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"Adrenomedulin merupakan peptida dengan berbagai aktivitas biologi baik pada keadaan fisiologis maupun pada keganasan. Pada keganasan adrenomedulin berperan sebagai faktor stimulasi proliferasi, menghambat apoptosis, serta menginduksi angiogenesis. Ekspresi adrenomedulin terutama dipengaruhi oleh hipoksia sehingga adrenomedulin banyak ditemukan pada berbagai tumor solid. Tujuan penelitian ini adalah untuk menganalisis ekspresi Adrenomedulin jaringan karsinoma payudara invasif NST baik yang metastasis dan non-metastasis, serta dilihat hubungan adrenomedulin dengan jumlah mitosis dan apoptosis yang dilakukan dengan memeriksa ekspresi Caspase-3. Metode penelitian: pada 50 kasus karsinoma payudara invasif NST dengan 25 sampel non-metastasis (N0) dan 25 sampel sisanya adalah sampel metastasis (N1) dilakukan pemeriksaan ekspresi adrenomedulin dan Caspase-3 dengan pulasan imunohistokimia, serta jumlah mitosis dengan pulasan HE. Hasil : ada perbedaan bermakna ekspresi Adrenomedulin pada jaringan karsinoma payudara invasif NST metastasis dengan non-metastasis (p=0,002) dan terdapat korelasi (koefisien korelasi Spearman 0, 490) antara ekspresi adrenomedulin dengan metastasis, ada perbedaan bermakna ekspresi Caspase-3 pada jaringan karsinoma payudara invasif NST metastasis dengan non-metastasis (p=0,038) dan ada korelasi (koefisien korelasi Spearman 0, 327) antara ekspresi Caspase-3 dengan metastasis, namun tidak ada perbedaan bermakna jumlah mitosis pada jaringan karsinoma payudara invasif NST metastasis dengan non-metastasis (p=0,004) dan tidak ditemukan korelasi (koefisien korelasi Spearman 0,188) antara mitosis dengan metastasis, tidak ada perbedaan bermakna antara ekspresi adrenomedulin dengan ekspresi Caspase-3 (p=0,697) maupun dengan mitosis (p=0,711) pada jaringan karsinoma payudara invasif NST metastasis dengan non-metastasis.

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Adrenomedullin is a peptide hormone with many biological activities either in physiological conditions or malignancy. Adrenomedullin in malignancy acts as a factor in stimulating proliferation, inhibiting apoptosis, and induces angiogenesis. Its secretion is influenced by hypoxia condition and cytokine secretion. Adrenomedullin is found in variety of solid tumors. The purpose of this study was to analyze the expression of adrenomedullin in invasive carcinoma NST of the breast tissue both metastatic and non-metastatic, and its relations with mitosis count and apoptosis.

Methods: in 50 cases of invasive carcinoma NST of the breast with 25 samples of non-metastatic (N0) and 25 metastastic (N1) samples were examined for the expression of adrenomedullin and Caspase-3 that investigated by immunohistochemistry staining, and mitosis count by HE staining. Apoptosis was investigated by the expression of caspase-3.

Results: There is significance differences of Adrenomedullin expression in breast invasive cancer NST tissue with metastasis compare to non-metastasis (p = 0.002) and correlation between the expression of adrenomedullin with metastasis to regional lymph node (Spearman coefficient correlation 0.490), there is significance differences of Caspase-3 expression in breast invasive cancer NST tissue with metastasis compare to non-metastasis (p = 0.038) and there is correlation between the expression of Caspase-3 with metastasis to regional lymph node (Spearman coefficient correlation 0.327), but there isn‟t significance differences in mitosis count between metastasis and non-metastasis (p = 0.906), there is no correlation between the expression of adrenomedullin and the expression of Caspase-3 (Spearman coefficient correlation 0.089) and mitosis (Spearman coefficient correlation 0.099).

Conclusion: adrenomedullin expression are found correlate to metastasis to the lymph nodes in breast cancer invasive NST, but there were no correlation with mitosis and apoptosis."

"[ABSTRAKTujuan: Menentukan hubungan ukuran tumor dan derajat histopatologi dengan metastasis tulang pada pasien kanker payudara berusia dibawah 40 tahun di RS Kanker Dharmais, membantu meningkatkan kualitas tatalaksana bagi klinisi.Metode: Analisa menggunakan data sekunder. Hasil ukuran tumor dikelompokkan menjadi ≤ 5 cm dan > 5 cm berdasarkan AJCC TNM staging system diperoleh melalui pencitraan radiologi payudara dari sistem PACS dan derajat histopatologi menurut derajat histopatologi Nottingham kombinasi diperoleh dari hasil ekspertise patologi anatomi, serta evaluasi metastasis tulang menggunakan skintigrafi tulang berdasarkan total populasi pasien kanker payudara berusia dibawah 40 tahun.Hasil: Jumlah subyek penelitian 32 perempuan kanker payudara berusia dibawah 40 tahun periode Januari 2011 hingga Juli 2014 di RS Kanker Dharmais. Tidak ada hubungan yang bermakna antara ukuran tumor dengan metastasis tulang (P= 0,715 (Fisher exact test), OR=1,71 (0,32-9,36)). Terdapat hubungan yang bermakna antara derajat histopatologi dengan metastasis tulang (P=0,010, P < 0,05).Dari 10 subyek derajat histopatologi tinggi, ternyata semua subyek mengalami metastasis tulang negatif. Pada subyek dengan derajat histopatologi sedang didapatkan 8 dari 15 subyek yang mengalami metastasis tulang. Pada subyek penelitian dengan derajat histopatologi rendah didapatkan 6 dari 7 subyek mengalami metastasis tulang negatif. Rerata usia 33,2 tahun dan simpang baku 3,7 tahun memiliki kejadian metastasis tulang lebih tinggi (P=0,024). Terdapat data tambahan dan ditemukan hubungan yang bermakna antara Cerb-b2/HER-2 positif dengan metastasis tulang (P=0,049 (P < 0,05), Odds Ratio=5,67 (0,84 ? 43,16)).Prevalensi metastasis tulang yaitu sebesar 28,1%.Kesimpulan: Pasien kanker payudara berusia dibawah 40 tahun dengan ukuran tumor besar tidak memiliki kejadian metastasis tulang lebih tinggi. Pasien dengan derajat histopatologi tinggi tidak memiliki kejadian metastasis tulang lebih tinggi, namun ditemukan angka kejadian metastasis tulang lebih tinggi pada derajat histopatologi sedang. Terdapat dua faktor lain yang juga mempunyai hubungan dengan kejadian metastasis tulang yaitu usia dan Cerb-br/HER-2. Rerata usia 33,2 tahun dengan simpang baku 3,7 tahun pada pasien kanker payudara berusia di bawah 40 tahun memiliki kejadian metastasis tulang lebih tinggi. Cerb-b2/HER-2 positif pada pasien kanker payudara berusia di bawah 40 tahun memiliki kejadian metastasis tulang lebih tinggi dengan resiko kejadian sebesar 5,67 kali. Prevalensi metastasis tulang cukup tinggi pada pasien kanker payudara berusia dibawah 40 tahun yaitu sebesar 28,1%.

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ABSTRACTObjective: Determine the relationship of tumor size and histopathology grade with bone metastases in breast cancer patients under 40 years old in Dharmais Cancer Hospital, to help improve the quality of management of the clinician.Methods: Analysis using secondary data. The results of tumor size are grouped into ≤ 5 cm and> 5 cm based on the AJCC TNM staging system from PACS system, obtained through breast radiology imaging and histopathologic grade according to histopathological Nottingham combination obtained from the anatomical pathology expertise, the evaluation of bone metastases using bone scintigraphy. These analyses are based on the total population of breast cancer patients under 40 years old.Results: The study subjects are 32 female breast cancer under 40 years old from January 2011 to July 2014 Dharmais Cancer Hospital. There is no significant relationship between the tumor size with bone metastasis (P = 0.715 (Fisher exact test), OR = 1.71 (0.32 to 9.36)). There is a significant relationship between the histopathology grade with bone metastases (P = 0.010, P <0.05). From 10 subjects with high grade histopathology, all subjects have no bone metastases. In subjects with moderate grade histopatholog, 8 of 15 subjects have bone metastases. In subjects with a low grade histopathology showed 6 of 7 subjects have no bone metastases. The mean age of 33.2 years and standard deviations of 3.7 years had a higher incidence of bone metastases (P = 0.024). There are additional data and found a significant association between Cerb-b2 / HER-2 positive patients with bone metastases (P = 0.049 (P <0.05), odds ratio = 5.67 (0.84 to 43.16)). The prevalence bone metastasis is equal to 28.1%.Conclusion: Breast cancer patients under 40 years with large tumor size did not have a higher incidence of bone metastases. Patients with a high grade histopathology do not have higher incidence of bone metastases, but found the incidence of bone metastases was higher in moderate grade histopathology. There are two other factors that also have a relationship with the incidence of bone metastases, that are age and Cerb-br / HER-2. The mean age of 33.2 years with standard deviations of 3.7 years in patients with breast cancer under 40 years old have a higher incidence of bone metastases. Cerb-b2 / HER-2 positive breast cancer patients under 40 years old have a higher incidence of bone metastases with the risk of occurrence 5.67 times. The prevalence of bone metastases in breast cancer patients under the age of 40 years is quite high equal to 28.1%.;Objective: Determine the relationship of tumor size and histopathology grade with bone metastases in breast cancer patients under 40 years old in Dharmais Cancer Hospital, to help improve the quality of management of the clinician.Methods: Analysis using secondary data. The results of tumor size are grouped into ≤ 5 cm and> 5 cm based on the AJCC TNM staging system from PACS system, obtained through breast radiology imaging and histopathologic grade according to histopathological Nottingham combination obtained from the anatomical pathology expertise, the evaluation of bone metastases using bone scintigraphy. These analyses are based on the total population of breast cancer patients under 40 years old.Results: The study subjects are 32 female breast cancer under 40 years old from January 2011 to July 2014 Dharmais Cancer Hospital. There is no significant relationship between the tumor size with bone metastasis (P = 0.715 (Fisher exact test), OR = 1.71 (0.32 to 9.36)). There is a significant relationship between the histopathology grade with bone metastases (P = 0.010, P <0.05). From 10 subjects with high grade histopathology, all subjects have no bone metastases. In subjects with moderate grade histopatholog, 8 of 15 subjects have bone metastases. In subjects with a low grade histopathology showed 6 of 7 subjects have no bone metastases. The mean age of 33.2 years and standard deviations of 3.7 years had a higher incidence of bone metastases (P = 0.024). There are additional data and found a significant association between Cerb-b2 / HER-2 positive patients with bone metastases (P = 0.049 (P <0.05), odds ratio = 5.67 (0.84 to 43.16)). The prevalence bone metastasis is equal to 28.1%.Conclusion: Breast cancer patients under 40 years with large tumor size did not have a higher incidence of bone metastases. Patients with a high grade histopathology do not have higher incidence of bone metastases, but found the incidence of bone metastases was higher in moderate grade histopathology. There are two other factors that also have a relationship with the incidence of bone metastases, that are age and Cerb-br / HER-2. The mean age of 33.2 years with standard deviations of 3.7 years in patients with breast cancer under 40 years old have a higher incidence of bone metastases. Cerb-b2 / HER-2 positive breast cancer patients under 40 years old have a higher incidence of bone metastases with the risk of occurrence 5.67 times. The prevalence of bone metastases in breast cancer patients under the age of 40 years is quite high equal to 28.1%.;Objective: Determine the relationship of tumor size and histopathology grade with bone metastases in breast cancer patients under 40 years old in Dharmais Cancer Hospital, to help improve the quality of management of the clinician.Methods: Analysis using secondary data. The results of tumor size are grouped into ≤ 5 cm and> 5 cm based on the AJCC TNM staging system from PACS system, obtained through breast radiology imaging and histopathologic grade according to histopathological Nottingham combination obtained from the anatomical pathology expertise, the evaluation of bone metastases using bone scintigraphy. These analyses are based on the total population of breast cancer patients under 40 years old.Results: The study subjects are 32 female breast cancer under 40 years old from January 2011 to July 2014 Dharmais Cancer Hospital. There is no significant relationship between the tumor size with bone metastasis (P = 0.715 (Fisher exact test), OR = 1.71 (0.32 to 9.36)). There is a significant relationship between the histopathology grade with bone metastases (P = 0.010, P <0.05). From 10 subjects with high grade histopathology, all subjects have no bone metastases. In subjects with moderate grade histopatholog, 8 of 15 subjects have bone metastases. In subjects with a low grade histopathology showed 6 of 7 subjects have no bone metastases. The mean age of 33.2 years and standard deviations of 3.7 years had a higher incidence of bone metastases (P = 0.024). There are additional data and found a significant association between Cerb-b2 / HER-2 positive patients with bone metastases (P = 0.049 (P <0.05), odds ratio = 5.67 (0.84 to 43.16)). The prevalence bone metastasis is equal to 28.1%.Conclusion: Breast cancer patients under 40 years with large tumor size did not have a higher incidence of bone metastases. Patients with a high grade histopathology do not have higher incidence of bone metastases, but found the incidence of bone metastases was higher in moderate grade histopathology. There are two other factors that also have a relationship with the incidence of bone metastases, that are age and Cerb-br / HER-2. The mean age of 33.2 years with standard deviations of 3.7 years in patients with breast cancer under 40 years old have a higher incidence of bone metastases. Cerb-b2 / HER-2 positive breast cancer patients under 40 years old have a higher incidence of bone metastases with the risk of occurrence 5.67 times. The prevalence of bone metastases in breast cancer patients under the age of 40 years is quite high equal to 28.1%., Objective: Determine the relationship of tumor size and histopathology grade with bone metastases in breast cancer patients under 40 years old in Dharmais Cancer Hospital, to help improve the quality of management of the clinician.Methods: Analysis using secondary data. The results of tumor size are grouped into ≤ 5 cm and> 5 cm based on the AJCC TNM staging system from PACS system, obtained through breast radiology imaging and histopathologic grade according to histopathological Nottingham combination obtained from the anatomical pathology expertise, the evaluation of bone metastases using bone scintigraphy. These analyses are based on the total population of breast cancer patients under 40 years old.Results: The study subjects are 32 female breast cancer under 40 years old from January 2011 to July 2014 Dharmais Cancer Hospital. There is no significant relationship between the tumor size with bone metastasis (P = 0.715 (Fisher exact test), OR = 1.71 (0.32 to 9.36)). There is a significant relationship between the histopathology grade with bone metastases (P = 0.010, P <0.05). From 10 subjects with high grade histopathology, all subjects have no bone metastases. In subjects with moderate grade histopatholog, 8 of 15 subjects have bone metastases. In subjects with a low grade histopathology showed 6 of 7 subjects have no bone metastases. The mean age of 33.2 years and standard deviations of 3.7 years had a higher incidence of bone metastases (P = 0.024). There are additional data and found a significant association between Cerb-b2 / HER-2 positive patients with bone metastases (P = 0.049 (P <0.05), odds ratio = 5.67 (0.84 to 43.16)). The prevalence bone metastasis is equal to 28.1%.Conclusion: Breast cancer patients under 40 years with large tumor size did not have a higher incidence of bone metastases. Patients with a high grade histopathology do not have higher incidence of bone metastases, but found the incidence of bone metastases was higher in moderate grade histopathology. There are two other factors that also have a relationship with the incidence of bone metastases, that are age and Cerb-br / HER-2. The mean age of 33.2 years with standard deviations of 3.7 years in patients with breast cancer under 40 years old have a higher incidence of bone metastases. Cerb-b2 / HER-2 positive breast cancer patients under 40 years old have a higher incidence of bone metastases with the risk of occurrence 5.67 times. The prevalence of bone metastases in breast cancer patients under the age of 40 years is quite high equal to 28.1%.]"

"ABSTRAKLatar belakang: Karsinoma urotelial kandung kemih merupakan kasus terbanyak di organ kandung kemih mencapai 90% kasus. Stadium dibedakan menjadi 2 kelompok yaitu non invasif jika belum menembus lapisan muskularis dan invasif jika sudah menembus lapisan muskularis. Kesintasan 5 tahun tergantung dari derajat keganasan dan stadium. Derajat keganasan rendah dan belum invasi muskuler dapat mencapai 90 %, tetapi angka rekurensi berkisar 40-60%. Derajat keganasan tinggi dan sudah invasi hanya berkisar 10-17%. Mitosis dan invasi limfovaskuler berhubungan dengan angka rekurensi tinggi. Namun masih terdapat kontroversial terhadap ekspresi Bcl-2 pada karsinoma urotelial kandung kemih. Penelitian ini bertujuan untuk menilai perbedaan ekspresi Bcl-2 dengan 4 faktor yang berhubungan dengan prognosis yaitu derajat keganasan, stadium, mitosis, dan invasi limfovaskuler.Bahan dan cara: Dilakukan penelitian deskriptif analitik secara potong lintang pada karsinoma urotelial kandung kemih tahun 2010-2014 di Departemen Patologi Anatomi FKUI/RSCM. Didapatkan 21 kasus derajat keganasan rendah dan 21 kasus derajat keganasan tinggi. Dilakukan pulasan Bcl-2 pada seluruh kasus dan dihitung persentasenya dan dilakukan skoring 0-3.Hasil: Usia terbanyak pada dekade 5 sebanyak 27 kasus. Didapatkan 4 kasus ditemukan invasi limfovaskuler. Penelitian ini mendapatkan hubungan antara mitosis dengan derajat keganasan(p:0,000)dengan koefisien korelasi 0,512 Penelitian ini mendapatkan hampir seluruh kasus mengekspresikan Bcl-2 (39 dari 42 kasus), 1 kasus tidak mengekspresikan dan 2 kasus mengekpresikan sedikit. Tidak didapatkan perbedaan antara ekspresi Bcl-2 dengan derajat keganasan (p:0,232), stadium(p:0,455), mitosis(p:0,835), dan invasi limfovaskuler(p:0,087).Kesimpulan: Tidak terdapat perbedaan ekspresi Bcl-2 dengan derajat keganasan, stadium, mitosis, dan invasi limfovaskuler.

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ABSTRACT

Background: Urothelial carcinoma comprises of 90% of all cases in bladder. There are two groups which are non invasive depend on whether the tumor has reached muscularis mucosa. 5-Years survival rate depend on grading and staging. Low malignant grade and non invasive can reach 90% survival rate, with recurrence rate 40-60%. High malignant grade and invasive tumor has only10-17% survival rate. Mitosis and lymphovascular invasion are related with recurrency. However, there are some controvesi regarding Bcl-2 expression in bladder urothelial carcinoma. This study aimed to evaluate different expression of Bcl-2 with 4 related factors contributy to survival, which are degree of malignancy, stage, mitosis, and lymphovascular invasion.

Material and methods: A retrospective and cross sectional study of urothelial carcinoma of the bladder was conducted in 2010-2014 in the Department of Anatomical Pathology, Faculty of medicine / RSCM. In this study found 21 cases of low grade and 21 cases of high high grade. Bcl-2 staining performed in all cases and percentages are calculated and made scoring 0-3.

Results: Most case is fifth decade as many as 27 cases. Obtained 4 cases found limfovaskuler invasion. This study obtains the relationship between mitosis with grade of tumor (p: 0.000). There were no differences between the expression of Bcl-2 with the degree of malignancy stage , mitosis and lymphovascular invasion.

Conclusions: There were no associated expression of Bcl-2 with the degree of malignancy, stage, mitosis, and invasion limfovaskuler."