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MATERI AJAR INI HANYA

UNTUK DIPERGUNAKAN
DALAM KEGIATAN
PENDIDIKAN DAN
KESEHATAN

Hanya untuk Pendidikan dan


JJE-13/07/2009 Kesehatan
Hanya untuk Pendidikan dan
JJE-13/07/2009 Kesehatan
Motto :

• Jalani hidup ini dengan sabar,


jujur dan ikhlas,

• Mau mengerti dan melaksanakan


tatacara (adab) yang benar, dan

• Mempunyai kemauan untuk


selalu berbuat baik memperbaiki
diri dan lingkungan, serta
JJE-13/07/2009
Hanya untuk Pendidikan dan
Kesehatan
Barang siapa mengamalkan apa-apa yang ia ketahui, maka Allah SWT akan mewariskan
kepadanya ilmu yang belum diketahuinya, dan Allah SWT akan menolong dia dalam amalannya
sehingga ia mendapatkan surga. Dan barang siapa yang tidak mengamalkan ilmunya, maka ia
tersesat oleh ilmunya itu, dan Allah SWT tidak menolong dia dalam amalannya sehingga ia akan
mendapatkan neraka (sabda Rasulullah Muhammad SAW)

Ilmu lebih utama dari harta, ilmu adalah pusaka para Nabi, sedangkan harta adalah pusaka
Karun atau Fir’aun.

Ilmu lebih utama dari harta, karena ilmu akan menjagamu sementara harta malah engkau yang
harus menjaganya.

Ilmu lebih utama dari harta karena di akherat nanti pemilik harta akan dihisab, sedangkan
orang berilmu akan memperoleh syafaat.

Ilmu lebih utama dari harta karena pemilik harta bisa mengaku menjadi Tuhan akibat harta
yang dimilikinya, sedangkan orang berilmu justru mengaku sebagai hamba Tuhan karena
ilmunya.
Harta itu jika engkau berikan menjadi berkurang, sebaliknya ilmu jika engkau berikan malahan
semakin bertambah.

Pemilik harta disebut dengan nama kikir dan buruk, tetapi pemilik ilmu disebut dengan nama
keagungan dan kemuliaan.

Pemilik harta itu musuhnya banyak, sedangkan pemilik ilmu temannya banyak.
Harta akan hancur berantakan karena lama ditimbun zaman, tetapi ilmu tidak akan rusak dan
musnah walau ditimbun zaman.

Harta membuat hati seseorang menjadi keras, sedangkan ilmu malah membuat hati menjadi
bercahaya.
(hamba Allah)
Hanya untuk Pendidikan
JJE-13/07/2009 dan Kesehatan
 Mampu melakukan pemeriksaan USG adneksa
 Mampu menilai adneksa normal, lesi jinak dan
curiga malignansi
 Mampu mengetahui kelainan adneksa yang
sering terjadi
 Mampu memberikan informed consent dengan
baik dan benar
 Mampu membuat laporan hasil pemeriksaan
USG adneksa
Hanya untuk Pendidikan dan
JJE-13/07/2009 Kesehatan
 Ovarian cancer is the fourth leading cause of
cancer deaths in American women today.
 About one in seventy women will be diagnosed
with this cancer in their lifetime.

 The death rate (see table) from ovarian cancer is


high, due in part to the fact that most women have
advanced disease that has spread outside the
ovaries at the time of diagnosis.
http://www.macgn.org/newsletter/nl27b.h
Hanya untuk Pendidikan dan
JJE-13/07/2009 Kesehatan
Hanya untuk Pendidikan dan
JJE-13/07/2009 Kesehatan
http://library.med.utah.edu/WebPath/jpeg4/
FEM082.jpg
http://www.femalehealthmadesimple.com/Ovariu
mSewe.jpg
http://labstend.ru/site/index/folies/univ/anatom
y/p0077.gif
Hanya untuk Pendidikan dan
JJE-13/07/2009 Kesehatan
http://www.macgn.org/newsletter/nl27b.htm

Hanya untuk Pendidikan dan


JJE-13/07/2009 Kesehatan
 Size, location, and characteristics

 Benign : < 5 cm, uniloculare

 Malignant : > 5 cm, complex mass, thick


septum, papillary projections or nodule

 Less sensitive to differentiate the


malignancy
B. Karsono : Pemeriksaan
ultrasonografi tumor ginekologik, 2006
Hanya untuk Pendidikan dan
JJE-13/07/2009 Kesehatan
 Vary in size depending on
age and menopausal status.
Normal size is approximately
3 x 2 x 2 cm

 Almond shaped

 Contain follicles in women of


childbearing age
Arthur C Fleischer, 2004

Hanya untuk Pendidikan dan


JJE-13/07/2009 Kesehatan
 ↑ frequency → ↑ resolution → better image
 Sliding organs sign : adhesions
 Pelvic pain
 At the end of menstruation period
 DD : corpus luteum, lutein cyst

 Bilateral ovaries (60%), unilateral (80%) →


atrophy, pelvic adhesion, compression by
ovarium or pelvic tumor
Hanya untuk Pendidikan dan
JJE-13/07/2009 Kesehatan
 Follicles are less than 10
mm when immature

 10 – 15 mm at
intermediate maturity

 18 – 25 mm when mature

Arthur C Fleischer, 2004

Hanya untuk Pendidikan dan


JJE-13/07/2009 Kesehatan
 Corpora lutea : thick wall, vascular
ring

 The main arterial supply of the


uterus and ovaries arises from the
aorta through the infundibulopelvic
ligament;

 Other blood supply is from the


adnexal branch of the uterine artery
Arthur C. Fleischer, 2004

Hanya untuk Pendidikan dan


JJE-13/07/2009 Kesehatan
 There is high-
impedance arterial flow
except around the
mature follicle / corpora
lutea, where low-
impedance high-
diastolic flow can be
seen
Arthur C. Fleischer, 2004

Hanya untuk Pendidikan dan


JJE-13/07/2009 Kesehatan
 History of ovarian cancer in the immediate family
(More details).

 Age (over 50 years).

 No children (pregnancies protect against ovarian


cancer so that two or more pregnancies lower the
risk for developing ovarian cancer).
 Self history of breast cancer.

http://www.geocities.com/HotSprings/Sauna/1913/SymptomsandRiskFactor

Hanya untuk Pendidikan dan


JJE-13/07/2009 Kesehatan
 Race --- ovarian cancer appears to occur more
frequently in Caucasian women than African
American women, but African-American women
that are socioeconomically similar to Caucasian
women may take on the Caucasian risk due to
smaller families and having children later.

 Jewish descent
http://www.geocities.com/HotSprings/Sauna/1913/SymptomsandRiskFactor

Hanya untuk Pendidikan dan


JJE-13/07/2009 Kesehatan
 HRT in post-menopausal women may account for
a very slight increase in ovarian cancer risk.

 Infertility drug use --- a nearly 3-fold increase in


risk characterizes women who fail to conceive.

 However, this risk may be due to an underlying


ovarian dysfunction in combination with a failure
to gain a protective advantage from pregnancy.
http://www.geocities.com/HotSprings/Sauna/1913/SymptomsandRiskFactor

Hanya untuk Pendidikan dan


JJE-13/07/2009 Kesehatan
 High fat diets have been reported to be
associated with higher rates of ovarian
cancer in industrialized nations.

 Talc-use in feminine hygiene sprays or in


sanitary napkins has been suggested as a
factor associated with some risk.
http://www.geocities.com/HotSprings/Sauna/1913/SymptomsandRiskFactor

Hanya untuk Pendidikan dan


JJE-13/07/2009 Kesehatan
 the risk of ovarian cancer is 1 in
55 (1.8%), but Age and Family
history may increase this risk.
 Jemal A, Thomas A, Murray T, Thun M. Cancer statistics, 2002. CA
Cancer J Clin. 2002;52:23-47.

Dr. Mohammed Abdalla


Egypt / Domiat general hos

Hanya untuk Pendidikan dan


JJE-13/07/2009 Kesehatan
Hanya untuk Pendidikan dan
JJE-13/07/2009 Kesehatan
 Symptoms significantly associated with
ovarian cancer when occurring more than
12 days a month:
 Pelvic / abdominal pain
 Frequent or urgent urination
 Increased abdominal size/ bloating
 Difficulty eating / feeling full

Goff et. al. Cancer 2007; 109:221-227.


http://www.geocities.com/HotSprings/Sauna/1913/SymptomsandRiskFactor

Hanya untuk Pendidikan dan


JJE-13/07/2009 Kesehatan
Diagnostic value of pelvic examination, ultrasound,
and serum CA 125 in postmenopausal women with a
pelvic mass. An international multicenter study

 Ninety-five malignant (41.7%) and 127 benign


(55.7%) pelvic tumors were found in addition to 6
borderline ovarian tumors (2. 6%) in the 228
patients.

 Seventy-two patients had ovarian carcinoma, 49 of


whom (68%) were International Federation of
Gynecology and Obstetrics Stage III or IV.

http://www3.interscience.wiley.com/journal/112686925/abs

Eltjo M. J. Schutter, et al, JUOG, 199


Hanya untuk Pendidikan dan
JJE-13/07/2009 Kesehatan
Diagnostic value of pelvic examination, ultrasound,
and serum CA 125 in postmenopausal women with a
pelvic mass. An international multicenter study

 Borderline tumors were excluded from the


statistical calculations.

 The individual accuracy of pelvic examination,


ultrasound, and serum CA 125 in discriminating
between benign and malignant pelvic masses was
approximately the same (76, 74, and 77%,
respectively).

Hanya untuk PendidikanEltjo


M. J. Schutter, et al, JUOG, 19
dan
JJE-13/07/2009 Kesehatan
JJE-20080821 http://www3.interscience.wiley.com/journal/112686925/abs
 Benign : uniloculare, thin
septum, thin wall, smooth internal
surface, low echogenicity or
sonoluscent

 Malignant : multiloculare, thick


septum, thick wall, papillary
projections from internal surface,
high echogenicity or not
homogenous
B. Karsono : Pemeriksaan ultrasonografi
tumor ginekologik, 2006

Hanya untuk Pendidikan dan


JJE-13/07/2009 Kesehatan
Prospective assessment of simple rules to
distinguish between malignant and benign adnexal
masses prior to surgery

 Sunday, 24 August 2008


 D. Timmerman 1 *, L. Ameye 2, C. Van Holsbeke 3, R. Fruscio 4, A.
Czekierdowski 5, S. Guerriero 6, A. C. Testa 7, V. Vandenbroucke 1, T.
Bourne 8, B. Van Calster 2, G. Betsas 1, P. Neven 1, S. Van Huffel 2, L.
Valentin 9
 1Dept Obstetrics and Gynecology, UZ Leuven, Leuven, Belgium
 2Electrical Engineering (ESAT-SISTA), Katholieke Universiteit Leuven, Leuven, Belgium
 3Dept Obstetrics and Gynecology, UZ Leuven and ZOL Genk, Leuven and Genk, Belgium
 4Dept Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy
 5Dept Obstetrics and Gynecology, Medical University, Lublin, Poland
 6Dept Obstetrics and Gynecology, Ospedale San Giovanni di Dio, Cagliari, Italy
 7Dept Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Rome, Italy
 8Dept Obstetrics and Gynecology, St George's Hospital and UZ Leuven, London and Leuven,
United Kingdom
 9Dept Obstetrics and Gynecology, University Hospital, Malmö, Sweden

 *Correspondence Hanya untuk Pendidikan


to D. Timmerman, dan
Dept Obstetrics and Gynecology, UZ
JJE-13/07/2009 Kesehatan
Leuven, Leuven, Belgium
The five simple rules to
predict malignancy (M-
rules) (Timmerman D, et al, JUOG, 2008)
 Irregular solid tumor;
 Ascites;
 At least four papillary structures;
 Irregular multilocular-solid tumor with a
largest diameter of at least 100 mm;
 Very high color score using color Doppler.
http://www3.interscience.wiley.com/cgi-bin/fulltext/121375169/HTMLST

Hanya untuk Pendidikan dan


JJE-13/07/2009 Kesehatan
http://www.femalehealthmadesimple.com/FileSevenFinal.

Hanya untuk Pendidikan dan


JJE-13/07/2009 Kesehatan
The five simple rules to
suggest a benign tumor (B-
rules)
 Unilocular cyst;
 Presence of solid components where the largest
solid component is < 7 mm in largest diameter;

 Acoustic shadows;
 Smooth multilocular tumor less than 100 mm in
largest diameter;
 No detectable blood flow at Doppler examination.

Hanya untuk Pendidikan dan


JJE-13/07/2009 Kesehatan
Sassone Morphology Scoring System for Ovarium and Pelvic Tumor

Score Internal Wall Septum Tumor


Surface Thickness Echogenicity

1 Smooth ≤ 3 mm No-septum Sonoluscent

2 Irregular > 3 mm ≤ 3 mm Low echogenicity


≤ 3 mm

3 Papil can’t be > 3 mm Low echogenicity


> 3 mmm measurement Echogenic nodule
> solid mass

4 can’t be _ _ complex echogenic


evaluation
> solid mass

5 _ _ _ High echogenicity

Hanya untuk Pendidikan dan


Kesehatan
JJE-13/07/2009
B. Karsono : Pemeriksaan ultrasonografi
Which parameters could be useful to predict
malignancy in sonographically solid adnexal
masses? (Acazar JL, et al, JUOG, 2008)

Symptoms suggestive Ovarian cancer 5.4% 49.5% < 0.0001


Suspicious Physical exam 17.9% 69.2% < 0.0001
Menopause 39.3% 69.2% < 0.0001
Ascites 3.6% 61.5% < 0.0001
Bilaterality 3.6% 23.4% < 0.0001
Central blood flow 16.1% 95.7% < 0.0001
Abundant blood flow 12.5% 67.6% < 0.0001
High PSV/Low RI 19.6% 58.1% < 0.0001
Median CA-125 (IU/mL) 19.6 312.1 0.005

tic regression analysis only central blood flow (odd ratio: 64.2, 95% CI: 17.07 to
ence of ascites (odd ratio: 32.77, 95% CI: 5.38 to 199.72) were identified as inde
s of malignancy. The presence of one of these two features correlated to malign
cases. The absence of both was found in 82.1% of benign tumours.

Hanya untuk Pendidikan dan


JJE-13/07/2009 Kesehatan http://www3.interscience.wiley.com/cgi-bin/fulltext/121375594/HTMLST
 Cut-off value of RI ??
Malignancy ?
CONTROVERSIAL !!
(equipment, knowledge of Doppler,
experience, and skills)
 RI : 0.30 – 0.60
 PI : 0.30 – 1.50

 Suspect malignancy : RI <


0.40 or PI < 1.0
 Benign : RI > 0.70 or PI > 2.00
B. Karsono : Pemeriksaan ultrasonografi tumor gineko

Hanya untuk Pendidikan dan


JJE-13/07/2009 Kesehatan
The clinical usefulness evaluation of new
ultrasonographic method E-flow in Doppler
index ovarian tumors malignancy prediction
 Ultrasound examinations was performed
preoperatively in 53 patients with ovarian tumors.
Malignant tumors were in 12 (22.6%) cases and 41
cases non malignant tumors.

 We estimated vascularisation as Doppler index


(number of vessels, localization, regularity,
vascular impedance and notch) of the tumors
using Color Doppler (CD), Power Doppler (PD) and
E-flow and compared this methods.
D. Szpurek et al, JUOG, 32,3, 200
Hanya untuk Pendidikan dan
JJE-13/07/2009 Kesehatan
The clinical usefulness evaluation of new
ultrasonographic method E-flow in Doppler
index ovarian tumors malignancy prediction
 Doppler index in occurrence of ovarian cancers has:
sensitivity of 83.3%, 83.3% and 91.7% for CD, PD and E-
flow, respectively; specificity of 90.2%, 87.8%, 92.7% and
accuracy of 88.7%, 86.8% and 92.5% for CD, PD and e-flow,
respectively.

 Negative and positive predictive values for e-flow


estimation were 97.4% and 78.6%, respectively.

 Prognostic values of analyzed methods in our group of


patients based on the area under ROC was: 0.940, 0.945
and 0.960 respectively D. Szpurek et al, JUOG, 32,3, 200
Hanya untuk Pendidikan dan
JJE-13/07/2009 Kesehatan
Hanya untuk Pendidikan dan
JJE-13/07/2009 Kesehatan
 ↑ Accuracy of the
location, volume, and
morphology (tumor and
vascular)

 Contrast- enhanced 3D
power Doppler

B. Karsono : Pemeriksaan ultrasonografi tumor gineko

Hanya untuk Pendidikan dan


JJE-13/07/2009 Kesehatan
 Functional Cysts : Follicular cysts, Corpus
luteum cysts, corpus luteum of pregnancy,
theca lutein cysts
 Surface Epithelium Inclusion Cysts
 Rete Cysts
 Hyperreactio Luteinalis
 Ovarian Hyperstimulation Syndrome
 Polycystic Ovarian Syndrome
 Ovarian Remnant Syndrome
 Neonatal Ovarian Cysts
 Paratubal, Paraovarial Cysts
 Endometriosis
 PID
 Peritoneal Inclusion Cysts Marcus J. Dill-Macky et al, 2000

Hanya untuk Pendidikan dan


JJE-13/07/2009 Kesehatan
Tabel 17.1. Jumlah kasus baru dan
lama neoplasma jinak ovarium tahun
2005 di RSPAD Gatot Soebroto
BULAN KASUS LAMA KASUS BARU
Januari 16 8
Februari 31 8
Maret 22 4
April 38 3
Mei 12 3
Juni 27 3
Juli 14 7
Hanya untuk Pendidikan dan
Agustus 20 Kesehatan
7
September 23 6
Oktober 15 4
November 8 5
Disember 11 5
Jumlah 237 63 JJE-13/07/2009
neoplasma ovarium
Pemeriksaan standar Risiko Malignansi Pemeriksaan Lanjutan
Anamnesis
• Data reproduksi (paritas, abortus), riwayat haid, KB pil, terapi infertilitas, terapi
sulih hormon, riwayat operasi (ovarium).

Umur
• Premanopause Rendah
• Pascamenopause Tinggi
Riwayat Keluarga kanker ovarium dan atau payudara Konseling genetik
• Ada Tinggi
• Tidak ada Rendah
Keluhan (bila ada) Singkirkan kelainan yang bukan berasal dari
• Pembesaran perut, rasa penuh atau penekanan didaerah perut atau pelvik, nyeri Tinggi ovarium (Rontgent, CT-scan, MRI)
perut atau pinggang bagian bawah, sering berkemih, lekas lelah, nafsumakan
berkurang, dan penurunan berat badan

Palpasi bimanual
• Halus, bundar, mobilitas baik, unilateral, diameter < 10 cm Rendah
• Ada bagian padat/padat, tidak bergerak (ada perlekatan), bilateral, batas tidak Tinggi
tegas, dan diameter > 10 cm

USG Transvaginal 2D : volume USG 3D lebih superior dari 2D dalam hal :


• < 20 cm3 – premenopause Rendah • tampilan karakteristik dinding dalam massa
• < 10 cm3 – postmenopause Rendah • Identifikasi infiltrasi tumor pada kapsul kista
• > 20 cm3 – premenopause Tinggi • Pengukuran volume
• > 10 cm3 – postmenopause
Tinggi
USG Transvaginal 2D : morfologi
• dinding halus, sekat tipis, tidak ada bagian padat, dan anekhoik

Rendah
ada pertumbuhan intrakista, papil-papil, sekat tebal, bagian padat, dan
ekhogenitas campuran Tinggi

USG Transvaginal Doppler berwarna dan Power Doppler, parameter arus Pemeriksaan kualitatif arus darah tumor dengan
darah : USG 3D Power Doppler
• PI > 1,0 , RI > 0,42 Rendah • Posisi
• PI < 1,0 , RI ≤ 0,42 Tinggi • Struktur
Lokasi arus darah • Pola
• Perifer
Hanya untuk Pendidikan dan Rendah
• Sentral Kesehatan Tinggi
Petanda tumor JJE-13/07/2009 Generasi kedua Ca 125, Ca 15-3, Ca 19-9
• Ca 125 < 35 U/ml Rendah
• Ca 125 > 35 U/ml Tinggi
 Ovarian Torsion
 Massive Ovarian
Edema
 Ovarian Vein
Thrombosis
Marcus J. Dill-Macky et al, 2000

Hanya untuk Pendidikan dan


JJE-13/07/2009 Kesehatan
 Surface Epithelial Stromal Tumors : Serous
tumors, Mucinous tumors, Endometrioid tumors,
Clear cell tumors, Transitional cell (Brenner)
tumors
 Germ Cell Tumors : Mature cystic teratomas
(ovarian dermoid cysts), mature solid teratomas,
Immature teratomas, Struma ovarii,
dysgerminoma, Yolk sac tumors
DYSGERMINOMA
 Sex Cord Stromal Tumors : Fibroma,
Thecoma, Granulosa cell tumors, Sertoli-Leydig
cell tumors
 Metastatic Tumors
 Ovarian Lymphoma
Marcus J. Dill-Macky et al, 2000
FIBROMA OVARII

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JJE-13/07/2009 Kesehatan
 Thin walled
 Unilocular
 3 – 8 cm
 Smooth & thin wall
 Contents : from serous or
serosanguineous fluid to clotted
blood

Marcus J. Dill-Macky et al, 2000


http://www.femalehealthmadesimple.com/FileSevenFinal.html

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JJE-13/07/2009 Kesehatan
 Commonly complicated
by hemorrhage (corpus
rubrum hemorrhagicum)

 Thick hyperechoic,
occasionally crenulated
wall, echogenic content

 Contents : from serous


or serosanguineous fluid
to clotted blood
Marcus J. Dill-Macky et al, 2000

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JJE-13/07/2009 Kesehatan
 Enlarged and cystic

 Kobayashi et al (1997)
: monitored as a
functional cyst if the
cysts gradual
diminution and
without complication
Marcus J. Dill-Macky et al, 2000

JJE-13/07/2009 Hanya untuk Pendidikan dan


Kesehatan
JJE-20080821

 Frequently multilocular
 The largest of the functional cysts
 Overstimulation by hCG
 Trophoblastic disease or iatrogenic
hyperstimulation
 Often bilateral
 Persist for days to weeks after
withdrawal of the stimulus
Marcus J. Dill-Macky et al, 2000

://library.med.utah.edu/kw/human_reprod/mml/hrot_ot_1.html

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JJE-13/07/2009 Kesehatan
 TAS : Adams criteria (1985) →
≥ 10 cysts, 2 - 18 mm, single plane, peripherally,
↑ central stroma or small cysts 2 - 4 mm

 TVS : Fox criteria (1991) : ≥ 15 cysts, 2 – 10 mm

http://www.femalehealthmadesimple.com/FileEightFinal.
Marcus J. Dill-Macky et al, 2000
Hanya untuk Pendidikan dan
JJE-13/07/2009 Kesehatan
Hanya untuk Pendidikan dan
JJE-13/07/2009 Kesehatan
JJE-20080821

 Mesonephric (Wolffian),
paramesonephric
(Mullerian), or mesothelial
structures

 Indistinguishable from
simple functional cysts

 Normal ipsilateral ovary


close to, but separate from
the cyst
Hanya untuk Pendidikan dan
Kesehatan Marcus J. Dill-Macky et al, 2000
JJE-13/07/2009
ariety of appearance

nechoic cysts to diffuse low


level echoes w / wo solid
components to a solid-
appearing mass

Marcus J. Dill-Macky et al, 2000


D : functional hemorrhage cysts
or other echogenic cysts
Hanya untuk Pendidikan dan
JJE-13/07/2009 Kesehatan
JJE-20080821

 25% benign ovarian neoplasms


 50 – 70% of all ovarian serous
tumors
 Sharply marginated, anechoic
masses, may be large, and usually
unilocular
 Internal thin walled septation
 Occasionally papillary projections
Marcus J. Dill-Macky et al, 2000

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JJE-13/07/2009 Kesehatan
 20 – 25% of all benign ovarian
neoplasms
 75 – 85% of all ovarian mucinous
tumors
 Thicker & more numerous
septations
 Frequently contains fine, gravity-
dependent echoes produced by the
thick contents
 Gentle tapping on the cyst wall
Marcus J. Dill-Macky et al, 2000

Hanya untuk Pendidikan dan


JJE-13/07/2009 Kesehatan
 Ovarian dermoid cysts

 5 – 25% of all ovarian neoplasms

 Reproductive years

 Regional diffuse bright echoes w /


wo posterior acoustic shadowing,
hyperechoic lines and dots,
shadowing echodensity, and fluid-
fluid level
Marcus J. Dill-Macky et al, 2000

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JJE-13/07/2009 Kesehatan
 Peritoneal inclusion cysts,
inflammatory cysts of the peritoneum
 Trapping by peritoneal adhesions
 A history of trauma, abdominal
surgery, PID, endometriosis, or
combinations
 May measure up to 20 cm, lined by
mesothelial cells
 Spider-web pattern
Marcus J. Dill-Macky et al, 2000

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JJE-13/07/2009 Kesehatan
 The current tests available to us are not
“routine,” unless you have a family history
of ovarian cancer or have several relatives
with early-onset breast cancer.

 Unfortunately, 75 percent of women with


ovarian cancer are diagnosed after the
disease has reached an advanced stage.
Judith R at http://www.msnbc.msn.com/id/203596

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JJE-13/07/2009 Kesehatan
Is ovarian cancer screening a
routine test?
 These results were not considered by statisticians to meet
the "we should routinely screen with these tests" criteria.

 For a test to be cost-effective (in simple terms, worth doing


on a large basis), it should have a PPV of 10 percent.
 This means that 10 surgeries are necessary to detect one
cancer.

 In this study the PPV was 4 percent for an abnormal CA-


125 result and 1.6 percent for an abnormal transvaginal
ultrasound.
Judith R at http://www.msnbc.msn.com/id/203596

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Is ovarian cancer screening a
routine test?
 When both tests were abnormal, this value was
23.5 percent (meaning approximately four
surgeries were needed to detect one cancer), but
in women where one or both tests were not
abnormal, 12 out of 20 invasive cancers were
missed (60%).

 That's an awful lot of cancers to miss in women


who were reassured that their tests were fine.
Judith R at http://www.msnbc.msn.com/id/203596

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Role of US in Ovarian Cancer
Screening
 Long-term survival : minimal
 If 25% stage I → 75% → the number of women dying would
be ↓ 50% (Van Nagell Jr JR, 1991)
 The best studied technique for ovarian cancer screening :
Ca 125 + Ultrasound examination
 Ultrasound : TAS, TVS
 Problems with Screening
 Population to be screened
Marcus J. Dill-Macky et al, 2000

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 Only about 85% of all women with ovarian
cancer have raised CA125

 Only 50% of women with early stage ovarian


cancer have raised CA125

 Women with other conditions can also have


raised CA125
http://www.cancerhelp.org.uk/help/default.asp?page=307

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Tabel 17.3. Hubungan diagnostik neoplasma ovarium secara sonografis dan patologi
anatomi di RSPAD Gatot soebroto
NO. NAMA DATA USG TEMUAN SAAT OPERASI PATOLOGI
PASIEN ANATOMI
1 SG Kistik, ekhointernal halus, 102x70 mm. D/: NOK, DD : Kista paraovarial kiri Kista hidatid Morgagni paratubae
(47 th) kista simpleks

2 EA Kistik, unilokular, 170x131 mm, asites(-), neovas- Kista endometriosis. Tidak ditemukan
(44 th) kularisasi (-). D/ : Kista endometriosis Ca 125 : 29,8

3 LK Kistik, > 200 mm, partikel halus bergerak, sekat 4 mm, Kistadenoma ovarium musinosum Kistadenoma musinosum papiliferum
(60 th) neovaskularisasi (-), asietes (-). Hidronefrosis multilokular papiliferum multilokular ovarium
dekstra. D/ : NOK permagna Ca 125 : 118,4

4 NL Kistik, multilokular, 224x86 mm, berisi ekhointernal halus, Kista musinosum. Kistadenoma musinosum papiliferum
(27 th) RI : 0,4. D/: NOK multilokular kiri suspek Ca 125 : 1258,18 multilokular ovarium
musinosum. DD : kista endometriosis

5 MN Kistik, 137x108x167 mm, ekhointernal, RI : 0,489. D/ : VC : kista endomet-riosis dengan sel Kista endometriosis, tidak ditemukan
(38 th) NOK suspek malignansi atipik sel ganas
Ca 125 : 961,5

6 DW Padat, di posterior uterus, mengisi rongga abdomen, arus VC : karsinoma dengan diferensiasi Karsinoma ovarium berdiferensiasi
(29 th) darah arteri sulit dinilai, asites berisi partikel kasar. buruk. buruk
D/: NOP suspek malignan. DD : mioma uteri Ca. Ovarium III-C
Ca 125 : 273,72

7 IR Kistik, multilokular, mengisi rongga pelvik dan abdomen Kista musinosum Kistadenoma musinosum papiliferum
(28 th) (asal massa tak jelas), RI : 0,513. D/: kista Ca 125 : 15 ovarium dengan bagian
ovarium permagna, keganasan belum dapat borderline
disingkirkan

8 RN Ovarium kanan : kista simpleks, 34x25,4x29,6 mm. Kista endometriosis kiri dan kista Kista endometriosis bilateral
(44 th) Ovarium kiri : D/ : NOK dgn bagian padat, ovarium kanan.
60x56x67 mm, multi lokular, RI : 0,536 Ca 125 : 68,42

9 SN Kistik, ekhointernal, 46x46 mm, melekat pd dinding Kista coklat bilateral Kista endometriosis kanan dan kista
(40 th) belakang uterus. D/: suspek kista endometriosis Ca 125 : 20,5 lutein kiri yang disertai
kanan perdarahan

10 TN Kistik, 44x43 mm, ekho-internal kasar dengan bercak- Kista dermoid kiri. Kista dermoid ovarium
(28 th) bercak hiperekhoik. D:/ Kista dermoid kiri Ca 125 : 10,2

11 NR Kistik, ekhointernal kasar, batas tegas, dinding tebal, Kista ovarium terinfeksi Kista endometriosis dan
(44 th) nyeri tekan, tidak tampak neovaskularisasi pada Ca 125 : 25,35 mengesankan adanya abses
dinding. D/ : suspek NOK terinfeksi tubo-ovarial
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http://www.sah.org.au/SUW/hycosy.html

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. Transvaginal Doppler sonogram of a large projection showing internal vascular flow.

Figure 3. Transvaginal spectral sonogram showing a relatively low resisti


with the mural projection, indicative of a tumor.

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http://www.jultrasoundmed.org/cgi/content/full/21/10/1171
 Choosing the appropriate techniques and
equipments
 From normal to pathological conditions, and from
benign to malignant
 Knowing the frequent cases
 Good Informed consent, reporting & archiving
 CPD
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 Perhaps the biggest obstacle to effective screening, early
detection, and (ultimately) the prevention of ovarian
cancer, is our lack of understanding of exactly how and
why this disease develops.

 For the time being, women who are concerned about their
ovarian cancer risk should be sure to have regular
gynecologic checks and maintain an open and ongoing
dialogue with their health care providers about appropriate
ways to address their health concerns.

http://www.macgn.org/newsletter/nl27b.h

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