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Diagnostic accuracy and cytomorphology analysis of fine-needle aspiration of salivary glands Lisnawati, Lisnawati; Stephanie, Marini; Hamdani, Chairil
Medical Journal of Indonesia Vol 21, No 2 (2012): May
Publisher : Faculty of Medicine Universitas Indonesia

Background: Fine-needle aspiration (FNA) is an effective and safe procedure for analyzing salivary gland lesions. Various morphological and overlapping cytomorphology features can bring difficulty in diagnosis of the salivary gland lesions. This study aimed to evaluate the diagnostic accuracy of fine needle aspiration cytology of salivary glands lesions.Methods: There were 107 cases of cytology and 39 cases of histopathology of salivary gland lesions collected and reviewed from the archives of Anatomical Pathology Department, Faculty of Medicine, Universitas Indonesia / Cipto Mangunkusumo Hospital from 2005-2009. Seven cases of cytology were excluded, due to unsatisfactory specimens. Diagnostic test was applied to analyze the 39 pairs of cytology-histopathology cases.Results: There were 100 cases of salivary gland lesions cytology obtained, consisted of 27 negatives, eight cases inconclusive and 65 cases of neoplastic lesions. Of the 39 pair cases, fourteen cases showed result discrepancies between cytology and histopathology, with 3 false-negative cases and 1 false-positive case. The sensitivity and specificity of cytology analysis in differentiating malignant from non-malignant lesions were 82.35%, and 95.45% respectively, NPV 87.5% and PPV 93.34%.Conclusion: This study showed diagnostic accuracy of FNA cytology salivary gland lesions was varied, with 82.35% sensitivity and 95.45% specificity in differentiating malignant from non-malignant hence this information can still be used for case management. (Med J Indones. 2012;21:92-6)Keywords: FNA cytology, salivary gland lesions

Overexpression of p53 in extra large (more than 10 cm) hepatocellular carcinoma Lalisang, Toar J.M.; Moenadjat, Yefta; Siregar, Nurjati C.; Stephanie, Marini
Medical Journal of Indonesia Vol 27, No 2 (2018): June
Publisher : Faculty of Medicine Universitas Indonesia

Background: Extra large hepatocellular carcinoma (HCC) of >10 cm managed in our center shows a specific characteristic in tropical regions. This type of HCC exhibits distinct p53 expression. This study aimed to determine the association between p53 expression and tumor size and behavior. Method: Subjects with HCC who underwent surgical resection in our hospital during 2012–2015 were enrolled in thisstudy. Subject’s characteristics, tumor size, histopathology findings, and tumor behavior were variables observed. Animmunohistochemical study on p53 expression was conducted to determine its association with those variables.Results: This study involved 38 subjects with tumor size ranging from 3 cm to 25 cm in diameter and 20 subjects (52.8%) with tumor size ranging from 10 cm to 25 cm in diameter. Only 13 samples were evaluated for p53 expression. Five subjects with >10 cm (extra large) tumor showed highly/overexpressed p53 (intensity>50%), two subjects with strong p53 expression (intensity>5%–50%), and two subjects with weak expression. Three subjects with <10 cm (large) tumor showed strong expression of p53 (5%–9%) and a subject with 3 cm tumor showed weak p53 expression (<5%). Highly expressed p53 was found in patients with microvascular invasion, inflammatory response, mitosis, and necrosis.Conclusion: Overexpression of p53 was associated with extra large and poorly differentiated HCC.

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.

Clinicomorphological Profile of Gastric Polyps in Anatomical Pathology Department, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital (CMH): A Retrospective Study in Correlation of Long-Term Use of Proton-Pump Inhibitors Sufangga, Fili; Rahadiani, Nur; Krisnuhoni, Ening; Handjari, Diah Rini; Stephanie, Marini
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 20, No 1 (2019): VOLUME 20, NUMBER 1, APRIL 2019
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Background: Gastric polyps are mucosal elevation into the lumen, found incidentally during endoscopic examination and generally brings no specific symptoms. Long-term use of proton-pump inhibitors (PPIs) is related to the development of the fundic gland polyp (FGP). This retrospective study was conducted to determine the distribution of gastric polyps in CiptoMangunkusumo Hospital along with histomorphological features and their relation with long-term PPI use.Method: This retrospective review is a descriptive analytic study. Gastric polyp cases were taken consecutively from the archive of the Anatomical Pathology Department, Faculty of Medicine Universitas Indonesia/CiptoMangunkusumo Hospital the period of 2016-2017. Clinical data obtained from patient’s medical records. Statistical analysis was carried out with the IBM ® SPSS version 23 program.Results: Among 83 cases of gastric polyps, there were 66 cases of FGP, 11 cases of inflammatory polyps, 5 cases of hyperplastic polyps, and 1 case of Peutz-Jegher polyp. Long term PPI was used in 40 cases and was related with parietal cell hyperplasia.Conclusion: FGP is the most common type of gastric polyp in the Department of Anatomical Pathology CMH. Long term PPI use was found in half of gastric polyps and was related to parietal cell hyperplasia morphology.

Analisis Hubungan antara Ekspresi MMP-2 dengan Derajat Neoplasia Serviks pada Pap Smear Berbasis Cairan Marini Stephanie; Lisnawati -; Rahmiati -
Majalah Patologi Indonesia Vol 22 No 3 (2013): MPI
Publisher : Perhimpunan Dokter Spesialis Patologi Indonesia (IAPI)

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ABSTRAK Latar belakang MMP (matrix metalloproteinase) merupakan protease yang memiliki peran yang sangat penting pada proses invasi dan metastasis. Seiring dengan perkembangan pengetahuan mengenai akivitas MMP dan matriks esktraseluler, MMP dipikirkan juga ikut berkontribusi dalam lesi-lesi intraepitelial neoplasia serviks, salah satu diantaranya adalah MMP 2. MMP 2 merupakan salah satu anggota kelompok gelatinase yang sering dilaporkan kaitannya dengan progresifitas lesi kanker serviks, yang penelitiannya pada umumnya dilakukan pada jaringan. Tujuan penelitian ini adalah untuk mengetahui hubungan ekspresi MMP 2 dengan derajat neoplasia serviks yang dilakukan pada bahan sitologi berbasis cairan. Metode Penelitian ini dilakukan secara prospektif, menggunakan studi deskriptif analitik dengan disain potong lintang pada sediaan pap smear berbasis cairan yang telah didiagnosis sesuai dengan klasifikasi Bethesda 2001. Kasus dengan papsmear abnormal akan dilanjutkan dengan imunositokimia MMP 2. Hasil Terdapat hubungan bermakna antara ekspresi MMP 2 dengan derajat neoplasia serviks (p=0,001). Kesimpulan Ekspresi MMP 2 dapat ditemukan pada lesi atipikal, prekanker dan kanker invasif pada serviks. Tampak proporsi positifitas ekspresi MMP 2 lebih tinggi secara bermakna pada lesi derajat tinggi dibandingkan pada lesi derajat rendah. Kata kunci: MMP 2, derajat neoplasia serviks, pap smear berbasis cairan. ABSTRACT Background MMP (matrix metalloproteinase) ia a protease which have important role in the invasion and metastatic process. Resent study of the activity and extracellular matrix of MMP, especially MMP-2 is suspected contribute in the cervical intraepithelial neoplasia MMP-2 is one of the gelatinase group, that have been reported having correlation with cervical cancer progresivity. Many studies concerning the activity of MMP-2 in the tissues had been done. The aim of this study is to learn the relation of MMP-2 expression with cervical neoplasia grading using liquid base cervical cytology specimen. Methods This is a prospective study by cross sectional analysis using liquid base cytology slides, that was diagnosed according the Bethesda 2001 classification. All cases were reviewed and the abnormal cases were continued to immunocytochemistry staining using MMP-2 antibody. Results There were significantly association between MMP 2 and degree of neoplasia cervical lesion with p=0.001. Conclusion MMP 2 expression can occur in atypical, precancer and cancer lesions of the cervix. It was shown that high grade cervical lesions had higher proportion of MMP 2 positivity than low grade cervical lesions significantly. Key words : MMP 2, degree of neoplasia cervical lesions, liquid based cytology.

Peran CD44 pada Progresivitas Non Alcoholic Steatohepatitis (NASH) Sarwanti; Marini Stephanie; Ria Kodariah
Majalah Patologi Indonesia Vol 29 No 2 (2020): MPI
Publisher : Perhimpunan Dokter Spesialis Patologi Indonesia (IAPI)

Non alcoholic Steatohepatitis (NASH) is part of a group of conditions called Non-Alcoholic Fatty Liver Diseases(NAFLD) where it is a chronic disease, which defined after elimination other causes of fatty liver, such as excessivealcohol consumption and other causes of chronic liver diseases. NASH is fatty liver disease which characterized byballooning of hepatocyte and lobular inflammation with or without fibrosis. Histopathology diagnose on NASH can bedefined by performing liver biopsy. The purpose of liver biopsy is to define level and degree of the disease. Cluster ofDifferentiation (CD) 44 is a transmembrane glycoprotein receptor which located on the surface of macrophage cells,lymphocytes and endothelial cells. In studies which conducted on mice and humans, showed that CD44 playsimportant role in the progression of NASH. CD44 regulates inflammation of adipose tissue and liver. CD44 ispresumed as a marker which increase macrophage infiltration and other inflammatory cells on liver. This processleads to ultimate increment on insulin resistance and fatty liver. Deficiency was discovered on mice which injectedwith methionine and choline deficiency diet (MCDD). CD44 is associated with preventive method to prevent livercomplication by reducing macrophage or monocyte and as well as neutrophil accumulation in liver which wasevaluated through reducing numbers of inflammatory focus, expression of inflammatory cytokines: tumor necrosisfactor α (TNFα), interleukin (IL) -1B and nitric oxide synthesis (iNOS), and pro-inflammatory types of macrophage. Inobese patients, number of CD44 is predicted to be increasing.

Ketepatan Pemeriksaan Imunohistokimia CK19 Dibandingkan dengan PDX-1 pada Tumor Pankreas dan Anak Sebarnya Bayu Perkasa Rosari; Michelle Linggodigdo; Yan Cahya Wijaya; Marini Stephanie; Nur Rahadiani
Majalah Patologi Indonesia Vol 30 No 3 (2021): MPI
Publisher : Perhimpunan Dokter Spesialis Patologi Indonesia (IAPI)

BackgroundMetastatic adenocarcinoma of unknown origin remains a serious problem in oncology. Pancreatic cancer is often diagnosed when ithas already metastasized. Therefore immunohistochemistry (IHC) examination for detecting metastases of pancreatic origin is veryimportant IHC marker of Pancreatic duodenal homeobox-1 (PDX-1) has a good accuracy for detecting metastases of pancreaticorigin, however it is not readily available in many centers in Indonesia. Instead, IHC marker that is often being used is CK19. Thismarker is not specific, because it is also expressed by gastrointestinal and hepatobilliary tumors. This evidence-based case reportaims to determine the accuracy of CK19 compared with PDX-1 IHC for detecting pancreatic tumor and its metastases.MethodsLiterature searches were conducted on Pubmed/MEDLINE®, Scopus®, Cochrane®databases. Four articles about PDX-1 and 5 articlesabout CK19 that are relevant were found. Those articles were critically appraised.ResultsAll articles are considered valid, as they fulfilled the important criteria for journal validity. A study of CK19 IHC found that this markerhas 100% sensitivity and 6% specificity for diagnosing liver metastases from well-differentiated pancreatic ductal adenocarcinoma.Studies of PDX-1 IHC have different results; a study found that 27 out of 67 were PDX-1 positive in metastases of pancreaticadenocarcinoma origin, while another study found that PDX-1 has 72% sensitivity and 93% specificity for pancreatic neuroendocrinetumor, with 100% sensitivity and 75% specificity for pancreatic neuroendocrine tumor metastases.ConclusionCK19 IHC is highly sensitive for detecting adenocarcinoma metastases of pancreatic origin, thus it can be utilized as a screening test.However, CK19 IHC specificity for detecting adenocarcinoma metastases of pancreatic origin is low compared to PDX-1 IHC

Perbedaan Profil Histomorfologik Jaringan Hati Resipien dan Donor Pascatransplantasi Hati Anak antara Kelompok Pasien Rejeksi dan Tidak Rejeksi di Departemen Patologi Anatomik FKUI/RSCM Periode 2010-2019 Alif Gilang Perkasa; Marini Stephanie; Nur Rahadiani; Diah Rini Handjari; Ening Krisnuhoni; Hanifah Oswari
Majalah Patologi Indonesia Vol 31 No 1 (2022): MPI
Publisher : Perhimpunan Dokter Spesialis Patologi Indonesia (IAPI)

BackgroundLiver rejection is an immune system response of recipient in which attacking the antigen originating from a donor that can causedamage to the transplanted organ. Although the prevalence of liver rejection has decreased due to the use of immunosuppressivedrugs, it is estimated that 20-40% of recipients still experience rejection and are at risk of re-transplantation and even death. Thisstudy aims to investigating histomorphological characteristics that can play a role as risk factors for rejection by assessing thedifferences in histomorphological characteristics before transplantation between recipient groups with rejection and non-rejection inpediatric liver transplant recipients in the Department of Anatomical Pathology, Faculty of Medicine, University of Indonesia, Dr.Cipto Mangunkusumo (PA-FKUI/RSCM)MethodsThis study was an analytical study with a cross sectional design, using secondary data from the archives of the Department ofAnatomical Pathology, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo 2010-2019. The clinical andhistopathologic data obtained were analyzed using comparative statistical tests.ResultsRejection were found in 25% of recipients. Rejection were more common in the group of recipients aged >1 (75%), male (58%),cirrhosis 4C (92%) and mild portal inflammation (56%). Rejection were more common in the group of donor with male (66%) andsteatosis ≤10% (92%). There were no significant differences in the histomorphological profiles of recipients and donors with orwithout rejection.ConclusionThe histomorphologic profiles of both recipients and donors were known to be descriptively associated with complications of posttransplant liver rejection. However, in terms of analysis, there was not any significant differences

Akurasi Diagnosis Pemeriksaan Biopsi Aspirasi Jarum Halus Tumor Tulang di Departemen Patologi Anatomik FKUI/RSCM Tahun 2015- 2019 Vabiayu Putri; Marini Stephanie
Majalah Patologi Indonesia Vol 31 No 1 (2022): MPI
Publisher : Perhimpunan Dokter Spesialis Patologi Indonesia (IAPI)

BackgroundFine needle aspiration biopsy (FNAB) is a safe and rapid technique and has an important role in making the preoperative diagnosisof bone tumors because it can help clinicians determine treatment for patients. This retrospective study aims to assess the accuracyof the FNAB cytological examination compared with the histopathological examination in preoperative diagnosis of bone tumors.MethodsThe data comes from the archives of the Department of Anatomic Pathology, FKUI/RSCM 2015-2019 in the form of a cytologicalexamination of FNAB lesions on bone. Then the histopathological examination data were searched for each cytology preparation.There were 133 pairs of cytology, and histopathology preparations. The preparations were reviewed by the investigator andsupervisor, assessed for the suitability of the cytologic diagnosis, and compared with the histopathological diagnosis.ResultsThere were 84 (63.2%) cases of malignant tumors, 44 (33.1%) cases of benign tumors, and 5 (3.7%) cases of non-tumors. Thediagnostic test results showed an accuracy rate of 86.5% with a sensitivity of 85.9%, a specificity of 100%, a positive predictivevalue (PPV) of 100%, and a negative predictive value (NPV) of 21.7%.ConclusionFNAB cytology examination of bone tumors that have adequate sample quality, supported by complete clinical information andinformative radiological images can produce an accurate preoperative diagnosis

Akurasi Diagnostik dan Analisis Gambaran Sitomorfologi Sikatan Bilier dan Endoscopic Ultrasound Guided Fine Needle Aspiration (EUS-FNA) Pankreas Berdasarkan The Papanicolaou Society of Cytopathology System Sarwanti; Marini Stephanie
Majalah Patologi Indonesia Vol 31 No 2 (2022): MPI
Publisher : Perhimpunan Dokter Spesialis Patologi Indonesia (IAPI)

BackgroundEndoscopic ultrasound guided fine needle aspiration (EUS-FNA) of the pancreas and biliary brushes is a minimally invasive method ofcytology sampling. The purpose of this study was to determine the sensitivity, specificity, and accuracy of examination of biliary brushcytology and EUS-FNA pancreas based on the System of standardized terminology and nomenclature for pancreatobilliary cytology(STNPC) as well as cytology characteristics of pancreatic malignancy.MethodsA search of the biliary brush preparation and EUS-FNA pancreatic in 2017-2020 was carried out in the Archives section of the Department ofAnatomical Pathology FKUI / RSCM. 506 cases of biliary brush cytology and EUS-FNA pancreatic, conducted a search of histopathologicalpreparations and re-categorized based on STNPC.ResultsCytological cases of biliary brushing and pancreatic EUS-FNA paired with histopathology in 2017-2020 151 cases, 85 cases of biliarybrushing and 66 cases of pancreatic EUS-FNA, were re-categorized based on STNPC with results of biliary brushing 27 non-diagnosticcases, 24 atypical cases, 7 suspicious for malignancy (SFM) cases and 17 malignant cases. Meanwhile, for pancreatic EUS-FNA cytology16 non-diagnostic cases, 2 negative cases, 16 atypical cases, 3 other neoplasms, 4 SFM cases and 25 malignant cases. Twenty sevencases of false negative biliary brushes on non-diagnostic and atypical preparations and 4 cases of false negative on pancreatic EUS-FNA onnon-diagnostic and atypical preparations. Biliary brushing diagnostic test results: sensitivity 82.35%, specificity 100%, positive predictivevalue (PPV) 100%, negative predictive value (NPV) 84.21% and accuracy 90.9%. In pancreatic EUS-FNA: sensitivity 84.21%, specificity100%, PPV 100%, NPV 986.67% and accuracy 92.86%.ConclusionCytological diagnosis of biliary brushing and pancreatic EUS-FNA has good specificity, sensitivity and accuracy, but definitive diagnosisrequires histopathological examination

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