VA RI U M

KISTA O
G,M .Kes
d an g,S pO
y un i Sa d
a h
Dr.hj.W
Anatomi genitalia interna
wanita
KISTA OVARIUM
Suatu kantong abnormal berisi: cairan,setengah cairan,
yang tumbuh dalam indung telur

Tidak bergejala

Keluhan muncul bila ukurannya sudah membesar atau

mengganggu organ lain sekitarnya
KLASIFIKASI
KISTA FUNGSIONAL : tdk berbahaya dan bagian dari
siklus menstruasi , ada 2 tipe :

a. Kista Folicular

B. Kista lutein

KISTA PATOLOGI : benign ( kistadenoma, kista dermoid)

, maligna
 Follicu

Follicular Cyst
 The cause of non-functional cysts varies according to the type of cyst.
um cyst is a functional cyst that forms after the egg
An is released from the
endometrioma
sac does not dissolve. The sac seals off and can sometimes fill with fluid
cysts are usually painless and resolve on their is a cyst
own afterthat develops
a few weeks. because of endome
The dark area against the
cells similar to the normal
lining of the uterus outs
ic cyst is a functional cyst that occurs when bleeding occurs within a cyst.
white ovary represents
and grow causing pain during sex and at m
KISTA PATOLOGI
tional cysts varies according to the type of cyst.
the endometriosis. Also seen is
A cystadenomaandevelops
or a thick, sticky gel,
on the
adhesion or scarring surface
of the
tubeit can
to the grow and cause
ovary.
cystadenomas (thick mucous) and serous c
An endometrioma

is a cyst that develops because of endometriosis. Endometriosis is an abnormal growth of

cells similar to the lining of the uterus outside the uterus. It may attach itself to the ovary
and grow causing pain during sex and at menstruation.
A cystadenoma develops on the surface ofThe the ovary.
darkOften
areafilled with a watery
against the fluid
or a thick, sticky gel, it can grow and cause pain. There are two varieties: mucinous
normal(thin
cystadenomas (thick mucous) and serous cystadenoma white ovary represents
fluid).
the endometriosis. Also seen is
an adhesion or scarring of the
tube to the ovary.
A cystadenoma contains multiple septa. They
rioma can be quite large.
KLASIFIKASI
Tumor non neoplastik
Tumor akibat radang
Tumor lain
Kista folikel,Kista korpus
luteum.Kista lutein, kista inklusi
germinal,kista endometrium,kista
stein leventhal
Tumor neoplastik jinak
Kistik ; kistoma ovarii simple,
kistadenoma ovarii
serosum,kistadenoma ovarii
musinosum,kista
endometroid,kista dermoid
Solid ; fibroma,tumor brenner,
tumor sisa adrenal
PATHOGENESIS
Penyebab pasti kista ovarium belum jelas

Angiogenesis  fase folikular dan fase luteal siklus

ovarium proses patologi ovarium ,termasuk
PCO,sindrom hiperstimulasi ovarium dan neoplasma
ovarium jinak /ganas

Abulafia,2000;fasciani,2001;Yamanato,1997 : VEGF
merupakan mediator angiogenesis dan pembentukan
neoplasma ovarium
INSIDENS
Valebil dkk(1995) US : 200000 wanita dengan kista
ovariumdi rawat di rumah sakit

1/3 dari total penyakit ginekology di amerika

Indonesia : 37,2 % dan paling sering di umur 20-50 thn

(Hanifa W,2005)

Surabaya : cenderung meingkat 24,4%

Insidens
Massa di ovarium sering
sekali di temukan pada kasus
gynekologi

Kebanyakan massa kista baik

jinak dan ganas , dominan
kistik

Insiden ; 5-15%
(dorum2005,millar1993;porcu
1994)
MANIFESTASI KLINIS
Kebanyakan asimptomatik

Nyeri dan sensasi tekanan yang samar samar

Nyeri yang muncul pada saat menstruasi : endometriosis

/endometrioma

Nyeri intermitten : torsi kista( akut abdomen)

Akut abdomen lainnya: ruptur kista atau abcess tuboovarial

Peningkatan lingkar perut dan cepat kenyang yang disertai asites

dan pembesaran ovarium yang cepat  keganasan ovarium
Manifestasi klinis
Gangguan hormonal

Kelebihan produksi estrogen :stimulasi tipe granulosa

sel  gangguan menstruasi, pencetus perdarahan pervagina
pada prepubertal atau post menopause

Virilitation : sel thecapeningkatan produksi androgen

DIAGNOSIS
Pemeriksaan fisik/pelvic examination

Penampakan fisik bermacam macam tergantung tipe

massa

mobile ,kistik,

tdk nyeri tekan

Di temukan di sisi lateral uterus

DIAGNOSIS
HUMAN CHORIONIC GONADOTROPIN
 Ditemukan peningkatan B-HCG : indikasi kehamilan
ektopik
 B-HCG merupakan petanda tumor pada neoplasma
ovarium
 Peningkatan BHCG :ovarian carcinoma, mixed germ cell
tumor, atau embryonal cell carcinoma
DIAGNOSIS
TUMOR MARKER

CA 125 : Antigen determinant on high molecular weight

glycoprotein

CA 125  : ephitelial ovarium cancer (Menon,1999)

CA 125 : bukan tumor spesifik antigen, me1% pada orang sehat

Peningkatan CA 125 biasa ditemukan pada nonmalignat :

leymioma,endometriosis dan salphingitis
DIAGNOSIS
TUMOR MARKER
• SERUM ALFA FETOPROTEIN (AFP) : endodermal
sinus tumor , embryonal cell carcinoma
• LACTAT DEHYDROGENASE : Dysgerminoma,

• CARCINOEMBRYONIK ANTIGEN & CA 19-9 : sekresi

carcinoma ovarium musinosum ephytelial
DIAGNOSIS
IMAGING

TVS(TRANSVAGINAL SONOGRAPHY)

TAS (TRANS ABDOMINAL SONOGRAPHY)

MRI/ CT SCAN
USG TRANSVAGINAL
 Dermoid cyst cut in half to demonstrate yellow
fatty/sebaceous material. Some will contain hair and
calcified material like teeth.

Polycystic ovaries occur when the e ggs mature withi n the sacs or follicles but the
follicles do not release the eggs. Ovulation does n ot occur. This c ycle repeats, foll icles
grow within the ova ry and cysts form.

Features of Polycystic ovaries are their larger

size and multiple bluish fluid filled follicles
seen to cover most of the surface of the
ovaries. Best seen on the right ovary being
held by the grasper.

Signs and Symptoms of Ovarian Cysts

Most ovarian cysts go unnoticed, cause no problems and go away spontaneousl y. If symptoms
occur, pain in the abdomen o r pelvis is the most common one. Depending on the reason for the
cyst, the pain can be at ovulation t ime, menstruation, dur ing sex or related to bowe l movements.
It may be constant or int ermittent; appear suddenly or gradually.
Other symptoms of ov arian c ysts may include :
Pressure or fullness in the abdomen
Irregular periods o r bleeding between p eriods
Dull ache in the lowe r back and thi ghs
Breast tenderness
Nausea or vomiting
You should seek immediate medical h elp if you have any of the following symptoms:
Pain with fever and vo miting
Sudden, sev ere abdominal pain
Faint ness, dizziness or weakness
Rapid breathing

Diagnosis of Ovarian Cysts

Because most ovarian cysts cause no symptoms and go away on their own, they are usually
found during a routine pelvic exam. Your healthcare provider may feel a sw elling or growth on
FOLLICULAR CYST

Follicular Cyst
demonstrating s
smooth cystic str
within the ovary

Follicular Cyst
demonstrating single dark
smooth cystic structure
within the ovary
 Polycystic Ovary with multiple small follicles

KISTA DERMOID

Solid and cystic appearance of Teratoma (Dermoid Cyst)

Solid and cystic appearance of Teratoma (Dermoid Cyst)

Multiseptated Cyst: cystadenoma or carcinoma.
Multiseptated Cy
The fluid contained within theThe
septa fluid
is not contain
completely dark
completely dark raising suspicion for a mucinous
cystadenoma.
cystadenoma.
 P

Polycystic Ovary with multiple small fol icles

KISTA OVARIUM &
FERTILITAS

Wanita dengan Kista ovarium biasanya tidak

mempengaruhi kemampuan untuk hamil.

Bahkan dengan kista ukuran yang besar ada beberapa

wanita tetap mampu untuk hamil
MANAGEMENT
Penanganan kista tergantung pada :

Penampakan dan ukurannya

Gejala yang menganggu

Menopause atau tidak

MANAGEMENT
OBSERVATION

Kebanyakan kista fungsional dapat hilang sendiri dalam

beberapa minggu – 6 bulan

Penggunaan pil kontrasepsi bisa digunaka dalam terapi

kista fungsional
MANAGEMENT
Surgical Excision

Kistektomi

Oophorectomy

Laparaskopi

Mini laparatomi

Laparatomi
MANAGEMENT
Tipe massa ovarium rekomendasi
Kista simple
a. Premenopause
diameter ≤ 3 cm Tdk perlu pengobatan
diameter ≥ 3 cm TVS setiap 6-8 bln,

b. Post menopause
diameter ≤ 5 cm Kebanyakan jinak, prx ca 125 , tvs
berkala
Observasi : Ca 125 normal,tdk ada
pertambahan ukuran kista

diameter ≥ 5 cm Sebaiknya operasi jika ukuran tetap

atau bertambah dan symptomatik
MANAGEMENT
Tipe massa ovarium rekomendasi
Complex mass

• Septation Malignancy,mature cystic teratoma, or

• Mural nodule endometrioma
• Irreguler wall thickening
• Shadowing echodensity Pd wanita menopause complex mass :
• Regional, diffuse,bright echoes pembedahan
• Hiperechoic lines and dots
Pada wanita premenopause persistent
complex mass : pembedahan
Massa Solid atau predominant solid pembedahan
THANK YOU
 Profil
WAHYUNI SADDANG
BIODATA
TTL : Pinrang , 14 April 1980

Status : Menikah

Anak : 1 orang
Pendidikan
SD INP Katangka, kab .Gowa 1986-1992

SMP Neg 2 Sungguminasa Kab.Gowa 1992-95

SMA Neg 3 Makassar 1995-1998

FAK Kedokteran UNHAS 1998-2002

S2 Biomedik 2008

Program profesi dokter spesialis obstetri dan gynecologi

Fellowship laparaskopic gynecology TU DU HOSPITAL Vietnam

Riwayat Pekerjaan
Dokter PTT Puskesmas Mandai 2004-2008

Dokter UGD RSUD DAYA 2005-2006

Dokter UGD RS Hikmah 2005-2008

Staf Dosen Bag.Farmakologi Fak.Kedokteran Universitas

Muslim Indonesia 2006-2008

PNS RSUD Salewangang Maros 2008-sekarang

Dokter Obgyn RS Siloam Makassar 2014-sekarang

Dokter obgyn RSIA Ananda 2015-sekarang