, derajat diferensiasi, subtipe histologik tertentu dan prognosis. Penelitian ini bertujuan menginvestigasi ekspresi p53 pada derajat diferensiasi, subtipe histologik dan stadium patologi tumor KSH.Bahan dan cara: Penelitian dilakukan di Departemen Patologi Anatomik FKUI/RSCM, Jakarta terhadap 41 kasus KSH yang diperoleh seara reseksi. Sampel kasus diklasifikasikan berdasarkan kelompok derajat diferensiasi (WHO), subtipe histologik dan stadium patologi tumor. Selanjutnya dilakukan pulasan imunohistokimia (IHK) protein 53 (p53) pada seluruh kasus dan dilakukan analisis untuk mengetahui ekspresi p53 pada variabel penelitian.Hasil: Ekspresi p53 ditemukan pada 35 kasus (85%). Berdasarkan derajat diferensiasi, ekspresi p53 ditemukan paling banyak pada derajat diferensiasi sedang dan buruk, yaitu 21 dan 14 kasus (91% dan 93%). Ekspresi p53 berdasarkan stadium patologi tumor ditemukan paling banyak pada pT1b dan pT2, yaitu 8 dan 14 kasus ( 88% dan 93%). Berdasarkan subtipe histologik, seluruh kasus macrotrabecular massive (MTM) menunjukkan ekspresi p53 (4 kasus, 100%), subtipe clear cell (CC) terpulas pada 15 kasus (93%), klasik (CL) ditemukan 16 kasus (88%) dan tidak ditemukan ekspresi p53 pada seluruh kasus steatohepatitic (SH). Terdapat perbedaan rerata bermakna ekspresi p53 pada kelompok baik dan sedang (p=0,011), baik dan buruk (p=0,015) dan tidak terdapat perbedaan rerata bermakna antara kelompok sedang dan buruk (p=0,339). Tidak ditemukan perbedaan rerata bermakna ekspresi p53 pada seluruh kelompok stadium patologi tumor (p=0,948) dan subtipe histologik (p=0,076).Kesimpulan: Terdapat perbedaan bermakna ekspresi p53 pada KSH kelompok diferensiasi baik dan sedang serta baik dan buruk.

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Background: Hepatocellular cell carcinoma (HCC) is the most common malignant neoplastic lesion of the liver. Malignant transformation of hepatocytes involves various factors such as inflammation and genetic causing HCC to be very heterogeneous at the histological and molecular level. Differences in phenotypes affected by various molecular changes produce different differentiation grade, histological subtype, clinical features and prognosis. TP53 as one of the most common molecular changes in HCC play an important role in cycle cell by controlling cell proliferation through DNA repair, apoptosis and cellular senescence, associates with several risk factors such as certain differentiation grade, histologic subtypes, and prognosis. This current study aimed to investigate p53 expression at HCC’s differentiation grade, tumor pathology stage and histologic subtype.

Materials and methods: The study was conducted at the Department of Anatomical Pathology FKUI / RSCM, Jakarta on 41 cases of resected HCC. Case samples are classified based on groups of differentiation grade (WHO), histologic subtypes and tumour pathology stage. Furthermore immunohistochemical (IHC) staining of protein 53 (p53) carry out in all cases and an analysis statistic was performed to evaluated the expression of p53.

Results: p53 expression was found in 35 cases (85%). Based on the differentiation grade, the expression of p53 was found mostly in the moderate and poor differentiation (91%, 21 cases and 93%, 14 cases). Based on tumour pathology stage, p53 expression was found mostly in pT1b and pT2, which were 8 and 14 cases (88% and 93%). Based on histologic subtypes, all macrotrabecullar massive (MTM) cases showed p53 expression (4 cases, 100%), clear cell (CC) subtypes were in 15 cases (93%), classic (CL) 16 cases (88%) and negative expression was found in all cases of steatohepatitic (SH). There were significant differences in mean expression of p53 in the well and moderate groups (p = 0.011), well and poor (p = 0.015) and there were no significant mean differences between the moderate and poor groups (p = 0.339). There were no significant mean differences in p53 expression in all groups of tumour pathology stages (p = 0.948) and histologic subtypes (p = 0.076).

Conclusion: There is significant difference mean of p53 expression in well and moderate as well as well and poor differentiation."

"Analisis praktik residensi merupakan laporan rangkaian kegiatan Ners SpesialisKeperawatan Medikal Bedah dengan penerapan Model Adaptasi Roy pada prosesasuhan keperawatan pasien gangguan sistem pencernaan, penerapan praktikkeperawatan berdasarkan evidence based serta melakukan inovasi keperawatan.Pengkajian kasus utama terhadap pasien karsinoma gaster dan 30 kasus resume pasienbedah digestif, gastrointestinal serta hepatobilier berfokus pada respon adaptif darimodel adaptasi Roy. Pelaksanaan evidence based dilakukan untuk mengelolakecemasan pasien sebelum menjalani operasi bedah digestif sebanyak 8 orang, denganintervensi mendengarkan Al-Qur`an Surah Al Waqi’ah dan terjemahannya selama 30menit. Program inovasi keperawatan dilakukan, terhadap 7 orang pasien yangdirencanakan menjalani operasi kolostomi berupa optimalisasi pemberian edukasimelalui media video. Kesimpulan: mendengarkan Al-Qur`an Surah Al Waqi’ah danterjemahannya dapat menurunkan tingkat kecemasan pasien sebelum operasi danedukasi melalui media video terhadap pasien yang akan menjalani operasi kolostomidapat meningkatkan pengetahuan pasien yang sangat memengaruhi terhadap keputusanpersetujuan pasien menjalani operasi.

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The residency practice analysis is a series of reports on the activities of Surgical

Medical Nursing Specialists with the application of Roy's Adaptation Model in the

nursing care process of patients with digestive system disorders, the application of

evidence-based nursing practices and nursing innovations. Major case studies of gastric

carcinoma patients and 30 cases of digestive, gastrointestinal and hepatobiliary surgery

resumes focused on the adaptive response of Roy's adaptation model. Evidence based

implementation was carried out to manage the anxiety of patients before undergoing

digestive surgery as many as 8 people, with the intervention of listening to Al-Qur'an

Surah Al Waqi'ah and its translation for 30 minutes. Nursing innovation program

carried out, for 7 patients who were planned to undergo colostomy surgery in the form

of optimizing the provision of education through video media. Conclusion: listening to

Al-Qur'an Surah Al Waqi'ah and its translation can reduce the level of patient anxiety

before surgery and education through video media for patients who will undergo

colostomy surgery can increase patient knowledge which greatly influences the decision

of consent for patients undergoing surgery."

"Keganasan pankreas merupakan keganasan dengan angka kematian yang tinggi, dengan Adenokarsinoma Duktal Pankreas/Pancreatic Ductal Adenocarcinoma (PDAC) mencakup 85-90% kasus. PDAC memiliki perjalanan penyakit yang sangat agresif, dan seringkali baru terdiagnosis pada stadium lanjut. Penegakan diagnosis pasti PDAC seringkali hanya dapat dilakukan melalui sediaan terbatas baik berupa biopsi maupun endoscopic ultrasound-guided fine-needle aspiration/EUS-FNA. Salah satu tantangannya adalah membedakan PDAC dari jaringan pankreas non-neoplastik/reaktif. Penelitian ini akan membahas mengenai peran von Hippel-Lindau gene product/pVHL dalam membedakan PDAC dengan jaringan pankreas non-neoplastik, serta hubungannya dengan profil klinikopatologiradira PDAC. Penelitian ini merupakan penelitian observasional analitik dengan desain cross-sectional pada kasus PDAC dan jaringan pankreas non-neoplastik yang dilakukan di RSCM pada sampel yang diperoleh pada bulan Januari 2012 hingga September 2023. Sampel penelitian dibagi menjadi 2 kelompok besar, yaitu kelompok PDAC dan pankreas non-neoplastik. Pemilihan sampel dilakukan dengan menggunakan simple random sampling dari kasus-kasus yang memenuhi kriteria inklusi dan tidak termasuk dalam kriteria eksklusi. Dilakukan pulasan imunohistokimia pVHL dan perhitungan Histoscore/H-score serta penentuan cut-offnya untuk membagi ekspresi pVHL menjadi tinggi dan rendah dan hubungannya dengan PDAC dan non-neoplastik, serta profil klinikopatologi pada kelompok PDAC. Penelitian ini menunjukkan tidak terdapat perbedaan ekspresi pVHL pada kelompok PDAC dan non-neoplastik, dan staging pN memiliki hubungan bermakna dengan ekspresi pVHL pada PDAC. Ekspresi pVHL yang rendah lebih banyak ditemukan pada PDAC berdiferensiasi sedang, tidak ditemukan invasi limfovaskular maupun invasi perineural, memiliki batas sayatan yang tidak bebas, memiliki staging pT2, pN0, M0, dan kesintasan > 7 bulan. Sebaliknya, ekspresi pVHL yang tinggi juga lebih banyak ditemukan pada PDAC berdiferensiasi sedang, ditemukan invasi limfovaskular, tidak ditemukan invasi perineural, status batas sayatan yang bebas, staging pT2 dan pT3, pN1 dan pN2, M0, dengan kesintasan ≤ 7 bulan. Temuan ini berbeda dengan penelitian sebelumnya yang mendapati hilangnya ekspresi pVHL pada tumor PDAC, dan sebaliknya pada duktus pankreas non-neoplastik. Hal ini kemungkinan disebabkan oleh perbedaan klon antibodi yang digunakan pada penelitian ini dibandingkan dengan penelitian sebelumnya. Klon antibodi yang digunakan adalah VHL40, sedangkan penelitian-penelitian sebelumnya menggunakan klon FL-181 yang berikatan dengan asam amino yang berbeda dan memiliki klonalitas yang berbeda pula. Selain itu, pada PDAC dapat terjadi mutasi pada gen VHL yang menghasilkan protein VHL yang non-fungsional yang kemungkinan masih dapat terdeteksi dengan ikatan antigen-antibodi pada penelitian ini. 

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Pancreatic malignancy is a malignancy with a high mortality rate, with Pancreatic Ductal Adenocarcinoma (PDAC) accounting for 85-90% of cases. PDAC has a very aggressive disease course, and is often only diagnosed at an advanced stage. Establishing a definite diagnosis of PDAC can often only be done through limited sample from biopsy or endoscopic ultrasound-guided fine-needle aspiration/EUS-FNA. In such limited sample, differentiating PDAC from non-neoplastic/reactive pancreatic tissue can be challenging. This research will discuss the role of von Hippel-Lindau gene product/pVHL in PDAC and non-neoplastic pancreatic tissue, as well as their relationship with PDAC pathological factors. This research is an analytical observational study with a cross-sectional design on cases of PDAC and non-neoplastic pancreatic tissue conducted at RSCM on samples obtained from January 2012 to September 2023. The research samples were divided into 2 large groups, namely the PDAC and non-neoplastic pancreatic groups. Sample selection was carried out using simple random sampling from cases that met the inclusion criteria and were not included in the exclusion criteria. Immunohistochemistry of pVHL was performed along with calculation of Histoscore/H-score and determination of cut-offs to divide pVHL expression into high and low and its relationship with PDAC and non-neoplastic, as well as pathological factors in the PDAC group. This study shows that there is no difference in pVHL expression in the PDAC and non-neoplastic groups, and pN staging has a significant relationship with pVHL expression in PDAC. Low pVHL expression is more often found in moderately differentiated PDAC, no lymphovascular invasion or perineural invasion, non-free incision margins, staging pT2, pN0, M0, and survival > 7 months. In contrast, high pVHL expression was also found more frequently in moderately differentiated PDAC, lymphovascular invasion was found, no perineural invasion was found, free incision margin status, pT2 and pT3 staging, pN1 and pN2, M0, with survival ≤ 7 months. This finding is different from previous studies which found loss of pVHL expression in PDAC tumors, and vice versa. This difference in results is likely due to differences in the antibody clones used in this study compared to previous studies. The antibody clone used was VHL40, whereas previous studies used the FL-181 clone which binds to different amino acids and has different clonality. In addition, in PDAC there is a mutation in the VHL gene which may produce a non-functional VHL protein that still be detectable by antigen-antibody binding in this study."

"Latar belakang: Kanker prostat merupakan tumor ganas terbanyak ketiga pria di dunia. Penyebabnya dipengaruhi faktor usia, genetik, ras, hormonal, diet dan lingkungan. Kanker prostat dapat mengalami Neuroendocrine Differentiation NED , meningkat pada kanker prostat berdiferensiasi buruk terutama yang tidak merespon baik terhadap terapi hormonal. NED akan menentukan prognosis dan pemilihan alternatif terapi.Tujuan: Mengetahui perbedaan ekspresi Chromogranin A CgA pada adenokarsinoma prostat berdiferensiasi baik, sedang dan buruk serta kaitannya dengan derajat keganasan berdasarkan grading tumor yang diharapkan dapat menentukan prognosis dan pemilihan alternatif terapi.Metode: Studi potong lintang terhadap jaringan biopsi yang difiksasi formalin, diletakkan dalam parafin dari pasien dengan adenokarsinoma prostat berdiferensiasi baik, sedang dan buruk. Sampel penelitian dipulas dengan pewarnaan imunohistokimia CgA, diidentifikasi dan dianalisa hubungan ekspresi CgA berdasarkan usia, diagnosis histopatologik, grade groups, skor Gleason dan kadar PSA.Hasil: Ekspresi CgA positif dengan median 40 0,4-100 banyak terjadi pada kelompok usia 7. Ekspresi CgA positif dengan median 35,4 0,4-88,6 banyak terjadi dengan kadar PSA > 52,4 ?g/ml. Didapatkan hubungan bermakna antara ekspresi CgA dengan diagnosis histopatologik, grade groups dan skor Gleason p = 0, 006;p = 0,021;p = 0,006 . Tidak didapatkan hubungan bermakna antara ekspresi CgA dengan usia dan kadar PSA p = 0,412;p = 0.969 . Kesimpulan: Terdapat kecenderungan positivitas ekspresi CgA lebih banyak terjadi pada kasus adenokarsinoma prostat berdiferensiasi buruk dengan grade tinggi, yang dapat mempengaruhi prognosis dan pemilihan alternatif terapi.Kata kunci: Ekspresi Chromogranin A, adenokarsinoma prostat, grade groups, skor Gleason.

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Background Prostate cancer is the third most common malignant tumor in men worldwide. Predisposing factors of prostate cancer are influenced by age, genetics, race, hormonal, diet and environment. Prostate cancer may undergo Neuroendocrine Differentiation NED , and it found to be increase in poorly differentiated type of prostate cancer, especially who do not respond well to hormonal therapy. NED will determine the prognosis and selection of therapeutic alternatives.Objective To determine differences in expression of Chromogranin A CgA in prostate adenocarcinoma well, moderately and poor differentiated and its relationship to the tumour grading, and its effect on determining prognosis and selecting therapeutic alternatives.Methods A cross sectional study conducted to formalin fixed paraffin embedded biopsy tissue that are taken from a patient with prostate adenocarcinoma well, moderately and poor differentiated. The sample are immunohistochemical stained with CgA, identified and analyzed. The reviewed and analized it rsquo s relationship to the parameter on age, histopathological diagnosis, grade groups, Gleason score and PSA level.Results Chromogranin A positive expression with median 40 0.4 100 was found in the age 7 of prostate adenocarcinoma. CgA positive expression with median 35.4 0.4 88, 6 was found with PSA level 52.4 g ml. There were a significant difference between CgA expression with histopathological diagnosis, grade groups and Gleason score p 0, 006 p 0.021 p 0.006 . There were no significant difference between CgA expression with age and PSA level p 0.412 p 0969 .Conclusion There is a statistically significant difference of CgA expression with histopathologycal diagnosis and grade groups of prostate adenocarcinoma that reflect a worse prognosis in CgA positive group among prostate adenocarcinoma, which will need alternative therapies beside widely used hormonal therapy.Keywords Expression Chromogranin A, prostate adenocarcinoma, grade groups, Gleason score."

"ABSTRAKLatar belakang : Insiden Adenokarsinoma di RSCM meningkat pada periode 2001-2006 dibanding periode sebelumnya 1995-2000 . Banyak penderita yang resisten terhadap pengobaan hormonal. Resistensi ini diduga akibat sel tumor mengalami transformasi Neuroendokrin. Akan dilakukan penelitian untuk melihat ekspresi Androgen Receptor AR dan Chromogranin A CgA pada adenokarsinoma prostat di RSCM tahun 2011-2015.Tujuan : Membuktikan korelasi ekspresi AR dan CgA dengan derajat keganasan.Metode : Studi potong lintang analitik terhadap 70 kasus adenokarsinoma prostat di departemen PA FKUI/RSCM tahun 2011-2015. Kasus dipulas imunohistokimia AR dan Cg A serta dilakukan interpretasi hasil. AR dinilai prosentase positivitasnya pada inti epitel dan stromal. CgA dinilai prosentase positivitasnya pada sitoplasma. Uji korelasi dilakukan untuk melihat kemaknaan dan kekuatan korelasi antar variabel terikat.Hasil : Karakteristik sampel usia 47,1 >70 tahun; diferensiasi histopatologik/skor gleason 42,9 buruk/>7, grade group 28,6 grade5 dan PSA 64,3 dalam rentang 11-100ng/ml. Ekspresi CgA berkorelasi negatif lemah dengan ekspresi AR epitel r=-0,288;p=0,016 . Ekspresi CgA tidak berkorelasi dengan ekspresi AR stromal p=0,886 . Terdapat hubungan bermakna ekspresi AR epitel dengan grade group p=0,003 . Tidak terdapat hubungan bermakna ekspresi AR epitel dengan usia, diferensiasi histopatologik/skor gleason dan PSA. Ekspresi CgA berhubungan bermakna dengan diferensiasi histopatologik/skor gleason dan grade group p=0,018;p=0,038 . Tidak terdapat hubungan bermakna ekspresi CgA dengan usia dan PSA. Ekspresi AR stromal tidak berhubungan bermakna dengan usia, diferensiasi histopatologik, grade group, skor gleason, maupun PSA.Kesimpulan : Terdapat korelasi yang lemah antara AR dan CgA sehingga pulasan AR dan CgA dapat dipakai untuk pemilihan terapi.

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ABSTRACT Background Prevalence of prostate adenocarcinoma doubled in 2001 2006 compared to 1995 2000 in RSCM. Many patients resistant to hormonal treatment. This resistance is thought to be due to tumor cells undergoing neuroendocrine transformation. Study will be conducted to analyze the expression of Androgen Receptor AR and Chromogranin A CgA in prostate adenocarcinoma at RSCM in 2011 2015. Objective To prove correlation of expression of AR and CgA with degree of malignancy. Methods A cross sectional study was carried out on 70 cases of prostate adenocarcinoma in department of Anatomic Pathology FKUI RSCM from 2011 2015. AR expressed in stromal and epithelial nuclei, CgA expressed in cytoplasm. Statistical tests used to discover significance and correlation between the dependent variables. Results Most samples are more than 70 years old 47,1 , has poor histologic gleason score 42.9 , are in clinical grade 5 28.6 , and has PSA score range between 11 100 ng ml. CgA expression negatively correlates to epithelial AR expression r 0,288 p 0.016 , while no correlation are found between CgA expression and stromal AR expression p 0.886 . There is significant difference between epithelial AR expression with grade group p 0.003 , but not with age, histopathologic differentiation Gleason score and PSA. There are significant difference between CgA expression and histopathologic differentiation grade group and Gleason score p 0.018 p 0.038 , but not with age and PSA. No significant difference observed between stromal AR expression with age, histopathologic differentiation gleason score, grade group or PSA. Conclusion There rsquo s a weak correlation between AR and CgA so that AR and CgA expression can be used for the selection of therapy. "

"ABSTRAKKanker kolorektal KKR dianggap sebagai masalah kesehatan utama, salah satu jenis kanker yang paling sering terjadi serta penyebab kematian kedua terbesar di negara barat dan di Indonesia. Adenokarsinoma kolorektal serrated AKS merupakan salah satu tipe dari KKR. Salah satu jalur karsinogenesis kolorektal adalah jalur serrated yang diketahui melibatkan mutasi gen KRAS. Penanda tumor lain yang juga terlibat dalam proses karsinogenesis adalah P53 dan Bcl-2. Gambaran histomorfologik yang ditemukan oleh Tuppurainen dkk. saat ini digunakan sebagai penanda AKS. Terbatasnya sarana laboratorium patologi molekular di Indonesia, menekankan pentingnya membuat model skoring gambaran histomorfologik AKS dan atau ekspresi protein P53 serta Bcl-2 untuk memprediksi mutasi KRAS.Penelitian potong lintang terhadap 39 kasus AKS didapatkan dari Arsip Departemen Patologi Anatomik FKUI/RSCM selama tahun 2013 ndash;2015. Setiap kasus dikumpulkan data klinisnya, dan dinilai ulang karakteristik histomorfologik dan penanda tumor Bcl2 dan P53 , serta dilakukan pemeriksaan status KRAS. Penelitian histomorfologik dilakukan per kasus dan per contoh yaitu terhadap 100 kelenjar/kasus.Pada penelitian ini, kasus AKS ditemukan paling banyak pada laki-laki 51,3 , usia ge; 40 tahun 71,8 , lokasi di kolon kiri 84,6 , tidak memiliki metastasis 92,3 , status mutasi KRAS 71,8 . Ekspresi protein P53 didapatkan pada 69,2 dan protein Bcl-2 51,3 , tidak didapatkan hubungan bermakna ekspresi protein tersebut dengan status KRAS. Gambaran histomorfologik status KRAS didapatkan hubungan pada epitel serrated, lokasi inti sel, kondisi inti, sitoplasma dan musin. Odds ratio tertinggi ditemukan pada epitel serrated OR 2,7; IK 95 2,30 ndash;3,07 dan musin OR 2,0; IK 95 , 1,15 ndash;3,65 . Berdasarkan uji statistik didapatkan model nilai skoring yang terdiri dari epitel serrated, keadaan lokasi inti, kondisi inti dan adanya musin CI 95 antara 61 ndash;65 . Nilai sensitivitas dan spesifisitas berdasarkan nilai titik potong pada angka 16 sensitivitasnya sebesar 72 dan spesifisitasnya sebesar 48 .Simpulan: Didapatkan model sistem skor dengan titik potong 16 untuk memprediksi adanya mutasi KRAS berdasarkan, epitel serrated, lokasi inti sel, kondisi inti, dan adanya musin.Kata kunci: Adenokarsinoma kolorektal serrated, Bcl-2, jalur serrated, Kanker kolorektal, mutasi KRAS, P53

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ABSTRACTColorectal cancer CRC is considered as major health problem, one type of cancer that most often occurs as well as the second largest cause of death in western countries and in Indonesia. Serrated colorectal adenocarcinoma SA is one type of CRC. One of colorectal carcinogenesis pathway is serrated pathway that known to involve KRAS gene mutation. Other tumor markers that also involved in the process of its carcinogenesis were P53 and Bcl 2. Histomorphological criteria found by Tuppurainen et al currently used as marker of SA. Limited facilities of molecular pathology laboratory in Indonesia emphasize the needs of making scoring model by using histomorphological features of SA and or P53 and Bcl 2 protein expression to predict KRAS mutation.A cross sectional study conducted to 39 cases of SA registered in Departement of Anatomical Pathology FMUI Ciptomangunkusumo Hospital from 2013 ndash 2015. All clinical data related to the cases were collected. Each case was reevaluated based on Tuppurainen histomorphological criteria, tumor markers Bcl 2 and P53 , and KRAS status. Histomorphological examination is conducted per case and per instance to 100 nodes case.Present study showed that most cases of SA was found in male 51.3 , aged ge 40 years 71.8 , located in left colon 84.6 , did not have metastasis 92.3 , with KRAS mutation status 71.8 . P53 and Bcl 2 protein expressions were found in 69.2 and 51.3 respectively, with no significant association with KRAS status. Histomorphological features of KRAS status found in epithelial serration, nucleus location, nucleus condition, cytoplasm and mucin. Epithelial serration has the highest odds ratio OR 2.7 IK 95 2.30 ndash 3.07 followed by mucin OR 2.0 IK 95 , 1.15 ndash 3.65 . Statistical values showed scoring models consisted of epithelial serrations, nucleus location, nucleus condition and presence of mucin CI 95 between 61 ndash 65 . The sensitivity and specificity cut off point located on the number 16, with sensitivity value was 72 and specificity 48 .Conclusion A scoring system model yielded 16 as cut off score was obtained to predict KRAS mutations based on epithelial serrations, nucleus location, nucleus condition and presence of mucin.Keywords Bcl2, Colorectal cancer, colorectal serrated adenocarcinoma, KRAS mutation, P53, serrated pathway"

"ABSTRAKLatar Belakang: Beberapa studi menyebutkan bahwa penilaian kelainan yang terjadi pada prostat adalah dengan mengukur jumlah Androgen Receptor AR pada setiap kasus dan dipakai sebagai evaluasi terhadap keberhasilan terapi hormonal baik pada hiperplasia prostat/benign prostat hyperplasia BPH maupun adenokarsinoma prostat /adenocarcinoma prostate CaP . AR memerankan peran dalam proses pertumbuhan, differensiasi dan memelihara kondisi jaringan prostat tetap normal. Pada penelitian lain menyebutkan bahwa ekspresi AR positif berhubungan erat dengan gambaran derajat dan differensiasi tumor serta nilai skor Gleason. Tujuan penelitian ini untuk mengetahui perbedaan ekspresi AR pada hiperplasia prostat dan adenokarsinoma prostat.Bahan dan Metode: Penelitian ini menggunakan metode potong lintang. Sampel penelitian terdiri atas 20 kasus hiperplasia prostat dan 25 kasus adenokarsinoma prostat tipe asinar. Dilakukan pulasan imunohistokimia AR dan penilaian intensitas pulasan pada inti stromal dan inti epitel dengan menggunakan histoscore H-score . Hasil: Terdapat perbedaan bermakna kadar PSA antara hiperplasia prostat dan adenokarsinoma prostat p=0,004 . Ekspresi AR pada inti sel stromal pada hiperplasia prostat lebih tinggi dibandingkan pada adenokarsinoma prostat, dan mempunyai hasil statistik yang bermakna p=0,000 . Sedangkan ekspresi AR pada inti sel epitel menunjukkan hasil yang tidak bermakna pada kedua kelompok kasus p=0,152 . Intesitas ekspresi AR pada adenokarsinoma prostat dengan skor Gleason rendah le;7 lebih kuat dibandingkan adenokarsinoma prostat dengan skor Gleason tinggi >7 .Kesimpulan: Ekspresi AR pada inti sel stromal pada hiperplasia prostat lebih tinggi dibandingkan pada adenokarsinoma prostat. Peningkatan skor Gleason cenderung diikuti dengan penurunan intensitas ekspresi AR. Ekspresi AR pada hiperplasia prostat dan adenokarsinoma prostat dapat digunakan dalam prognosis dan prediksi serta evaluasi keberhasilan terapi hormonal.

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ABSTRACT"Background Previous studies suggested that Androgen Receptor AR expression could be used to evaluate the successful rate among patient with Benign prostate hyperplasia BPH or Adenocarcinoma acinar of the prostate CaP treated with hormonal therapy. AR plays role in prostate growth and differentiation, and maintains the normal state of the tissue. While in pathologic state, AR expression correlate with tumor grade and differentiation, and Gleason score GS . This study aimed to compare the expression of AR between BPH with CaP.Method This research use a cross sectional study conducted twenty cases of BPH and twenty five cases of CaP. Each tissue were stained using antibody against AR, and histologically reviewed. The captured photomicrographs were further analyze using histoscore H score .Result There was statistically signifinat levels PSA between BPH and CaP p 0,004 . The nucleus of stromal AR expression in BPH group compare to CaP group was statistically significant difference diagnose vs nucleus of stromal AR expression p 0,000 . Meanwhile, no significant difference is found between nucleus of epithelial AR expression between two group p 0,152 . The intensity expression AR in CaP with low Gleason score GS le 7 is higher than CaP with high Gleason score GS 7 Conclusion BPH expresess more nucleus of stromal AR than CaP. The higher Gleason score tends followed by declining intensity expression of AR. Thus suggest AR rsquo s role can use in prognosis, prediction and evaluation of hormonal theraphy of BPH or prostate malignancy."