Tesis

Insidensi occult metastasis kelenjar getah bening pada karsinoma ovarium dan hubungannya dengan tipe histopatologik = Incidence of lymph nodes occult metastases in ovarian carcinoma and its association with histopathologic type.

Latar Belakang: Karsinoma ovarium merupakan tumor ganas ginekologik yang paling mematikan. Metastasis kelenjar getah bening ditemukan pada 78% kasus stadium lanjut yang dilakukan sampling atau diseksi kelenjar getah bening. Metastasis ini juga ditemukan pada kasus yang secara klinis sesuai dengan stadium I dan II. Faktor risiko terjadinya metastasis kelenjar getah bening pada karsinoma ovarium meliputi tipe histologik serosum, tumor high grade, dan kadar CA125 serum yang tinggi pada saat diagnosis. Pemeriksaan ulang kelenjar getah bening negatif pada kasus keganasan ginekologik lain menunjukkan adanya mikrometastasis hingga 8%14%. Tujuan: Penelitian ini dilakukan untuk mengetahui insidensi occult metastasis, baik berupa mikrometastasis maupun isolated tumor cells, pada kelenjar getah bening negatif dengan menggunakan pulasan imunohistokimia sitokeratin AE1/AE3 pada karsinoma ovarium dengan berbagai tipe histologik. Metode: Penelitian retrospektif dengan desain potong lintang pada sediaan kelenjar getah bening negatif dari operasi histerosalpingoovorektomi disertai limfadenektomi kasus karsinoma ovarium di RSCM periode Januari 2016 sampai Desember 2020. Pada seluruh blok parafin berisi kelenjar getah bening negatif berukuran >1 cm dilakukan potong dalam dua kali untuk masing-masing dipulas hematoksilin-eosin dan imunohistokimia sitokeratin AE1/AE3. Data imunoekspresi AE1/AE3 dianalisis untuk menentukan mikrometastasis/isolated tumor cells, dan mengetahui hubungannya dengan tipe histologik serosum. Hasil: Dari 57 sampel yang memenuhi kriteria inklusi dan eksklusi didapatkan rerata usia 49,5 tahun. Tipe histopatologik terbanyak (40,3%) adalah karsinoma sel jernih, 66,7% kasus memiliki tumor high grade, dan 57,9% kasus terdiagnosis pada stadium dini. Occult metastasis didapatkan pada 1 (1,75%) kasus dari seluruh sampel. Tidak ditemukan perbedaan kejadian occult metastasis pada kelompok karsinoma serosum dan non-serosum (p=1). Kesimpulan: Insidensi occult metastasis kelenjar getah bening sebesar 1,75% dari seluruh kasus karsinoma ovarium dalam penelitian ini. Tidak ditemukan perbedaan kejadian occult metastasis pada kelompok karsinoma serosum dan non-serosum.
Kata kunci: karsinoma ovarium, mikrometastasis, isolated tumor cells


Background: Ovarian carcinoma is the most lethal gynecologic malignant tumor. Lymph node metastases were found in 78% of advanced stage cases that underwent lymph node dissection. These metastases were also found in cases with clinical stage I and II. Risk factors for lymph node metastasis in ovarian carcinoma include serous histologic type, high grade tumor, and high serum CA125 level at diagnosis. Reexamination of negative lymph nodes in cases of other gynecologic malignancies shows micrometastases in up to 8%-14%. Aim: This study was conducted to determine the incidence of occult metastases, either in the form of micrometastases or isolated tumor cells, in negative lymph nodes by using cytokeratin AE1/AE3 immunohistochemistry in ovarian carcinomas of various histologic types. Method: A retrospective study with a cross-sectional design on negative lymph node preparations from hysterosalpingoovorectomy surgery accompanied by lymphadenectomy for ovarian carcinoma cases at RSCM January 2016-December 2020. All paraffin blocks containing negative lymph nodes measuring >1 cm were cut in two sections and stained with hematoxylin-eosin and cytokeratin AE1/AE3. AE1/AE3 immunoexpression data were analyzed to determine micrometastases/isolated tumor cells, and their relationship with serous histological type. Result: Of the 57 samples that met the inclusion and exclusion criteria, the mean age was 49.5 years. The most histopathological types (40.3%) were clear cell carcinomas, 66.7% cases had high grade tumors, and 57.9% cases were diagnosed at an early stage. Occult metastases were found in 1 (1.75%) cases of the entire sample. There was no difference in the incidence of occult metastases in the serous and non-serous carcinoma groups (p=1). Conclusion: The incidence of occult lymph node metastases was 1.75% of all ovarian carcinoma cases in this study. There was no difference in the incidence of occult metastases in the serous and non-serous carcinoma groups.
Keywords: ovarian carcinoma, micrometastasis, isolated tumor cells