Genital Wanita
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Genital Wanita
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VULVA
KELAINAN KONGENITAL
1. imperforated hymen hematocolpos
hematosalfing hematometra
. d!pli"asi
#. hipolasia
IN$LA%A&I
gangg!an "!lit psoriasis
e'(ema
alergi
nonspesifi" )!l)itis *lood discrasia
!remia
+%
maln!trisi
a)itaminosis
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A+ENITI& ,artholin
Kista ,artholin Go
a"!t a*ses
"roni" asimptomati" e'aser*asi a"!t
"ista #- cm/ dilapisi epitel transitional-flatted
0E2E& &I%2LEK&
no setelah GO
Klini"3 demam/ malise #-4 hari post coit!s
KG, ing!inal 55 sem*!h spontan
pap!la merah/ )esi"el/ !l"!s infe"si laten persisten
le!corrhoe relaps
i*! hamil
ser)i"s3 displasia
"arsinoma
Terapi3 )!l)o)aginitis s!lit
acyclo)ir 6topi"al/ IV7
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+istropi )!l)a
d!l!3 le!"opla"ia
opa8!e/ p!tih/ pla8!e li"e m!"osa
pr!rit!s/ sisi"
histologi" -9ina" -lain3 premaligna
maligna
*iopsi :le!"opla"ic; lesions
1. )itiligo
. inflamasi dermatosis 6 psoriasis/ dermatitis "roni" 7
#.
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+istropi?
1. Atrophic dystrophy @ lichen sclerosis 6 et atrophic!s 7
"has3 atropi epitel
fi*rosis s!*epitel. hyperplastic dystrophy hiperplasia-atipia sel!ler
"has3 hiperplasia mild
hiperpara"eratosis moderate
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T!mor ses!ai dengan "omponen 9aringan
*enign
1. hidradenoma :ectopis *reast;"elen9ar apo"rin
ma"ros3 nod!l pada l.mayor @ inter la*ial fold
!lserasi
mi"ros3 d!"t!s t!*!ler dilapisi 1- lapisan epitel tora" td" *ersilia/
sel mioepitel 6 "has "elen9ar "eringat 7
. "ondiloma a"!minata
)erroco!s3 1. "ondiloma a"!minata lesi s"!amosa 02V /11
@ )enereal >art
. polip m!"osalproliferasi stroma silapisi epitel
s"!amosa
#. syphilitic condyloma lat!m se' transmitted
perineal/ )!l)a/ perianal/ )agina
ma"ros3 soliter/ m!ltipel/ "oalesen
mi"ros3 9ar. I"at fi*ro!s dilapisi ep. &"!amosa papiler/ a"antosis/para"eartosis/ hiper"eratosis/ inti atipi"/ "oilositosis.
dapat regresi spontan
*!"an lesi pre"an"er
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%aligna
"arsinoma dan VIN
#B 5 C tah!n
patogenesis31. 02V DCB - 1/13 m!ltisentri"/ precancero!s change VIN
@in sit! @ penya"it ,o>en
inti atipi"/ mitosis 55
VIN grade I mild
II moderate se)erity atipia
III se)ere
. "arsinoma sel s"!amosa
etiologi F
morfologi "arsinoma
E'tra mammary 2aget disease
9arang dengan pr!rit!s/ merah/ cr!sted/ *atas tegas
:map li"e; la*i!m mayor
mi"ros3 sel halo/ *esar
melanoma
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VAGINA
Kelainan "ongenital
atresia
a*sent
septate
do!*le
"ista d!"t!s Gartner
- cm/ epitel "!*is/ "ol!mner/ transtitional.
Inflamasi
trichomonas )aginalis 6 post menopa!se
stra>*erry 7
monilia
0. simple"s
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Karsinoma
F 2rimer @ se"!nder
insidio!s/ in)asif terapi s!lit th C-#CB1C th -1B
1B
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&ar"oma *otryiodes
9arang/ infant H tah!n
tdd3 rha*domiosar"oma em*rional
ma"ros"3 polipoid/ grape li"e cl!ster/
"onsistensi gelatino!s
dapat pecah perdarahan
infe"si se"!nder
mi"ros3 s!*eiptel )agina :cam*i!m;/ sel t!mor ganas/ stroma fi*romiomato!s/
edem/ sel radang
in)asi lo"al
"ematian3 peneetrasi "a)!m peritone!m/ o*str!"si sal!ran "emih
+@ dini operasi
"hemoterapi
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Karsinoma
#B
hiperplasia atipi"
displasia
papiloma 9ina"
penya"it ,o>en
B -
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2ELVI< IN$LA%%ATO +I&EA&E
dim!lai pada )!l)a@"elen9ar tra"t!s genital se*agian @sel!r!h sistem gen
>anita
Etiologi3 GO
non GO
a*ort!s stafilo"o"
part!s normal strepto"o"
part!s a*normal coliform clostridi!m perfringen
dilatasi
"!retase mi"oplasma
chlamydia
*a"teri anaero*
2 *
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2enye*aran
GO *artholin @ )esti*!ler m!"osa t!*a t!*a o)arial
d!"t!s s"ene
"elen9ar peri!retra
"elen9ar endoser)i"s
non GO sistem limfati" rea"si ter!tama pada lapisan yang le*ih dalam
)ena
ad!lt 3 )agina resisten
infant3 )!l)o)aginitis
ma"ros3 -4 hari s!p!rasi a"!t/ hiperemia/ edem
mi"ros3 m!"osa/ s!*m!"osa nonspesifi"
endometritis salfingitis s!p!rasi a"!t salfingooo)aritis
piosalfing
setelah *!lan @ tah!n "roni" hidrosalfing 6proteolisissero!s7t!*ao)arial a*ses
&tafilo"o"
&trepto"o" dinding t!*a sero!s ligamen str!"t!r pel)is/ peritone!m
*a"teriemia
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Klini"3 nyeri pel)is/ dismenorhoe/ f!ngsi intestinal
si"l!s haid a*normal/ ac!te a*domen
"ompli"asi3 peritonitis
o*str!"si 6 adesi small *o>l organ pel)is 7
*a"teriemia 6endo"arditis/ menigitis/ arteritis s!p7
infertil
terapi3penisilin 6 GO dini/ s!p - 7
2I+ post a*ort!s
post part!m operasi
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The central role of infectio!s cer)icitis in the propagations of
se'!ally transmitted disease
2I+
6endometritis
salfingitis7
ascending infc
male partner infectio!s cer)icitis
hori(ontal transmission
)ertical trans-
mission
placental 6fet!s/ neomates
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&EVIK&
le!corrhoe
"arsinoma J $ B
&EVI&ITI& AKUT +AN KONIK
etiologi / patogenesis
gono"o" strepto"o"
T.)aginalis stafilo"o"
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&er)isitis "roni" nonspesifi"
dim!lai pada endoser)i"s
ma"ros3 merah/ *eng"a"/ gran!laritas/ stenosis inflamasi "ista Na*othi ser)isitis foli"!laris.
mi"ros3 infiltrasi sel %N
epitel hiperplasia
9aringan gran!lasi inflamasi sel mengel!ar"an gli"ogen
&chillertest sol!tion 6 yodi!m 7 co"lat
epitel "elen9ar endoser)i"s metaplasia s"!amosa.
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KA&INO%A IN&ITU
KA&INO%A INVA&I$
ma"ros3 f!ngating 6e'ofili"7
!lserasi
infiltratif
DB "arsinoma s"!amosa
>ell diff sp poorly diff
non"eratini(ing 6CB7
"eratini(ing
"lasifi"asi macam-macam
grading3 diff *ai" prognosis *ai"
!ndiff
th s!r) rate 1B
anaplasti" B
TU%O &EVIK&
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TU%O &EVIK&
LE&I3 KA&INO%A
2OLI2
2A2ILLO%A
KA&INO%A
DB
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.terapi dietil stil*estrol
.pil "ontrasptif
.$ menopa!se terapi hormonal
.cigarette smo"ing F
VIU&
0erpes simple"s II
1. infe"si genital 0&V II C/1B $ displasia/ "arsinoma
. $ dengan ser)isitis herpes = 55
#. $ displasia
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02V
)enereal transmitted )!l)a
"ondiloma a"!minata ser)i"s
9!ga ditem!"an pada3 penderita displasia ser)i"s lesi pre"an"er
02V tipe 1 lesi maligna ser)i"s
/ 11 "ondiloma a"!minata
sel yang terinfe"si3 "oilositosis sel )a"!ol/ sitoplasma *allooned
pada $ "ondiloma *enigna
displasia ringan
H1CB
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2er9alanan penya"it3
slo>ly *e*erapa tah!n
in)asif
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$IGO
stage
C 3 een the t!mor and the pel)ic >all
t!mor 1@# *a>ah )agina
IV 3 "el!ar tr!e pel)is ata! m!"osa re"t!m @ ). !rinaria
o*)io!sly incl!des those >ith metastatic dissemination
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2enye*aran3
1. e"stensi "e *a>ah a3 pert!m*!han encircle e"sternal os
o*str!"si "analis ser)i"alis/ piometra
*3 )agina
. e"stensi lateral !reter parametri!m
o*str!"si !reter oleh te"anan @ in)asi
#. e"stensi anterior dan posterior
in)asi langs!ng pada ). !rinaria @ re"t!m fistel !terosacral ligament sacral ner)e intracta*le pain
=. limfati"
iliacal/ sacr!m
&teps in the pathogenesis of cer)ical neoplasma
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02V e'pos!re
cer)ical transformation (one
intraepithelial lesion
high parity
family history
lo> grade other )ir!ses high grade
imm!ne stat!s
host gene alterationstime
condyloma 6lo> ris"7
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Lesi-lesi s"!amo!s ser)i"s
1. displasia
.
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%orfologi
dim!lai pada s8!amo-col!mner 9!nction
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1.
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2OLI2
T!mor inflamasi -B $ ad!lt 6de"ade =-7
ser)isitis "roni"
"lini"3 irreg!lar )aginal spotting @ *leeding
ma"ros3 singel 6DCB7
"ecil/ sesslle/ pedinc!lated/ l!na"/ m!"oid
mi"ros3 stroma fi*romi"somato!s/ "elen9ar endoser)i"s hipertropi/dilatasi "isti"/ se"resi m!sin/ inflamasi "roni"/
metaplasia s"!amosa
terapi3
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UTEU&
KELAINAN KONGENITAL
0ipoplasia gangg!an endo"rin 6hipof!ngsi o)ari!m/ hipofisis7
infantil
septate !ter!s
do!*le !ter!s
do!*le cer)i'
IN$LA%A&I
endometri!m
miometri!m relatif resisten infe"si
postpart!s
post"!ret
strepto"o"
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+&$UN
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stim!lasi estrogen 55@ lama
tanpa fase progestational
a"i*at3 1. gangg!an endo"rin 6penya"it tiroid/ adrenal/ t!mor hipofisis7
. lesi primer spesifi" 6t!mor sel gran!losa-theca/ poli"isti" o)ari!m7
#. gangg!an meta*oli" general 6o*esitas/ maln!trition/ peny. &istemi" "roni"7
555 dasar -/ tetapi di"ata"an stress fisi"/ demam/ per!*ahan c!aca
o)!lasi - foli"el graaf persisten
endometri!m men!n9!"an efe" estrogen 55
a"tifitas a"i*at progenteron
nonse"resi3 hiperplasia ringan/ mitosis J
"elen9ar endometri!m !"!ran *esar
si"l!s ano)!lasi3 1. menarche
. menopa!se 6premenopa!se7
penderita "arsinoma endometri!m dengan si"l!s
ano)!lasi *er !lang.
$ase l!te!m inade"!at
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perdarahan a*normal si"l!s o)!lasi
gangg!an hormonal pada fase ini F
1. fase l!te!m inade"!at
f!ngsi "orp!s l!te!m inade"!at progesteron HH
si"l!s o)!lasi ireg!ler"lini"3 infertil/ perdarahan *anya"/ amenorhoe
*iopsi endometri!m3 post o)!lasi se"resi
Irreg!lar shedding
si"l!s o)!lasi
"has3 haid 55 6D-1 hari7 reg!ler/ progesteron "orp!s l!te!m normal
in)ol!si "orp!s l!te!m lam*at
endometri!m3 *iopsi hari =- haid proliferasi ses!ai dengan early prol.
EN+O%ETIO&I&
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EN+O%ETIO&I&
stroma @ "elen9ar endometri!m tida" pada tempatnya3
o)ari!m !m*ili"!s
ligamen !ter!s )agina
sept!m re"to)aginal )!l)a
peritone!m appendi"s
9ar.par!t laparatomi
insidensi3 !sia reprod!"si/ de"ade #-=
e"onomi 55 married later in life ana" HHH
fertilitas HH
patogenesis3
1. teori metaplasia 6 diff a*normal epitel coelomic 7
. rig!rgitasi @ implantasi 6 haid 7 stenosis @ sempit ser)i"s#. limfati" @ hematogen
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%orfologi
fo"!s endometri!m si"l!s haid nod!l merah *ir!/ "!ning co"lat
a"!m!lasi darah organisasi o*literasi "a)!m +a!glas/ fi*rosis/
distorsi/ pel)is "a"!.
o)ari!m-"isti" mengand!ng de*ris darah co"lat "ista co"lat
mi"ros3
"lini"3 dismenorrhoe
nyeri pel)is 6perdarahan intra pel)i"/ adesi peri!terin7
dispare!ni
nyeri defi"asi
dis!ria
haid ireg!"er
infertil
1. adenomiosis
. endometriosis
0I2E2LA&IA EN+O%ETIU%
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0I2E2LA&IA EN+O%ETIU%
a*normal *leeding
-penting *erh!*!nga dengan "arsinoma endometri!m
0ertig dan &ommer p!l!han tah!n yang lal!3
per!*ahan endometri!m progresif hiperplasia "arsinoma
6melal!i atipi"7
F Kriteria )aria*le
pengg!naan terminologi yang *er*eda diagnosis
1. hiperplasia "isti" K!rman dan Norris3
. hiperplasia adenomato!s 1. hiperplasia ringan
#. hiperplasia atipi" . hiperplasia sedang
#. hiperplasia atipi"
1. hiperplasia simple"s
. hiperplasia "omple"s sel atipi" J @-
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stim!lasi estrogen 555
Kista foli"el o)ari!m persisten
T!mor gran!losa/ theca f!ngsional
$!ngsi adreno"orti"al 55
2ema"aian estrogen .. @ lama
0iperplasia potensial men9adi "arinoma
0iperplasia adenomato!s
0iperplasia atipi" lesi pre"an"er
2enelitian3 hiperplasia endometri!m yang tida" di terapi
4B
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KA&INO%A EN+O%ETIU%
insedensi3 1CB dari sel!r!h "an"er >anita
!sia t!a/ B post menopa!se
high ris"3 1. o*esitas 6CB *erat 1C l*s7
. dia*etes 6gl!"os tolerans 5CB -llB
#. hipertensi 6CB os7
=. infertilitas 6single/ n!lipara ses!ai dg ano)!latory cycl!s
patogenesis3 1. os dengan t!mor sel theca/ gran!losa o)ari!m
. fre"r!ensi men!r!n pada >anita agenesis o)ari!m "astrasi !sia dini
#. ri>ayat hiperplasia endometri!m @ si"l!s ano)!lasi
=. "arsinoma endometri!m anita menopa!se "arsinoma endometri!m F
%orfologi3 t!mor polipoid/ dif!s perm!"aan endometri!m/ f!ngate/ nod!ler/"erasMlem*!t ne"rosis in)asi "e miometri!m
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"eras lem*!t/ ne"rosis/ in)asi "e miometri!m
0istologi B adeno"arsinoma
Grade I >ell diff
II moderate diff dengan daerah solid
III poorly diff
CB adenoacantoma m!sino!s adeno
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Terapi 3 operasi ata! operasi J radiasi
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Terapi 3 operasi ata! operasi J radiasi
stadi!m I DCB 6 th s!r)i)al rate7
II #C-CB
III H C B
metastasis3 1. e"stensi lo"al t!*a/ parametri!m/ ser)i"s/ )agina
in)asi langs!ng "e ). !rinaria
metastasis3 1. limfogen para Ao/ iliac interna
li"al limfati" )agina . hematogen )agina/ o)ari!m
#. melal!i t!*a o)ari!m/ peritone!m
=. metastasis 9a!h hati/ par!/ t!lang
Grade3 1. H CB solid
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. -CB
#. 5CB
staging3
I A 3 grade 1//#
t!mor ter*atas pada endometri!m
, 3 grade 1//#
in)asi H1@ miometri!m
I < 3 grade 1//#
in)asi 51@ miometri!m
A 3 grade 1//#
gland!lar in)ol)ement endoser)i"s 6only7
II , 3 grade 1//#
in)asi stroma ser)i"s
III A 3 grade 1//#
t!mor in)asi serosa dan @ adne"sa
dan ata! sitologi peritone!m J
III , 3 grade 1//#
metastasis )agina
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III < 3 grade 1//#
metatasis KG, pel)i"s dan @ para aorta
IV A 3 grade 1//#
in)asi ". "emih dan @ m!"osa !s!s
IV , 3 distant metastasis inc!ding intra a*domen dan @ ing!inal lymph node
&AKO%A
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&AKO%A
B dari t!mor !ter!s
1. %i'ed mesodermal t!mors @ mi'ed m!lerian t!mor
ganas 55/ darimesoderm m!ller tdd 1. "elen9ar ganas
. sar"oma stroma
mesoderm3 "omponen otot/ t!lang/ t!lang ra>an/ osteoid
>anita menopa!se adeno "arsinoma/ perdarahan
&e*el!mnya terapi radiasi
. endomtrial stromal t!mor
tdd3 *enign stroma nod!le
endolymphatic stroma myosis
endometrial stroma sar"oma
EN+O%ETITI& KONIK
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EN+O%ETITI& KONIK
1. 2I+ "roni"
. t*c 6salfing7
#. post part!m post a*ort!s sisa "ehamilan J
=. IU+
"lini"3 perdarahan a*normal
nyeri/ discharge
infertil
OAL
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LEIO%IO%A
t!mor 9ina" otot polos
1@# $ mas!" & 1 dari = $ reprod!"si
de"ade #-=/ "!lit hitam
hiperestrogen
lo"alisasi3 intram!ral
s!*m!"o!s
s!*sero!s
leiomioma *esar daerah "!ning co"lat merah proteoliti" li"!ifa"sidegenerasi "isti"
!sia lan9!t3 masa atropi/ "olagen 55/ "eras/ "alsifi"asi
mi"ros3
"lini"3 dapat asimptomati"
periode haid darah555/ nyeri/ infertil>anita hamil a*ort!s spontan/ fetal malpresentasi/ inertia !ter!s/
hemoragi"/ postpart!m
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LEIO%IO&AKO%A
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9arang
ma"ros3 *!l"y/ flesh/ in)asi dinding !ter!s
polipoid
mi"ros3 atipi" !ndiff
1. mitosis 5 1C @ L2, J dengan @ tanpa sel!ler atipi"
. mitosis -1C J sel atipi"
pre @ post menopa!se =C-C th 55
re"!ren
metastasis3 par!/ t!lang/ ota"
"a)!m a*domen
th s!r)i)al rate =CB
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2OLI2 EN+O%ETIU%
Ter!tama pada menopa!se premenopa!se
segala golongan !sia
"lini"3 perdarahan/ !"!ran "ecil asimptomati"
ma"ros3 "ecil 6C/-# cm7 sessile/ pedinc!lated !lserasi/ degeneratif
mi"ros3 1. f!ngsional ses!ai dengan si"l!s nonpolipoid endometri!m
. hiperplasti" endometri!m "isti" @ adenomato!s
ses!ai dengan hiperplasia / estrogen 55
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TU,A
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TU,A
endosalfingitis
inflamasi "roni"
adesi pli"a adesi fim*riae P
peritone!m
O*str!"si o*str!"si piosalfing salfingo oo)aritis
partial "omplit
2ossi*le infertil peritonitis inflamasi s!*side
ectopic
pregnancy "alsifi"asi hidrosalfing
p!s
salfingitis dengan "aseosa
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spread of infection adesi t!*a
T*c endometritis peritonitis t*c infertil encysted
caseo!s t!*e
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TU%O
"ista par o)arian @ 0idatid of %orgagni
C/1 cm/ *erisi cairan sero!s 9ernih
adeno"arsinoma 9arang metatasis t!lang
OVAIU%
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OVAIU%
Oo)aritis
se"!nder dari 3 t!*a
peritone!m
s>ollen t!*a inflamasi t!*a o)arial
adesi fim*riae to o)ari!m
possi*le de)elopment of t!*o o)arian a*scess
or peritonitis
inflamasi s!*side
adesi intensif
*ilateral infertil
TU%O
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TU%O
!r!tan "e # setelah t!mor ser)i"s dan endometri!m
B sel!r!h "an"er >anita
U&A termas!" "an"erdete"si dini Q fatal "ematian separ!h >anita dengan "an"er
CB 9ina" C-=C tah!n
ganas =C- tah!n
>anita "!lit p!tih
n!llipara/ ri>ayat "el!arga
!nmarried
terapi estrogen efe" negatif
ana" dengan disgenesis gonad
"lasifi"asi R0O3 1. s!rface coelomic epithelial
. germ cell #. stroma
TU%O
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KI&TA NONNEO2LA&TIK
Kista f!ngsional
1. "ista foli"el3 !nr!pted foli"el Graaf
pecah men!t!p dengan cepat
single @ m!ltipel
1-1/ cm/ *erisi cairan sero!s
pada "orte"s o)ari!m
mi"ros3 dilapisi epitel gran!losa
. "ista l!teal3 pen!t!pan "orp!s l!te!m hemoragi" cepat
mi"ros3 dilapisi epitel l!te!m
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74/104
-
7/24/2019 Genital Wanita
75/104
2oli"isti" o)ari!m
&tein P Le)enthal 61D#7
dengan sindroma3 amenorrhoe se"!nder o*esitas
hirs!tism
infertil
poli"isti" o)ari!m *ilateral
"lini"3 1. sindroma &tein Le)enthal
. hipermenorrhoe
)irilism
$ de"ade -#
"ista dilapisi 9aringan "olagen/ sel gran!losa/ sel theca
patogenesis3 gangg!an me"anisme hipotalam!s-hipofisis
stim!l!s o)ari!m a*normal $&0 P L0
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76/104
TU%O OVAIU% *erdasar"an sel asal
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7/24/2019 Genital Wanita
77/104
s!rface epithelial 3 64B dari sel!r!h t!mor o)ari!m/
DB dari t!mor ganas o)ari!m7
sero!s t!mors
sero!s cystadenoma
*orderline sero!s t!omrs
sero!s cyctadenocarcinoma
adenofi*roma P cystadenofi*roma
m!cino!s t!mors
m!cino!s cystadenoma
*orderline m!cin T
m!cino!s cystadenocarcinoma
endometrioid carcinoma
clear cell adenocarcinoma
,renner t!mor
!ndifferentiated carcinoma
Germ cell t!mors 61B dari t!mor o)ari!m/ 1B dari t!mor ganas o)ari!m7
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teratoma3 9ina" 6mat!re/ ad!lt7
teratoma "isti" 6"ista dermoid7
teratoma solid
ganas 6immat!re7
monodermal @ speciali(ed 6carcinoid/ str!ma o)ari!m7
disgerminoma
choriocarcinoma
others 6em*rional carcinoma/ poliem*rioma/ mi'ed germ cell T7
se' cord stroma 6-1CB7 fi*roma
gran!losa-theca cell T
&ertoli-Leideg cell T
metastasis o)ari!m 6B7
TU%O &EOU&
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#CB dari t!mor o)ari!m
1. 9ina" 1CB
. *or*erline #CB
#. ganas CB 61CB dari sel!r!h "eganasan o)ari!m7
C-C tah!n 555
HH se*el!m p!*ertas
ma"ros3 1C-1 cm 6=C cm7 singel @ m!ltipe
mi"ros3 papiler @ nonpapiler
C-#CB 9ina" *ilateral
=CB *orderline *ilateral
@# ganas
1C th s!r) rate "an"er 1C-CB
*orderline 4B
e'tra o)ari!m operasi J radiasi 4CB
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80/104
-
7/24/2019 Genital Wanita
81/104
-
7/24/2019 Genital Wanita
82/104
%!cino!s t!mor
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83/104
CB t!mor o)ari!m
m!cino!s cystadenocarcinoma -1CB
ma"ros3 !nilateral B 9ina"
CB ganas *ilateral
5 "g m!ltilo"!ler
metastasis r!pt!r pse!domy'oma peritonei 6perm!"aan serosa7
mi"ros3
progonsis3 1C th s!r) rate *orderline BS
"arsinoma #=B
2er9alanan penya"it3
"lini"3 nyeri a*domen *a>ah/ per!t55/ *a" 55/ dis!ria/ pene"anan pada pel)is
ganas3 lemah/ ,, t!r!n/ asites 6 sel t!mor J7
torsi t!mor "isti" @ r!pt!r ac!te a*domen
T!mor endometroid
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CB
dapat 9ina" @ *orderline
"arsinoma 5551-#CB "arsinoma o)ari!m
%a"ros3 solid/ "isti"/ polipoid/ papiler
#CCB *ilateral
%i"ros3 gland!ler mirip "elen9ar endometri!m dapat diff s"!amosa/ "arsinoma sero!s @ m!cino!s
th s!r) rate =C-CB
0istogenesis P interrelationships of t!mors of germ cell origin
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GE%
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l. Teratoma 9ina" 6mat!r7
Ranita m!da/ reprod!"si
ma"ros3 !nilateral #CB
H1C cm/ mengand!ng macam
mi"ros3
. ganas 6imat!r7 prep!*ertas/ >anita m!da 61 th7
ma"ros3
mi"ros3 1. deri)at imat!r
. adanya ne!roepitel
grade I3 t!lang ra>an mat!r55/ *e*erapa ne!roepitel prog3 *ai"
II3 sar"omato!s 3 *!r!"
&es!ai dengan "horio"arsinoma/ t!mor sin!s endodermal/ ca em*rional
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87/104
+isgerminoma
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7/24/2019 Genital Wanita
88/104
!nilateral 6C-DCB7/ solid
penampang "!ning p!tih/ a*!-a*! pin"
l!na"/ fleshy
histol3
malignant/ 1@# agresif
radiosensitif
th s!r) rate 4C-DCB
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Gar!losa theca cell t!mor
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7/24/2019 Genital Wanita
90/104
@# postmenopa!se
ma"ros3 !nilateral/ solid/ "isti"
encaps!lated/ C-#C cm 6-1C cm7
mi"ros3 sel t!mor call e'ner *ody
"lini"3 1. estrogen 55
. malignant p!*ertas pre"o"
>anita de>asa estrogen 55 hiperplasia endometri!m/
penya"it mammae "isti"/
"arsinoma mammae/
"arsinoma endometri!m 61C-1B7 steroid555
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$i*roma
B fi*roma nonf!ngsional
fi*rothecoma
ma"ros3 !nilateral 6DCB7/ solid/ sferi"al/ lo*!lated/ en"aps!l/ -1C cm
"eras/ dilip!ti serosa o)ari!m
mi"ros3
"lini"3 nyeri/ massa/ gangg!an intestinal te"anan t!mor
asites 6F76=CB7
%eigs syndrome3 asites
hidrotora"s/ t!mor o)ari!m
mitosis 51C L2, ganas
%ETA&TA&I& TU%O 6Kr!"en*erg t!mor7
$IGO
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&taging3
I. Ter*atas pada o)ari!m
A. ter*atas pada 1 o)ari!m
asites 6-7
,. o)ari!m J asites 6-7
II. 1 @ o)ari!m J e"stensi pel)is
A. e"stensi dan @ ata! metastasis "e !ter!s
dan @ ata! t!*a 6only7 ,. e"stensi pada 9aringan pel)is lain
III. 1 @ o)ari!m/ metastasis intraperitone!m
a*domen 6oment!m/ small intestinal/ mesenteri!m 6-7
IV. 1 @ o)ari!m J metastasis 9a!h o!t side "a)!m peritone!m
2LA&ENTA $actor predesposing to to'aemia of pregnancy
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Genetic conc!rrent dia*etes parity
Imm!ne respons genesF hypertension
0istocompati*ility
raceF
!terine )asc!lar lesion
Trom*oplastin li"e plasental ischaemic
s!*stance 2GEHH ENIN55
increace )asc!lar
)asoconstricti reacti)ity
+Ianita to'aemia resistensi 6-7 hipertensi
-prostaglandin E !teroplasental )asc!lar *ed selama hamilmediated resistensi normal
>anita to'aemia prostaglandin HH
hipersensitif angiotensin 55 6to'aemia7 prostaglandin HH renin 55
2lasenta FF 2rostaglandin HH renin 55
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dari data3 !tero)asc!lar *lood flo> HH is"hemi" plasenta
per!*ahan )as"!ler 6a. spirale !ter!s7 ne"rosis fi*rinoid/
a"!m!lasi ma"rofag foamy 6pada dinding pem*!l!h darah ne"rosis7
aterosis a"!t rea"si im!nologi"
+Ianita3 penya"it inflamasi 6lo"al @ sistemi"7
!ter!s a*normal
tra!ma
to'oplasma/ mi"oplasma
*lighted o)!m
KE0A%ILAN EKTO2IK
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t!*a 6DCB7
o)ari!m
a*domen
intra!terine portion t!*a 6interstitial7
predesposisi3 l. salfingitis
. adesi t!*a appendisitis
endometriosis
leiomioma t!mor t!*a 9ina"
"ista
#. IU+ 6B7
T!*a3 hemoragi" intra t!*a
r!pt!r/ hemoragi" intraperitone!m
regresi spontan
a*ort!s t!*a
GE&TATIONAL TO20O,LA&TI< NEO2LA&%
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%OLA0I+ATI+O&A
Insidensi3 reprod!"si a"tif/ =C-C th
"ehamilan U&A 1 dalam CCC F
Tai>an/ $ilifina/ India 1 dalam 1C-CC
2atogenesis? l. geografis 6diet/ geneti"7
. mole J =- mingg! gestasi
#. DCB diploid =. "romosom "omplement 6% @ $7 dari sperma
androgenesis
. mola tr!e neoplasma dan lesi tropo*lasti"
memp!nyai potensi maligna 6ane!ploid agresif7
%orfologi3 "omplit
in"omplit @ partial
-
7/24/2019 Genital Wanita
101/104
2er9alanan penya"it3
perdarahan grape li"e masses
-
7/24/2019 Genital Wanita
102/104
g
!ter!s 55 - fet!s
0
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103/104
a*normal 6mola7
!ter!s
"ehamilan e"topi"
Insidensi3 U&A 1 dari C.CCC-#C.CCC
Asia/ Afri"a 1dari CC
mola 6=CB7
a*ort!s 6B7
"ehamilan normal 6B7
"ehamilan e"topi"
teratoma
2er9alanan penya"it3 perdarahan ireg!ler/ 0
-
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104/104
&taging
C- molar pregnancy 6 *enign mola7
1- ter*atas pada !ter!s
0