SITOLOGI

susilorini
Laboratorium Patologi Anatomi FK UNISSULA

PENGERTIAN DASAR PEMERIKSAAN
SITOLOGI :
SITOLOGI
ILMU YANG MEMPELAJARI MORFOLOGI SEL
( GEORGE NICHOLAS PAPANICOLLAOU, 1928 )
MUDAH
MURAH
PEMERIKSAAN MORFOLOGI SEL

SEDERHANA
AMAN
AKURAT

SITOLOGI JINAK NEOPLASMA GANAS / KANKER STATUS HORMONAL PENENTUAN SEKS KHROMATIN .

PEMERIKSAAN MORFOLOGI SEL KUALITAS SITOPLASMA KUANTITAS BENTUK NUKLEUS GRANULA KHROMATIN NUKLEOLUS .

JENIS PEMERIKSAAN SITOLOGI EFUSI PLEURA EKSFOLIATIF ASCITES SPUTUM CERVICAL SMEAR NON EKSFOLIATIF BRONCHIAL W / B ASPIRASI JARUM HALUS .

ALUR PEMERIKSAAN MORFOLOGI SEL PENGAMBIL SAMPEL DOKTER UMUM DOKTER SPESIALIS BIDAN / PARAMEDIS PROSESING SAMPEL ANALIS / TEKNISI LAB DIAGNOSE DOKTER SPESIALIS PA .

SAMPLE / BAHAN YANG DIPERIKSA • • • • • • • • • CERVICAL / VAGINAL SMEAR SPUTUM BRONCHIAL WASHING / BRUSHING NASOPHARYNGEAL SMEAR / WASHING / BRUSHING URINE CAIRAN LAMBUNG / PLEURA / ASCITES / SENDI LIQUOR CEREBROSPINAL ASPIRAT AJH INPRINT NEOPLASMA .

FIKSASI SAMPEL • FIKSASI SAMPEL ADALAH CARA MENGAWETKAN SAMPEL DENGAN BAHAN KIMIA TERTENTU AGAR SEL YANG TERKANDUNG DALAM SAMPEL TIDAK RUSAK / LISIS • PEMILIHAN BAHAN KIMIA UNTUK FIKSASI DISESUAIKAN DENGAN METODE PEWARNAAN YANG AKAN DILAKSANAKAN • BAHAN KIMIA UNTUK FIKSASI ALKOHOL 95 % ALKOHOL 50 % ALKOHOL 70 % EITHER-ALKOHOL 95 % METHANOL .

METODE FIKSASI DAN PEWARNAAN PEWARNAAN PAPANICOLAOU BAHAN FIKSASI LAMANYA FIKSASI ALKOHOL 95 % 30 MENIT PEWARNAAN GIEMSA BAHAN FIKSASI LAMANYA FIKSASI METHANOL 15 MENIT UNTUK SAMPEL BERUPA CAIRAN. DIGUNAKAN CAIRAN FIKSASI ALKOHOL 50 % SEJUMLAH CAIRAN SAMPEL UNTUK SPUTUM TAMPUNG DIRENDAM DALAM ALKOHOL 70 % .

diudara terbuka .Pengecatan Giemsa • Fiksasi Methanol 5-15 menit. hingga kering • Dicuci dgn air mengalir • Cat Giemsa 5-10 Menit • Dicuci dgn air mengalir • Keringkan.

The Pap Smear: Technique and Interpretation .

Objectives • Review the epidemiology of cervical cancer • Review current screening recommendations • Discuss the role of HPV in the development of cervical dysplasia and cancer • Discuss the reporting of pap smear results using the Bethesda System • Determine the appropriate management of abnormal pap smear results using new guidelines from the American Society for Colposcopy and Cervical Pathology (ASCCP) .

particularly HPV • Immunosupression • SMOKING!!! .Risk Factors for Cervical Cancer • Early age at first intercourse (age <16) • Multiple sexual partners • Presence of STD.

150 cervical cancer cases and 3670 deaths • 50% of women in the US with cervical cancer have never been screened • 5-year survival rate for local disease is 92% • 5-year survival for distant metastasis is 13% .5 million women have abnormal pap results in the US annually (about 7% of total paps performed) • In the US in 2007 there were 11.Epidemiology • Cervical cancer continues to be the second leading cause of cancer related deaths among women world wide • 3.

000 women .Cytologic screening for cervical cancer • Cervical cancer screening has decreased morbidity and mortality – Deaths from cervical cancer decreased from 26.2 to 7.8 cases per 100.000 to less than 5. the incidence of cervical cancer decreased from 14.000 between 1941 and 1997 – Between 1973 and 1994.

Pap smears are not perfect • For a high grade lesion. the sensitivity of a single pap smear is only 60-80% • Estimated false negative rate is 3050% • Requires adequate specimen collection • Requires adequate cytological review .

Pap smears are not perfect • Requires adequate patient and physician follow-up – 10% of women with cervical cancer had inappropriate follow-up • Requires access to care – 50% of women with cervical cancer were never screened and 10% had not been screened within 5 years of diagnosis .

Who to screen • Any woman with a cervix who has ever had sexual intercourse – This includes women who have sex with women – This may mean women who have only had digital vaginal penetration .

a.When to screen • Start within 3 years of onset of sexual activity or by age of 21.k. whichever is first • Risk factors for cervical dysplasia – – – – Early onset of sexual activity Multiple sexual partners Tobacco Oral contraceptives. no condoms . a.

then may decrease frequency to every three years – ACOG and ACS recommend annual screening for high-risk women .Screening frequency • Yearly until three consecutive normal pap smears.

When to stop routine screening • Age 65 and “adequate recent screening” – Three consecutive normal pap smears – No abnormal pap smears in last 10 years – No history of DES exposure – No history of cervical or uterine cancer .

SMEAR PEMERIKSAAN EPITHEL PELAPIS CERVIX UTERI .PAP.

ANATOMI TOPOGRAFI CERVIX UTERI .

Cervical histology .

Original Squamous Epithelium • Vagina and outer ectocervix • 4 cell layers • Well-glycogenated (plump and pink) unless atrophic .

Columnar Epithelium • Upper and middle endocervical canal • Single layer of columnar cells arranged in folds • Mucin producing (not true glands) .

Squamous Metaplasia • Central ectocervix and proximal endocervical canal • Replacement of columnar epithelium by squamous epithelium • Progressive and stimulated by – Acidic environment with onset of puberty – Estrogen surges causing eversion of endocervix .

Transformation Zone • Zone between original squamocolumnar junction and the “new” squamocolumnar junction • Nabothian cysts visually identify the transformation zone if present .

Original Squamocolumnar Junction • Placement determined between 1820 weeks gestation • Most often found on ectocervix • Can be found in vagina or vaginal fornices in DES exposed women • Less apparent over time with maturation of epithelium .

SQUAMOCOLUMNER JUCTION ( TRANSFORMATION ZONE ) .

e. i. the leading edge of the squamocolumnar junction .“New” Squamocolumnar Junction • Border between squamous epithelium and columnar epithelium • Found on ectocervix or in endocervical canal • Majority of cervical cancers and precursor lesions arise in immature squamous metaplasia.

Pap Smear Technique .

ALAT DAN CARA PENGAMBILAN PAP-SMEAR .

SMEAR • POSISI PASEN .CARA KERJA PENGAMBILAN SAMPEL PAP.

Technique • Visualize entire cervix if possible • Carefully remove any obscuring discharge • Sample ectocervix first with spatula • Sample endocervix with gentle cytobrush rotation • Apply material uniformly to slide • Fix rapidly with spray or liquid fixative .

Technique • Hold spray fixative 10 inches away from slide • Collect cells before bimanual exam • Avoid contamination with lubricant • Test for GC and Chlamydia after pap smear • For DES patients sample cervix and upper 2/3 of vagina .

CARA MEMBUAT SEDIAAN APUS .

YANG HARUS DIPERHATIKAN DALAM PEMBUATAN SEDIAAN APUS • • • • • • • BUATLAH SEDIAAN DENGAN APUSAN TIPIS MERATA SEGERA FIKSASI SESUAI METODE PEWARNAAN BUATLAH SEDIAAN SEDIKIT MUNGKIN MENGANDUNG DARAH JAGA KEBERSIHAN OBYEK GLAS YANG DIGUNAKAN HINDARI BAHAN KIMIA YANG MERUSAK SEL SIMPAN DITEMPAT YANG BERSIH . KERING DAN AMAN OBYEK GLAS YANG DIPERGUNAKAN DIBERI LABEL .

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GAMBARAN NORMAL EPITEL CERVIX UTERI • SEL EPITHEL SUPERFICIAL DAN INTERMEDIATE .

SEL EPITEL PARABASAL

SEL ENDOCERVIX

SEL LAIN YANG BISA TERDAPAT DALAM SEDIAAN APUS
SEL KERATINISASI
ERITROSIT

SEL TELANJANG
SPERMA

SEL

SEL INFILTRAT RADANG PADA SEDIAAN APUS
LEUKOSIT PMN
PLASMA

LIMFOSIT & SEL

HISTIOSIT

PERUBAHAN MORFOLOGI SEL KARENA RADANG .

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CANDIDIASIS TRICHOMONIASIS .

SEL ENDOCERVIX METAPLASI .

GAMBARAN MIKROSKOPIK PERUBAHAN DISPLASIA EPITEL CERVIX UTERI CIN 1 CIN 2 CIN 3 .

GAMBARAN MIKROSKOPIK SEL GANAS CARCINOMA CERVIX UTERI SQUAMOUS CELL CARCINOMA .

SQUAMOUS CELL CARCINOMA ADENOCARCINOMA .

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Bethesda 2001 .

“Normal” Pap Smear • Negative for intraepithelial lesion or malignancy • Other non-neoplastic findings – – – Reactive cellular changes Glandular cells status post hysterectomy Atrophy • Other – Endometrial cells (women  40 yrs) .

The Abnormal Pap Smear .

Introduction • The Papanicolaou (Pap) smear has been in use since 1941 • It is the single most effective cancer screening test to date • Sensitivity is 60-85% .

Epithelial Cell Abnormalities: cells • Atypical squamous Squamous – ASC-US: undetermined significance – ASC-H: cannot exclude HSIL • LSIL: low grade (CIN 1) • HSIL: high grade (CIN 2 .3) • Squamous cell carcinoma .

SIL and CIN .

endometrial or extrauterine . endometrial or glandular cells (NOS) • Atypical endocervical or glandular favor neoplastic • Endocervical adenocarcinoma in situ • Adenocarcinoma: endocervical.Epithelial Cell Abnormalities: Glandular • Atypical endocervical.

ASCCP Guidelines .

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ASPIRASI JARUM HALUS .

PERLU PANDUAN USG . MRI DAN BILA PERLU MEMAKAI JARUM DENGAN MANDRINE . CT-SCAN .ASPIRASI JARUM HALUS ( A J H ) • CARA MENGAMBIL SEL JARINGAN TUBUH YANG DICURIGAI SUATU NEOPLASMA • CARA MENGAMBIL DENGAN TEKNIK ASPIRASI MEMAKAI SPUIT DAN JARUM INJEKSI BIASA UNTUK LESI YANG TERABA • PADA LESI YANG TIDAK TERABA.

A J H .ALAT YANG DIGUNAKAN UNTUK .

MACAM JARUM YANG DAPAT DIGUNAKAN UNTUK AJH • Jarum disposible ukuran 22-25 gauge • Jarum disposible dengan mandrine .

ALAT BANTU YANG DIGUNAKAN SYRINGE HOLDERS Franzen syringe holder Cameco syringe pistol Dng Spuit disposible 10 cc Simple syringe holder .

CARA PELAKSANAAN AJH .

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PENYULIT TINDAKAN AJH .

AJH DENGAN PANDUAN ULTRASONOGRAFI CT-SCAN .

CARA MEBUAT SEDIAAN APUS DARI ASPIRAT AJH .

AJH CARA MEMBUAT SEDIAAN DARI HASIL ASPIRAT PADAT CARA MEMBUAT SEDIAAN DARI HASIL ASPIRAT CAIR .CARA MEMBUAT SEDIAAN APUS DARI ASPIRAT .

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BIOPSI JARUM HALUS TANPA ASPIRASI .

AJH GAMBARAN MIKROSKOPIK SEDIAAN HASIL .

SKUAMUS CELL CARCINOMA

ADENOCARCINOMA

AJH KELENJAR LIMFE
REAKTIF LIMFADENOPATI

NHL LIMFOSITIK

NHL LARGE B CELL
CENTROCYTIC CENTROBLASTIC

IMUNOBLASTIC

NHL PLASMACITOID

NHL T CELL
CONVULATED T CELL

AJH

PAYUDARA
LESI FIBROKISTIK

INFILTRATING DUCT CARCINOMA

FIBROADENOMA

MEDULARE ADENOCARCINOMA

AJH TYROID COLOID GOITER ADENOCARCINOMA PAPILER ADENOMA / ADENOCARCINOMA FOLIKULER .

AJH LIVER CIRRHOSIS CA HEPATIS HEPATOCELLULARE .

AJH PROSTAT ALAT BANTU YANG DIGUNAKAN .

AJH PROSTAT BPH ADENOCARCINOMA .

AJH TUMOR JARINGAN LUNAK GIANT CELL TUMOR OSTEOSARKOMA .

KEPUSTAKAAN .