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All Journal Medical Journal of Indonesia Journal of Dentistry Indonesia Kesmas: Jurnal Kesehatan Masyarakat Nasional Paediatrica Indonesiana Molecular and Cellular Biomedical Sciences (MCBS) Alami Journal (Alauddin Islamic Medical) Journal The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Majalah Kedokteran Andalas Majalah Patologi Indonesia The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia

Ening Krisnuhoni

Department Of Anatomic Pathology, Faculty Of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General National Hospital, Jakarta

Author-ID : 300209

Biochemistry, Genetics & Molecular Biology Dentistry Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Colorectal cancer among young native Indonesians: A clinicopathological and molecular assessment on microsatellite instability Sudoyo, Aru W.; Hernowo, Bethy; Krisnuhoni, Ening; Reksodiputro, Ary H.; Hardjodisastro, Daldiyono
Medical Journal of Indonesia Vol 19, No 4 (2010): November
Publisher : Faculty of Medicine Universitas Indonesia

Aim: To obtain clinicopathological characteristics of colorectal cancer among young native Indonesians and to assess MLH1, MSH2, and SMAD4 protein expressions, comparing them with a matched population of colorectal cancer patients aged 60 years old and older.Methods: Medical records of colorectal cancer patients aged 40 years or younger and 60 years or older from several hospitals in three Indonesian cities â Jakarta, Makassar, and Bandung - were reviewed. The ânativeâ ethnic groups were selected from those originating from Java, Makassar (South Celebes),Â Minangkabau (West Sumatra). Ethnicity of 121 colorectalÂ carcinoma patients was confirmed by fulfilling requirements in a questionnaire. Tumor specimens of those patients underwent evaluation for histopathology, tumor grading as well asÂ immunohistochemical analysis to assess MLH1, MSH2 protein expressions to detect microsatellite instability mutation pathway and SMAD4 protein expression to reconfirm that the specimens were not microsatellite instability origin.Results: There were 121 colorectal carcinoma cases of Sundanese, Javanese, Macassarese and Minangkabau ethnic group. This study indicated that colorectal cancer has statistically different grade (p = 0.001) between the young and the older patients. Immunohistochemical staining for MSH2 protein and MLH1 were done for 92 and 97 specimens respectively. There was no significant difference between the expressions of MLH1 and MSH2 on tumor grading, indicated there was no correlation between microsatellite instability and tumor grading in this study.Conclusion: Colorectal cancer in young native Indonesian patients (40 years old or less) was not different in clinicopathological characteristics compared to older patients (60 years old or more) in similar ethnic groups. There was also no difference in MSH2 and MLH1 protein expressions, important indicators of microsatellite instability and. (Med J Indones 2010; 19:245-51)Keywords: colorectal cancer, microsatellite instability, MLH1, MSH2, native Indonesian, SMAD4

The low prevalence of colonic serrated adenocarcinoma with high KRAS mutational status at Cipto Mangunkusumo Hospital, Indonesia Rahadiani, Nur; Handjari, Diah R.; Stephanie, Marini; Krisnuhoni, Ening
Medical Journal of Indonesia Vol 27, No 3 (2018): September
Publisher : Faculty of Medicine Universitas Indonesia

Background: Serrated adenocarcinoma (SA), a subtype of colorectal carcinoma, and the KRAS mutation, a strong marker for the patient’s response to anti-epidermal growth factor receptor therapy, have a clinical importance because of its progressive nature and tendency for chemoresistance. The purposes of this study were to (1) determine the prevalence of SA, (2) evaluate the histomorphological characteristics of SA and classical adenocarcinoma based on its prognostic factors, (3) determine the prevalence of the KRAS mutation in SA cases, and (4) identify the main characteristics of SA cases and classical adenocarcinoma with a KRAS mutation.Methods: This study was conducted by reviewing hematoxylin-eosin-stained slides of colorectal carcinoma (CRC) cases from January 2013 to July 2015 at the Department of Anatomical Pathology Cipto Mangunkusumo General Hospital. The final diagnosis of SA was based on the Tuppurainen et al criteria and the KRAS mutation was evaluated using real-time polymerase chain reaction.Results: Among the 117 adenocarcinoma cases, there were 41 unequivocal SA, 11 equivocal SA, and 65 classical adenocarcinoma. The prevalence rates of unequivocal and equivocal SA among all CRC cases were 7.7% and 2.1%, respectively. There were 11 (28.2%) cases of wild-type KRAS and 28 (71.7%) cases of mutated KRAS among all unequivocal SA cases. Tumor budding (TB) was the predominant prognostic factor.Conclusion: The prevalence of SA among all CRC cases was 7.7%. The KRAS mutation was found in almost three-quarters of all SA cases.

Demographic Characteristic of Fundic Gland Polyp and Its Association with Gastritis in Pathology Anatomy Department, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital Handayani, Liza; Krisnuhoni, Ening
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 18, No 1 (2017): VOLUME 18, NUMBER 1, April 2017
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: Fundic gland polyp (FGP) is the most common polyp found in the stomach with the incidence of 47% from all stomach polyps. FGP is more common to be found in female with the ratio of 5:1 and occurs in the average age of 53-year-old. Gastrin is a hormone produced by G cell, which function is to facilitate epithelial cell proliferation. Gastritis is a frequently found digestive tract disturbance. Torbenson et al showed the presence of chronic gastritis in FGP patients. The aim of this study is to observe the demographic characteristics of FGP and to identify the association between number of polyps with morphologic appearances of gastritis in Anatomical Pathology Department, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital in year 2012-2014.Method: This retrospective study was a descriptive analytical study. This study was performed by reviewing the slides of FGP cases and evaluating the severity of gastritis based on visual analog scale from Sydney System (SS).Results: Study of FGP demographic obtained 44 cases with predominantly female aged 30 (68.2%), patients’ average age was 55.4 year old with dominant age group in age group 51-60 year old which accounted for 16 (36.4%). This study was performed in 38 cases. The frequency of single polyp was 18 and multiple polyp was 20. Most cases were chronic inflammation which accounted for 21 (55.3%) and mild atrophy 18 (47.4%). Mild intestinal metaplasia was found in 1 case. There was no case of neutrophil infiltration, H. pylori infection or dysplasia. Chi-square test revealed that there was no significant association between number of polyps with gastritis.Conclusion: Chi-square test which was performed in this study showed there is no significant association between number of polyps with gastritis.

Hepatocellular Carcinoma in an Infant due to HBV Vertical Transmission Rahmah, Nunung Ainur; Marwoto, Wirasmi; Yuwono, Vera; Krisnuhoni, Ening; Handjari, Diah Rini; Kartono, Darmawan; Muljono, David Handojo
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 10, ISSUE 1, April 2009
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Hepatocellular carcinoma (HCC) is one of the common tumors in the world. The incidence of HCC generally increases with age in all population but there is a tendency of decreasing incidence in the elderly and it is very rare in children. This is a case report of HCC in a 9-month-old boy, who was admitted to the hospital with palpable abdominal mass in the right upper quadrant. Imaging modality by ultrasonography could not adequately demonstrate definite findings demonstrating that the tumor was derived from liver, and the diagnosis was neuroblastoma. Intra-operatively, the tumor mass appeared to be derived from the surface of the posterior edge of the liver, so it was a pedunculated tumor. The histopathological examination revealed a pedunculatedhepatocellular carcinoma grade 3. The Victorian blue staining and immunohistochemical staining were done afterward, which showed HBsAg positive result as found in non-tumor lesion as well as inneoplastic lesion of liver tissue.Keywords: hepatocellular carcinoma, pedunculated HCC, infant HCC, occult hepatitis B virus infection

Colorectal Cancer Metastasis of and the Risk Factors Soefyani, Ahmad; Rani, Abdul Aziz; Simadibrata, Marcellus; Abdullah, Murdani; Krisnuhoni, Ening
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 11, NUMBER 1, April 2010
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: Colorectal cancer (CRC) is the fourth most prevalent cancer in the world and is positioned the second most common cancer in the United States. Patients with CRC in Indonesia showed a greater proportion. In Jakarta, 47.85% of CRC cases occur under the age of 45 years. The purpose of this study is to determine metastasis and the factors that influence colorectal cancer patients. Method: This study was conducted retrospectively from January 2003-December 2007 in Cipto Mangunkusumo hospital. Patients are eligible if they underwent colonoscopy, tumor biopsy, anatomical pathology, abdominal CT scan, abdominal ultrasonography, and radiology procedures. Result: Of all 1,615 patients who underwent colonoscopy procedure, 377 patients were diagnosed with colorectal cancer. Subject that met the criteria consist of 86 patients, where 56 (65.1%) male. Most aged 51-60 years old (26.7%), mean age 47.90 ± 14.53 years old. The tumor is most commonly located in the rectum and sigmoid 40 (46.5%), in which 18 (45%) among them had metastasized. Compared with male patients, female patients experienced more metastases, but not statistically significant. Among the patients with metastasized CRC, 42.3% of them < 40 years old, 37.2% patients 41-60 years old, and 29.4% patients > 60 years old. Well-differentiated CRC produce larger number of metastatic cases than poorly-differentiated CRC. Poorly-differentiated CRC tend to produce adjacent metastasis, and also happened in relatively young age in compared with well-differentiated cancer. Conclusion: There was significant correlation between younger age group with a poor degree of histopathologic differentiation. Patients with CRC consist of more male patients than female ones. Factors sex, age group, histopathologic subtypes, and tumor location was not associated with metastasis. Keywords: colorectal cancer, metastasis, well-differentiated, poorly-differentiated

Chronic Diarrhea Due to Intestinal Amyloidosis Simatupang, Lydia D; Utia, Kharia; Syam, Ari Fahrial; Simadibrata, Marcellus; Govinda, Arya; Krisnuhoni, Ening
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 6, ISSUE 3, December 2005
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Amyloidosis is a rare disease, when diagnosed it’s incurable and mostly affect over 40 years old male. Diagnostic is confirmed if histopathologic stained positive with Congo red and evidence of monoclonal protein. Survivals for untreated patients are 13 months in primary amyloidosis but if secondary to other chronic disease and systemic, survival could be 3-4 years. It can not be prevented but when affected, control of the underlying illness can prevent progression of amyloidosis. We report a rare case of a 67 year old male, who came with chronic diarrhea. The stool analysis, there were no negative gram microorganisme found, only food maldigestion and fungus infection. Stool analyze from parasitology department were found microspore, but the stool culture were sterile. The patient underwent colonoscopy which revealed hyperemis mucosa in rectum, sigmoid, descending & transverse colon. From the biopsy was concluded intestinal amyloidosis. We treated the patient symptomatically and couldn’t find the underlying inflammatory disease which causes the problem. Keywords: secondary amyloidosis, chronic diarrhea, malabsorption, colonoscopy, protein electrophoresis

Correlation between Carcinoma Percentage (CP) and Lymphatic Microvessel Density (LMVD) Based on D2-30/Podoplanin as Metastatic Prognostic Factor to Lymph Nodes in not Otherwise Specified (NOS) Colorectal Adenocarcinoma Sari, Elisabeth Indria; Krisnuhoni, Ening; Wuyung, Puspita Eka
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 18, No 1 (2017): VOLUME 18, NUMBER 1, April 2017
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: In colorectal carcinoma (CRC), myofibroblast are the main component cells in tumour stroma which have an important role in the metastases process. The precentage between carcinoma and desmoplastic stroma known as carcinoma percentage (CP), can be used as an independent predictor metastases. D2-40/Podoplanin (PDPN) known as a spesific marker for lymphatic endothelial cell (LEC), which used to assess lymphatic microvessel density (LMVD) and lymphatic vessel invasion (LVI). This study aims to determine correlation and association between CP, LMVD and LVI with the metastases process to lymph node (LN).Method: CP assessment conducted on 44 samples of adenocarcinoma not otherwise specified (NOS) colorectal were divided into 22 cases with CP-High and 22 cases with CP-Low and examination D2-40/Podoplanin to assess LMVD and LVI. The statistical test is performed to find the correlation between CP and LMVD, as well as the relationship between CP, LVI and metastasis KGB.Results: There were a strong correlation between CP and LMVD intratumoral and peritumoral area with the negative correlation. There were a significant association (p=0,00) between LMVD (intratumoral and peritumoral area) with the LVI. There was a significant association between LVI and lymph node metastases (p = 0,03). Intratumoral area showed significant association with lymph node metastases (p = 0,04), whereas peritumoral area showed no significant association (p = 0,17).Conclusion: CP examination in histopathology specimen can be used to predict high/low rate of tumour cells metastases to the lymph node, based on a strong correlation between CP and LMVD.

Comparison of Helicobacter pylori Detection Using Immunohistochemistry and Giemsa and Its Association with Morphological Changes in Active Chronic Gastritis Nurdin, Wildawati; Krisnuhoni, Ening; Kusmardi, Kusmardi
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 17, No 1 (2016): VOLUME 17, NUMBER 1, April 2016
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: Gastritis is an inflammation of the gastric mucosa as a response to infection or irritation of the gaster. The most common aetiology of chronic gastritis is Helicobacter pylori (H. pylori) infection. Presence of H. pylori is associated with the occurrence of inflammation, atrophy, and intestinal metaplasia. In terms of morphology, H. pylori is known in 2 forms, which are rod-shaped and coccoid-shaped. Coccoid-shaped bacteria are difficult to detect using Giemsa staining. Therefore, immunohistochemistry staining of H. pylori and evaluation of the sensitivity of coccoid-shaped of H. pylori are needed.Method: Cross-sectional study on 90 biopsy tissues of chronic gastritis patients in year 2015 and 2014, which included 30 Giemsa cases with positive H. pylori, 30 cases of active chronic gastritis with negative H. pylori but coccoid-shaped was found, and 30 non-active chronic gastritis, were subsequently stained with immunohistochemistry staining of H. pylori.Results: Expression of coccoid-shaped H. pylori in active chronic gastritis was significantly different (p < 0.05) in immunohistochemistry staining. There was a significant difference between active chronic gastritis with positive H. pylori and negative H. pylori in immunohistochemistry staining with degree of inflammation. Sensitivity and specificity test between Giemsa and immunohistochemistry staining showed sensitivity of 65% and specificity of 100%.Conclusion: Immunohistochemistry staining in active chronic gastritis was more sensitive compared to Giemsa staining in detecting H. pylori, particularly the coccoid-shaped bacteria.

Clinical Manifestation and Diagnosis of Cryptosporidiosis in Adult Infected with HIV Krisnuhoni, Ening; Syam, Ari Fahrial; Rahmah, Nunung Ainur
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 4, ISSUE 3, December 2003
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Cryptosporidiosis is a rare infection caused by a coccidian parasite, Cryptosporidium, which could cause diarrhea in humans, especially those who are immunocompromised Cryptosporidiosis could cause self- limited diarrhea infection in immunocompetent hosts, but in immunocompromised hosts, especially those with AIDS, the diarrhea can be chronic and severe. To date, no known effective therapeutic agents have been identified. The following is one case report of cryptosporidiosis of a 27 year-old male admitted with chronic diarrhea since 2 months. Endoscopy of the ileum and colon showed hyperemia, erosion and edema, and biopsy was performed. Histopathological examination of ileum showed an atrophic villous and atypical degeneration. There was a number of circular cryptosporidium lining up along the surface of epithelium. There was inflammatory cell infiltration, consisting of lymphocytes, eosinophils and a few neutrophils in the lamina propria. Serological examination revealed an HIV-positive result. Keywords: Cryptosporidiosis, HIV, diarrhea

Correlation of Carcinoma Percentage (CP) in Colorectal Adenocarcinoma with Several Clinical Pathological Aspects in Anatomical Pathology Department Faculty of Medicine Universitas Indonesia/Cipto Mangunkusumo Hospital Jakarta in Year 2012-2013 Sari, Elisabeth Indria; Krisnuhoni, Ening
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 18, No 2 (2017): VOLUME 18, NUMBER 2, August 2017
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: Colorectal carcinoma is malignant tumour of the large intestinal epithelial, where more than 90% of colorectal carcinoma is adenocarcinoma. Desmoplastic stroma in primary tumour holds an important role in tumour development process. Mesker et al described carcinoma percentage (CP) evaluation in routine preparations with Haematoxylin-eosin (HE) staining as one of the prognostic factors.Method: This retrospective study was performed by collecting forms and slides of colorectal carcinoma resection cases from the archives of Anatomical Pathology Department FMUI-CMGNH in 2 years period (2012-2013). Collection of clinical data and re-evaluation of HE slides by 2 people which were the writer and supervisor were performed to determine CP value by observing the comparison between tumour percentage and desmoplastic stroma.Results: We included 92 cases of colorectal adenocarcinoma within those 2 years period (2012-2013). Comparison of total cases between male and female was 3:2, age > 40 years old were the most commonly found; in regard to location in the colon, most were found in the left side compared to the right side of the colon with the ratio of 3:7. Tumour histological grading with good differentiation were the most commonly found and most pT value being found were pT3; most lymph node involvement was N1. The most CP value attained in every parameter was CP-Low.Conclusion: Carcinoma percentage (CP) which was divided as CP-High and CP-Low could be used as a prognostic factor. In this study, we found more cases of CP-Low compared to CP-High, either based on sex, age, location, degree of differentiation, pT value, or even lymph node involvement. CP-Low which showed worse prognosis could also be used as a marker of patients who were at higher risk of colorectal carcinoma.

Co-Authors Abdul Aziz Rani Abdul Aziz Rani Abdullah, Arman Adel Achmad Fauzi ACHMAD FAUZI Adang Bachtiar Agustina, Yohana Alfa Ahmad Aulia Jusuf Ahmad Soefyani Alan R. Tumbelaka Alif Gilang Perkasa Ari Fahrial Syam Ari Fahrial Syam Arman Adel Abdullah Aru W. Sudoyo Ary H. Reksodiputro Arya Govinda Badriul Hegar Bethy Hernowo Chudahman Manan Chudahman Manan Chyntia Olivia Maurine Dadang Makmun Dadang Makmun Dadang Makmun Daldiyono Daldiyono Daldiyono Daldiyono Daldiyono Hardjodisastro Darmawan Kartono David Handojo Muljono Devy Serevina Dewantoro, Okto Diah Rini Handjari Diah Rini Handjari Diah Rini Handjari Diah Rini Handjari Diah Rini Handjari Dyonesia Ary Harjanti Eka Susanto Elisabeth Indria Sari Elisabeth Indria Sari Erni Erfan, Erni Esti DS Soetrisno Farida Briani Sobri Fili Sufangga Flora Dameria Handayani, Liza Handjari, Diah R. Hanifah Oswari I Wayan Murna Yonathan Iamaroon, Anak Ifransyah Fuadi Ifransyah Fuadi, Ifransyah Ika Dhuhani Indriasti Indah Wardhany Irsan Hasan Irwina Eka Deraya Isabella Kurnia Liem Iskandar, Rizka Puteri Jelita Inayah Sari Juwita Cresti Rahmaania Kaka Renaldi Kharia Utia Kuntjoro Harimurti Kusmardi Kusmardi Kusmardi Kusmardi Kusmardi Suid Lia Mulyani Liza Handayani Lydia D Simatupang Lydia Kencana Marcellus Simadibrata Marcellus Simadibrata Marini Stephanie Marini Stephanie Marini Stephanie Marini Stephanie Murdani Abdullah Murdani Abdullah Murdani Abdullah Nafrialdi Nafrialdi Nelly Tandiari Nita Afriani Nunung Ainur Rahmah Nur Rahadiani Nur Rahadiani Nur Rahadiani Nur Rahadiani Nurdin, Wildawati Nurjati C Siregar Okto Dewantoro Patria Wardana Yuswar Paulus Kusnanto Primariadewi Rustamadji Puspita Eka Wuyung Puspita Eka Wuyung Puspita Eka Wuyung Rabbinu Rangga Pribadi Reni Oktavina Ria Kodariah Ria Kodariah Rino Alvani Gani Rino Alvani Gani Rino Alvani Gani Rizka Puteri Iskandar Santoso Cornain Santoso Cornain Sari, Elisabeth Indria Saut Horas Hatoguan Nababan Seruni Tyas Khairunissa Sonar Soni Panigoro Sufangga, Fili Velma Herwanto Velma Herwanto Vera Yuwono Welly Hartono Ruslim Wildawati Nurdin Wirasmi Marwoto Wirasmi Marwoto Wiwit Ade Fidiawati Yonathan, I Wayan Murna Yuniardini Septorini Wimardhani Zakiyah Zakiyah

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