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"[ABSTRAKLatar Belakang: Kanker kolorektal merupakan tumor ganas ketiga di dunia.Sembilan puluh lima persen kanker kolorektal merupakan adenokarsinoma yangberasal dari lesi prekursor adenoma. Dilaporkan 15%-20% kanker terkait denganinfeksi virus. Virus yang diduga berhubungan dengan kanker kolorektal adalahhuman papilloma virus (HPV) dan tipe tersering adalah 16 dan 18. Hubunganantara HPV dan kanker kolorektal masih menjadi perdebatan. Penelitian inibertujuan untuk mengetahui perbedaan prevalensi infeksi HPV pada adenoma danadenokarsinoma kolorektal di Departemen Patologi Anatomik FKUI/RSCMJakarta dengan menggunakan teknik polymerase chain reaction (PCR). Bahandan Metode: Pemeriksaaan DNA HPV pada 33 kasus adenoma dan 33 kasusadenokarsinoma kolorektal dengan teknik nested PCR MY/GP dan elektroforesis.Pada kasus dengan hasil HPV positif, dilanjutkan PCR menggunakan primerspesifik HPV 16 dan HPV 18. Subjek penelitian berasal dari Departemen PatologiAnatomik FKUI/RSCM. Hasil: Satu dari 33 kasus (3,0%) adenoma dan 3 dari 33kasus (9,1%) adenokarsinoma positif infeksi HPV. Satu kasus adenoma positifHPV bukan merupakan tipe 16 dan 18. Satu kasus adenokarsinoma denganpositif, HPV merupakan tipe 16, 2 kasus merupakan gabungan tipe 16 dan 18.Kesimpulan: Prevalensi infeksi HPV pada adenokarsinoma lebih tinggidibandingkan adenoma kolorektal. Tipe HPV pada kasus adenokarsinomakolorektal merupakan tipe 16 dan 18.

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ABSTRACTBackground : Colorectal cancer is the third malignant tumor in the world.Ninety-five percent of colorectal cancers are adenocarcinomas derived fromprecursor lesions adenoma. There are 15% -20% of cancers associated with viralinfections. Virus are suspected associated with colorectal cancer is the humanpapilloma virus (HPV) and the most common types are 16 and 18. Therelationship between HPV and colorectal cancer is still being debated. This studypurpose to determine the prevalence differences of HPV infection in colorectaladenomas and adenocarcinomas in the Department of Anatomic Pathology,FKUI/RSCM Jakarta by using the polymerase chain reaction (PCR). Materialsand Methods : HPV DNA examination on 33 cases of adenoma and 33 cases ofcolorectal adenocarcinoma by nested MY/GP PCR technique and electrophoresis.In the cases with positive HPV results, continue by specific primers HPV 16 andHPV 18 PCR. The subject of the study came from the Department of AnatomicPathology, FKUI/RSCM. Result : One (3.0%) adenomas and 3 (9.1%)adenocarcinoma from 33 cases adenoma and adenocarcinoma are HPV positive.One case of HPV positive adenomas are not types 16 and 18. HPV positiveadenocarcinoma, 1 case was type 16, two cases are combination of types 16 and18. Conclusion : The HPV prevalence in adenocarcinoma was higher thancolorectal adenoma. HPV types on positive colorectal adenocarcinoma cases aretypes 16 and 18., Background : Colorectal cancer is the third malignant tumor in the world.Ninety-five percent of colorectal cancers are adenocarcinomas derived fromprecursor lesions adenoma. There are 15% -20% of cancers associated with viralinfections. Virus are suspected associated with colorectal cancer is the humanpapilloma virus (HPV) and the most common types are 16 and 18. Therelationship between HPV and colorectal cancer is still being debated. This studypurpose to determine the prevalence differences of HPV infection in colorectaladenomas and adenocarcinomas in the Department of Anatomic Pathology,FKUI/RSCM Jakarta by using the polymerase chain reaction (PCR). Materialsand Methods : HPV DNA examination on 33 cases of adenoma and 33 cases ofcolorectal adenocarcinoma by nested MY/GP PCR technique and electrophoresis.In the cases with positive HPV results, continue by specific primers HPV 16 andHPV 18 PCR. The subject of the study came from the Department of AnatomicPathology, FKUI/RSCM. Result : One (3.0%) adenomas and 3 (9.1%)adenocarcinoma from 33 cases adenoma and adenocarcinoma are HPV positive.One case of HPV positive adenomas are not types 16 and 18. HPV positiveadenocarcinoma, 1 case was type 16, two cases are combination of types 16 and18. Conclusion : The HPV prevalence in adenocarcinoma was higher thancolorectal adenoma. HPV types on positive colorectal adenocarcinoma cases aretypes 16 and 18.]"

"ABSTRACTA 20-year old man was admitted for evaluation of Cushings syndrome. He presented with a history of headache, fatique, mood disorder, hypertension (Blood Pressure 170/120 mmHg), moon face, buffalo hump, striae rubrae. Cortisol serum laboratory increased 33.53 µgr/dl (Normal range: 3.09 -16.6ugr/dl). Abdominal CT Scan showed a right adrenal mass diameter 10.53 x 6.83 cm, with calcified and necrotized area. Levels of ACTH < 5 pg/ml (Normal range : 6 - 50 pg/ml), absence hypothalamus pituitary defect in brain MRI angiography lead the primary site on adrenal. Patient was given ketoconazole 600 mg daily to treat hypercortisolemia. The patient underwent laparoscopic right adrenalectomy. Preparation of hydrocortisone 100 mg during anesthesia-surgery to prevent occurrence of adrenal crisis. Patient position was LLD, 11mm trocar port with 0, 30 degree optic, 2 port 5mm was used for working element. Harmonic ultrasoundshear was used for dissection, hemoLock clip to control vascular. Right subcostal incision make to remove adrenal gland. EBL 1000 cc, close monitoring in ICU ward. Hydrocortison was continued 5 days after surgery. Ventilatory support removed in 2 day after surgery. On the fifth day condition stable without signs of adrenal crisis, and the patient sent to elective ward. The pathology report revealed a cushing adenoma of adrenal gland. On the fifth day after surgical intervention, postoperative cortisol levels at 12 µgr/dl. On seventh day, surgical wound healing was well with minimum dose NSAID orally. Striae thining, ginecomastia, buffalo neck, moon face was reduced. The patient was regularly followed up at Endocrine division, Department of Internal medicine. Moon face have been eliminated, no striae and good mood condition. Blood pressure was 130/ 70 mmHg (without antihypertensive drugs) and cortisol serum was 4.52 µgr/dL and independent from steroid medication. Multidisciplinary approach including endocrine treatment, prevention adrenal crisis and laparoscopic adrenalectomy procedure have good result for Cushings syndrome due to adenoma of adrenal gland."

"Analisis praktik residensi keperawatan medikal bedah ini merupakan karya akhir ners spesialis. Analisis praktik residensi ini bertujuan memberikan gambaran pelaksanaan praktik resiensi, terutama pengelolaan berbagai kasus neurologi. Analisis ini terdiri dari kasus kelolaan utama menggunakan pendekatan model adaptasi Roy, penerapan evidence based nursing (EBN) dan proyek inovasi. Kasus kelolaan utama pada laporan ini adalah adenoma hipofisis. Pada kasus kelolaan diagnosa keperawatan diantaranya gangguan mobilitas fisik, Risiko ketidak efektifan perfusi serebral teratasi, dan pada 30 kasus resume diagnose terbanyak yaitu penurunan kapasitas adaptif intrakranial dan nyeri akut. Penerapan EBN yang dilakukan pada praktik residensi ini adalah tentang early removal catheter pada pasien paska kraniotomi, dan terbukti dapat menurunkan length of stay pasien paska kraniotomi. Pada praktik residensi ini residen juga menerapkan proyek inovasi dalam meningkatkan pengetahuan perawat untuk melakukan asuhan keperawatan pada pasien dengan pembedahan spinal, hasil penerapan inovasi ini menunjukkan terjadinya peningkatan pengetahuan perawat terkait asuhan keperawatan perioperative pada pasien pembedahan spinal. Banyak manfaat yang didapatkan dari praktik residensi yang telah dilakukan diantaranya latihan critical thinking dalam mengelola kasus sulit, melatih kemampuan kolaborasi dengan tenaga kesehatan lainnya, menerapkan asuhan keperawatan berbasis bukti. Perawat neurosains dapat menerapkan EBN dalam setiap intervensi keperawatan yang dilakukan, melatih kemampuan berfikir kritis dan kemampuan kolaborasi dengan tenaga kesehatan yang lainnya, sehingga kepuasan pasien terhadap pelayanan keperawatan semakin meningkat.

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This analysis of medical surgical nursing residency practice is the final work of specialist nurses. This residency practice analysis aims to provide an overview of the practice of residency, especially the management of various neurological cases. This analysis consists of the main managed cases using Roy's adaptation model approach, the application of evidence-based nursing (EBN), and the innovation project. In cases managed, nursing diagnoses included impaired physical mobility, the risk of ineffective cerebral perfusion was resolved, and in 30 cases the most resumed diagnoses were decreased intrakranial adaptive capacity and acute pain. The application of EBN in this residency practice is about early catheter removal in post-craniotomy patients and has been shown to reduce the length of stay of post-craniotomy patients. In this residency practice, the resident also implemented an innovation project in increasing the knowledge of nurses to perform nursing care for patients with spinal surgery, the results of the application of this innovation showed an increase in nurses' knowledge regarding perioperative nursing care for spinal surgery patients. Many benefits have been obtained from the residency practice that has been carried out including critical thinking exercises in managing difficult cases, training in collaboration skills with other health teams, and implementation of evidence-based nursing care. It is expected for nurses, especially neuroscience nurses using EBN in every nursing intervention carried out, and practice critical thinking skills and collaboration skills with other health teams, so that patient satisfaction with nursing services will increase."

"Adenoma hipofise adalah tumor yang walaupun mempunyai gambaran histopatologi jinak, akan tetapi seringkali memberikan penampakan klinis yang tidak ringan. Penampakan klinis ini dapat merupakan efek dari adanya masa tumor, gangguan hormonal, atau keduanya. Disamping itu, tumor ini sering kali mengalami kekambuhan setelah terapi. Penanganan jenis tumor ini banyak mengalami kemajuan dengan adanya perbaikan baik teknik berbagai modalitas terapi yang digunakan yaitu pembedahan dan radiasi, maupun ditemukannya berbagai obat. Penanganan multimodalitas seringkali diperlukan dalam penanganan adenoma hipofise untuk mendapatkan hasil terapi yang optimal. Radiasi merupakan salah satu agen sitotoksik dengan menggunakan sinar pengion yang banyak digunakan dalam pengobatan adenoma hipofise bersama dengan modalitas terapi lainnya. Pemberian radiasi pasca pembedahan terbukti menurunkan angka kekambuhan (22-71% vs 8-23%) secara bermakna. Saat ini telah terjadi perkembangan yang pesat dalam teknik pemberian radiasi pada adenoma hipofise. Perkembangan tersebut didasari baik oleh perbaikan pengetahuan dalam bidang teknologi komputer dan peralatan radiasi, maupun oleh berkembangnya pengetahuan dalam bidang biologi seluler maupun molekuler baik jaringan sehat maupun tumor. Tujuan untuk mengembangkan teknik dan metode radiasi adalah supaya mendapatkan dosis radiasi yang tinggi dan homogen di daerah target radiasi dengan dosis serendah mungkin pada jaringan sehat di sekitarnya. Dengan berbagai perkembangan ilmu pengetahuan maupun teknologi, khususnya sehubungan dengan ilmu komputer, maka terjadi perkembangan dalam metode maupun teknik radiasi. Makalah ini membahas berbagai aspek penggunaan radiasi yang mutakhir dalam penanganan adenoma hipofise.

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The Role of Irradiation in Hypophyseal Adenoma. Pituitary adenomas are histopathologically benign, however the clinical presentations are often quite severe. These clinical signs are due to the tumor mass effect, hormonal disturbances or both. Besides that, these tumors often recurred after treatment. The treatment of pituitary tumors have developed greatly with the improvement of techniques of several modalities such as surgery, radiation and medication. Multimodality treatment is often used for optimal results in treating these tumors. Radiotherapy is a cytotoxic agent using ion radiation for the treatment of pituitary tumors in combination with other methods. Post-surgical radiotherapy has shown to decrease the recurrence rate significantly (22-71% vs 8-23%). At present there has been rapid improvements in radiation techniques for pituitary tumors. These developments are not only based upon the increase of know-how in computer technology and radiation instruments, but are also based upon the development of cellular and molecular biology in connection with normal and tumor tissues. The objective in developing radiation methods and techniques is to create a high radiation dose, homogeneous in the target area with low radiation dose in normal tissue. The development in science and technology, in particular concerning computer science, have created the development of radiation techniques and methods. This paper elaborates on several aspects of radiation in the treatment of pituitary tumors."

"Primary hyperaldosteronism is an adrenal abnormality in which there is some degree of autonomy of aldosterone secretion. We report a case of thirty three years old Javanese female presented with uncontrolled hypertension, muscular weakness, cramps and progressing shortness of breath during working for 6 years. She had history of hypertension since age 20. Her serum potassium level was always low that associated with inappropriate kaliuresis. Blood gas analysis revealed metabolic alkalosis. Sonography of the adrenal gland showed right hipoechoic architecture; CT scan of the abdomen confirmed an right adrenal tumor measured 4 cm in its greatest dimension. Endocrine evaluation revealed high plasma aldosterone concentration, suppressed plasma renin activity, aldosterone/renin ratio of 112 and confirmed the diagnosis of primary aldosteronism. She underwent unilateral adrenalectomy. Histopathological report from excised adrenal tumor were compatible to benign adrenocortical adenoma. The patient discharge home with well controlled blood pressure and normokalemia. No clinical symptoms was reported in follow-up."

"Berdasarkan pengalaman Departemen Bedah Saraf Fakultas Kedokteran Universitas Indonesia – Rumah Sakit Cipto Mangunkusumo (FKUI-RSCM), pasien datang berobat dengan durasi keluhan yang beragam untuk suatu diagnosis adenoma hipofisis. Sebagai rumah sakit pusat rujukan nasional, semua pasien adenoma hipofisis yang datang ke institusi kami merupakan pasien rujukan dari dokter spesialis mata, spesialis saraf, maupun dokter spesialis bedah saraf dari institusi lain. Adenoma hipofisis dapat menyebabkan keluhan visus, lapang pandang, dan keluhan-keluhan lain yang diakibatkan oleh gangguan hormonal. Beberapa penelitian telah menyatakan hubungan antara durasi keluhan dengan luaran klinis dengan hasil yang signifikan. Pada penelitian ini akan dicari hubungan antara durasi, yang dihitung mulai dari awal keluhan sampai dilakukan tindakan operasi, dengan luaran visus dan lapang pandang pada pasien adenoma hipofisis yang dilakukan operasi dengan pendekatan transnasal transfenoid. Penelitian ini merupakan penelitian restrospektif pada pasien adenoma hipofisis yang dilakukan tindakan operasi dengan pendekatan transnasal transfenoid antara tahun 2015-2017. Seluruh operasi dilakukan oleh spesialis bedah saraf di RSCM. Semua pasien pada penelitian ini mengalami penurunan visus dan penyempitan lapang pandang. Durasi antara onset sampai dengan dilakukan tindakan operasi dihitung dalam satuan bulan. Dilakukan pemeriksaan visus dan lapang pandang 1 hari sebelum operasi dan dalam 1 sampai 2 bulan pasca operasi. Penelitian ini juga menghitung volume tumor, presentase tumor yang diambil, dan perluasan tumor, tetapi tidak dapat dilakukan uji statistik karena dibutuhkan jumlah sampel yang lebih banyak. Tujuh puluh satu pasien dengan keluhan penurunan visus dan penyempitan lapang pandang dengan median usia 42 tahun (20-77 tahun). Terdapat 36 pasien berjenis kelamin laki-laki dan 35 pasien perempuan. Median durasi mulai dari onset sampai dilakukan tindakan operasi untuk keluhan penurunan visus dan penyempitan lapang pandang adalah sama yaitu 12 bulan (1-108 bulan). Tedapat perbaikan visus pasca operasi pada 50 pasien (40,5%), dengan median durasi onset sampai dilakukan tindakan operasi adalah 11 bulan (p=0,58). Pada pasien keluhan penyempitan lapang pandang didapatkan perbaikan klinis pada 48 pasien (67.6%), dengan median durasi onset sampai dilakukan tindakan adalah 12 bulan (p=0.01). Dari penelitian ini dapat ditarik kesimpulan bahwa terdapat hubungan bermakna secara statistik antara durasi onset sampai dilakukan tindakan operasi dengan luaran klinis lapang pandang. Perbaikan lapang pandang didapatkan pada pasien yang memiliki durasi onset sampai dilakukan tindakan operasi sampai dengan 12 bulan.

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Based on the experience of the Department of Neurosurgery, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital (FMUI-Cipto Mangunkusumo Hospital), patients came seeking treatment with varying duration of complaints for a diagnosis of pituitary adenoma. As a national referral center hospital, all pituitary adenoma patients who came to our institution were referred from ophthalmologists, neurologists, and neurosurgeons from other institutions. Pituitary adenomas can cause decrease of visual acuity (VA), narrowing visual field (VF), and other complaints caused by hormonal disorders.¹ Several studies have showed that the duration of complaints were related significantly with clinical outcomes.^2,3,4,5,6

In this study, we investigated the relationship between duration, which is calculated from the time of symptoms first appeared to the time of surgery, and outcome (visual field and visual acuity) in pituitary adenoma patients who underwent surgery via transnasal-transsphenoidal approach.

This study used retrospective design on pituitary adenoma patients who was performed surgery via transnasal-transsphenoidal approach between 2015-2017. All surgeries were performed by neurosurgeons at RSCM. All patients in this study experienced decreased VA and narrowing of the VF. The duration between symptoms’ onset and surgery was calculated in months. VA and VF examinations were performed 1 day before surgery and within 1 to 2 months postoperatively. This study also calculated the volume of tumor, the percentage of tumor removal, and the extent of tumor, but statistical tests cannot be carried out on these parameters because more samples are needed.

There were 71 patients with decreased visual acuity and narrowed visual field, consisted of 36 male and 35 female patients, with a median age of 42 years (20-77 years). The median length of duration of onset for both symptoms is the same, which was 12 months (1-108 months).

Fifty patients (40.5%) had improved VA postoperatively, with median duration of onset was 11 months (p = 0.58). Clinical improvement in VF was experienced in 48 patients (67.6%), in which the median duration of onset was 12 months (p = 0.01)

There was a statistically significant relationship between the duration of onset and the VF outcomes. Improvements in the VF were found in patients who underwent surgery up to 12 months after the time of onset."

"Adenoma merupakan jenis tumor jinak pada lapisan epidermis jaringan. Adenoma dapat berubah menjadi kanker ganas yang kemudian disebut Adenocarcinoma. Terdapat salah satu bentuk data biologi molekuler yang sedang berkembang saat ini, yaitu data ekspresi gen microarray. Microarray dapat digunakan untuk pendeteksian dan penelitian dalam bidang onkologi. Salah satu metode untuk mengolah dan menganalisis data ekspresi gen microarray adalah dengan biclustering. Dalam skripsi ini akan dilakukan implementasi salah satu metode biclustering pada data ekspresi gen microarray, yaitu dengan algoritma Binary Inclusion-Maximal. Algoritma akan diimplementasi pada data Adenoma kolon yang terdiri dari 7070 gen dengan 4 sampel sel adenoma dan 4 sampel sel normal. Implementasi tersebut membutuhkan waktu kurang dari 1 detik dan menghasilkan 22 bicluster yang terdiri dari 25 gen secara keseluruhan.

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Adenoma is a benign type of tumor in the epidermal layer of a tissue. Adenoma can turn into a malignant cancer which is then called Adenocarcinoma. There is a form of molecular biology data which is developing today, namely microarray gene expression data. Microarray can be use for detection and research in the field of oncology. One method for processing and analyzing microarray gene data is by biclustering. In this study the writer will be using one method of biclustering, the Binary Inclusion Maximal algorithm, and implement it on microarray gene expression data. The algorithm will be implemented on Colon Adenoma data consisting of 7070 genes with 4 adenoma cell samples and 4 normal cell samples. The implementation took less than one second and resulted in 22 biclusters composed of 25 genes."

"ABSTRACTPurpose: Duodenal adenoma and adenocarcinoma (AC) are rare tumors, and few studies have examined their genetic features. We aimed to determine the key genetic changes in duodenal adenoma and AC, and to clarify the possible involvement of the adenoma-carcinoma sequence in duodenal tumor carcinogenesis.Methods: Nineteen duodenal tumors collected by endoscopic mucosal resection or surgical resection were classified as AC, adenoma with high-grade dysplasia (HGD), or adenoma with low-grade dysplasia (LGD) per the World Health Organization tumor classification. When a tumor contained two or more components with different dysplasia grades, the highest grade was assigned as the tumor grade. Representative areas of these components with different grades were microdissected and evaluated by a genomic analysis. Mutational hotspots involving 50 oncogenes and tumor suppressor genes were analyzed by next-generation sequencing, and their association with the dysplasia grade was investigated.Results: We analyzed 27 tumor components of AC or adenoma, with 11 normal mucosal samples obtained from 19 patients with duodenal tumors. The most prevalent abnormality among 50 genes tested was the KRAS mutation, which was detected in 12/19 (63.2%) patients, followed by APC and TP53 mutations (47.4 and 36.8%, respectively). According to the tumor dysplasia grading of each component, KRAS mutations were found in 5/8 (62.5%) tumors with AC components, 6/9 (66.7%) tumors with HGD components, and 3/10 (30.0%) tumors with LGD components. TP53 mutations were found in 4/8 (50.0%) tumors with AC components, 3/9 (33.3%) tumors with HGD components, and 1/10 (10.0%) tumors with LGD components. APC mutations were found in 2/8 (25.0%) tumors with AC components, 6/9 (66.7%) tumors with HGD components, and 5/10 (50.0%) tumors with LGD components. Notably, an APC:T1556fs mutation was detected in six cases (31.6%), five of which were adenoma cases. Furthermore, STK11 mutations were confirmed in 2/8 (25.0%) AC cases and in 1/11 (9.1%) adenoma cases.Conclusion: APC:T1556fs and STK11 mutations found in duodenal adenomas/ACs highlight the importance of proteins encoded by these genes in tumor development. APC mutations were identified in duodenal adenomas more frequently than in duodenal ACs, which differed from the observations of typical adenoma-carcinoma sequences seen in colorectal cancer, suggesting the limited involvement of this mechanism in duodenal cancer development."

"Pendahuluan. Adenoma pituitari atau pituitary neuroendocrine tumor (PitNET)meliputi 10% hingga 15% dari seluruh tumor intrakranial. Sekitar 30%-40% pasienadenoma pituitari membutuhkan tatalaksana pembedahan. Dari pasien yangdilakukan operasi tersebut sekitar 25%-40% memiliki luaran yang kurang baikseperti menginvasi secara lokal, resisten terhadap terapi konvensional, memilikitingkat rekurensi yang tinggi serta dapat mengalami metastasis. Tujuan penelitianini untuk mengetahui apakah faktor-faktor klinikopatologi tertentu yaitu ukuranadenoma, tipe/ subtipe adenoma, sifat invasif, sifat proliferatif (Ki-67, mitosis, danp53), dan grade adenoma mempengaruhi luaran yang agresif pada adenomapituitari pasca operasi.Metode. Penelitian ini merupakan studi meta analisis dengan menggunakan sumberdata elektronik maupun pencarian manual. Studi-studi yang disertakan adalah studiobservasional. Pemilihan studi didasarkan pada strategi penelusuran literatur sesuaipanduan PRISMA dan kriteria eligibilitas yang telah ditentukan sebelumnya.Variabel bebas yang dinilai antara lain ukuran adenoma, tipe/ subtipe, sifat invasif,sifat proliferatif, ki-67, tingkat mitosis, p53, dan grade. Luaran yang dinilai adalahagresivitas pasca operasi yang terdiri atas rekurensi atau progresi. Penilaian kualitasdan risiko bias pada tiap studi terpilih mengunakan perangkat Newcastle OttawaScale. Analisis data dilakukan baik secara kualitatif maupun kuantitatif. Semuatahapan dalam penelitian ini dilakukan oleh setidaknya 2 peneliti.Hasil. Dari 736 studi awal yang terjaring terdapat 10 studi terpilih. Jumlah subjekpenelitian 2727 orang dengan 632 orang kasus. Durasi pemantauan berkisar antara3 hingga 11 tahun. Seluruh studi memiliki kualitas sedang hingga baik. Metaanalisis dilakukan pada masing-masing variabel bebas terhadap agresivitasadenoma pituitari pasca operasi dengan hasil ukuran adenoma ≥10mm dengan<10mm OR 1,79 (CI 1,29-2,48), tipe kortikotrof dengan non kortikotrof OR 1,91(CI 1,41-2,58), sifat invasif dengan non invasif OR 3,67 (CI 1,95-6,90), sifatproliferatif dengan non proliferatif OR 4,78 (CI 3,61-6,32), Ki-67 ≥ 3% dengan <3% OR 4,13 (CI 2,94-5,81), tingkat mitosis > 2 dengan ≤2 OR 3,91 (CI 2,74-5,57),p53 positif dengan negatif OR 1,92 (CI 1,28-2,90), dan grade 2b dengan non 2bOR 4,56 (CI 3,0-6,91).Simpulan. Faktor-faktor klinikopatologi tertentu yaitu ukuran adenoma, tipe/subtipe adenoma, sifat invasif, sifat proliferatif (Ki-67, mitosis, dan p53), dan gradeadenoma mempengaruhi luaran yang agresif pada adenoma pituitari pasca operasi.

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Introduction. Pituitary adenoma/ pituitary neuroendocrine tumor (PitNET)

comprise of 10% up to 15% of intracranial tumor. About 30%-40% of pituitary

adenoma patients need surgery. For those who have undergone surgery about 25%-

40% will have bad outcomes like locally invasive, resistant to conventional

treatment, high rate of recurrence, and malignant tendency. The aim of this study

was to determine whether certain clinicopathologic factors consisting of size, type/

subtype, invasiveness, proliferative (ki-67, mitotic rate, and p53), and grade

influenced the aggressive outcome of post-operative pituitary adenoma.

Methods. This meta-analysis study used electronic and manual data source.

Included studies were observational studies. Study selection was based to literature

searching strategy according to PRISMA guideline and predetermined eligibility

criteria. Independent variables reviewed were size, type/ subtype, invasiveness,

proliferative, ki-67, mitotic rate, p53, and grade. Outcome reviewed were postoperative

aggressiveness comprised of recurrence or progressive. Quality and risk

of bias assessment to each study included were based on Newcastle Ottawa Scale.

Data analysis was carried out both qualitatively and quantitatively. All stages in this

study were carried out by at least 2 reviewers.

Results. Of the 736 initial studies, 10 were selected. The number of research

subjects were 2727 people with 632 cases. The duration of monitoring ranged from

3 to 11 years. All studies had moderate to good quality. Meta-analysis were carried

out on each independent variable on the aggressiveness of post-operative pituitary

adenoma with the results were size ≥10mm vs <10mm OR 1,79 (CI 1,29-2,48),

corticotroph vs non-corticotroph OR 1,91 (CI 1,41-2,58), invasive vs non-invasive

OR 3,67 (CI 1,95-6,90), proliferative vs non proliferative OR 4,78(CI 3,61-6,32),

Ki-67 ≥ 3% vs < 3% OR 4,13 (CI 2,94-5,81), mitotic rate > 2 vs ≤2 OR 3,91 (CI

2,74-5,57), p53 positive vs negative OR 1,92 (CI1,28-2,90), and grade 2b vs non

2b OR 4,56 (CI 3,0-6,91).

Conclusions. Certain clinicopathologic factors consisting of size, type/ subtype,

invasiveness, proliferative (ki-67, mitotic rate, and p53), and grade influenced the

aggressive outcome of post-operative pituitary adenoma."

"ABSTRAK Latar belakang: Salah satu lesi prekursor terjadinya kanker kolorektal KKR adalah polip kolon. Polip hiperplastik PH masuk dalam kategori non neoplastik bersama polip inflamasi dan hamartoma. Sedangkan polip serrated PS dan adenoma konvensional masuk kedalam golongan polip neoplastik. World Health Organization WHO pada tahun 2010 memasukkan PH kedalam subtipe PS bersama dengan Sessile serrated adenoma SSA/P dan Traditional serrated adenoma TSA . Ketiga polip diatas harus dapat dibedakan secara morfologik, karena prognosis, terapi, serta survelain endoskopi yang berbeda. Beberapa penelitian terakhir mengemukakan Annexin A10 ANXA 10 dapat digunakan sebagai penanda SSA/P, untuk membedakannya dengan polip lainnya. Tujuan penelitian ini untuk mengetahui perbedaan ekspresi ANXA 10 pada PH, SSA/P dan Adenoma. Bahan dan cara kerja: Penelitian ini merupakan penelitian deskriptif analitik menggunakan desain potong lintang. Sampel terdiri dari 16 kasus PH, 16 kasus SSA/P dan 16 kasus adenoma konvensional. Dilakukan pulasan ANXA 10 dan penilaian dilakukan menggunakan H score. Hasil: Titik potong H score pada ekspresi ANXA 10 didapatkan pada 215,05 71,6 dengan sensitivitas 81,3 dan spesifisitas 81,2 . Ekspresi ANXA 10 tinggi didapatkan pada 13 kasus SSA/P dan 3 kasus PH, sedangkan pada 16 kasus adenoma konvensional umumnya memiliki ekspresi ANXA 10 yang rendah p < 0,001 . Kesimpulan: Terdapat perbedaan ekspresi ANXA 10 pada PH, SSA/P dan adenoma konvensional. Pulasan ANXA 10 berpotensi digunakan sebagai penanda untuk membantu mendiagnosis SSA/P.

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ABSTRACT Background One of precursor lesion of colorectal cancer CRC is colon polyps. Hyperplastic polyp HP is one of non neoplastic polyps category along with inflammatory polyp and hamartomas. While serrated polyps SP and conventional adenomas categorized as neoplastic polyp. World Health Organization WHO in 2010 divided SP into hyperplastic polyps HP , Sessile Serrated adenomas SSA P and Traditional Serrated adenomas TSA . We must be able to distinguish this polyps, because they have different prognosis, therapy and endoscopic surveillance. Several recent studies have suggested that Annexin A10 ANXA 10 can be used as a marker of SSA P, to distinguish it from other polyps. The aim of this study is to know the difference of expression of ANXA 10 on HP, SSA P and conventional adenoma.Materials and methods This was a cross sectional study with 16 cases of HP, 16 cases of SSA P and 16 cases of Adenoma. All cases stained by ANXA 10 antibody and evaluated using H score. Results The cut off point H score on ANXA 10 expression was obtained at 215.05 71.6 with 81.3 sensitivity and 81.2 specificity. High ANXA 10 expression was obtained in 13 cases of SSA P and 3 cases of PH, while in 16 cases of conventional adenomas were generally have low expression of ANXA 10 p "