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Abstrak :
Latar Belakang: Karsinoma tiroid papiler (KPT) adalah salah satu bentuk paling umum dari keganasan pada tiroid di dunia. Di Indonesia, ditemukan bahwa dari semua keganasan tiroid, KPT menyumbang 83% dari semua kasus, serta menyumbang 61% dari semua kasus nodul tiroid. Namun secara luas, etiologi sebagian besar kasus masih belum diketahui dan tidak memiliki etiologi spesifik. Varian ini dapat dibagi menjadi dua jenis, yaitu varian agresif dan non-agresif. Metastasis kelenjar getah bening juga dapat terjadi pada beberapa kasus KPT, dengan penelitian menunjukkan bahwa 50-60% kasus metastasis kelenjar getah bening terjadi. Pasien dengan KPT dan metastasis kelenjar getah bening (KGB) juga terbukti memiliki prognosis yang lebih buruk dibandingkan dengan pasien tanpa metastasis KGB. Penelitian ini bertujuan untuk mengetahui profil klinikopatologi KPT dan hubungannya dengan metastasis KGB. Metode: Penelitian ini merupakan penelitian deskriptif analitik dengan menggunakan metode retrospektif dengan menggunakan data sekunder dari rekam medis dan arsip pasien dari Departemen Patologi Anatomi FKUI-RSCM yang telah didiagnosa KPT dari periode Januari 2014 hingga Desember 2018. Hasil: Penelitian ini menemukan bahwa terdapat perbedaan antara varian agresif dan non-agresif dalam kejadian metastasis KGB (p = 0,001). Selain itu, jenis kelamin pasien menunjukkan perbedaan yang signifikan secara statistik untuk kejadian metastasis KGB di KPT (p = 0,001). Selain itu, ukuran tumor menunjukkan perbedaan kejadian metastasis KGB yang signifikan secara statistik di PTC (p=0,026). Selanjutnya, invasi jaringan lunak menunjukkan kejadian metastasis KGB yang signifikan secara statistik di KPT (p = 0,001). Penelitian ini juga menemukan bahwa tidak ada perbedaan yang signifikan antara usia, ukuran tumor, atau invasi limfovaskular pada kejadian metastasis KGB pada kasus KPT. Kesimpulan: Studi menunjukkan bahwa jenis kelamin, varian, ukuran tumor, dan invasi jaringan lunak pada pasien KPT menyebabkan peningkatan risiko terjadinya metastasis KGB. Penelitian di masa depan dapat menggunakan studi longitudinal prospektif untuk melacak data penting dari pasien dengan lebih baik. ......Introduction: Papillary thyroid carcinoma (PTC) is one of the most common forms of malignant thyroid in the world. In Indonesia, it is found that out of all thyroid malignancies, PTC accounts for 83% of all the cases as well as accounting 61% of all thyroid nodule cases. Broadly though, the etiology of most cases remains unknown and does not have a specific etiology. The clinicopathological characteristics of PTC consists of age, sex, tumor size, lymphovascular invasion, soft tissue invasion, and variant of the PTC. Lymph node metastasis (LNM) may also occur in some cases of PTC, with research showing that 50-60% of LNM cases occurring. Patients with PTC and LNM have also shown to have a worse prognosis compared to their counterparts without LNM. This study aims to find the clinicopathological profile of PTC and its association with the LNM. Methods: This research is a descriptive analytical research using a retrospective method using secondary data from medical records and patient archives from the Department of Anatomical Pathology FKUI-RSCM that had been diagnosed with PTC from a period of January 2014 to December 2018. Results: This study found that there are differences between aggressive and non-aggressive variants in the occurrence of LNM (p =0.001). In addition, the sex of the patient and tumor size showed statistically significant differences for LNM occurrences in PTC (p = 0.001 and p=0.026, respectively). Furthermore, soft tissue invasions showed statistically significant differences of LNM occurrences in PTC (p = 0.001). This study also found that there were no significant differences of age or lymphovascular invasion in the occurrence of LNM in cases of PTC. Conclusion: The study shows that the sex, variant, tumor size, and presence soft tissue invasion in patients with PTC are associated with the increased risk of LNM occurrence. Future research may use prospective longitudinal studies to better keep track of essential data from patients.

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ABSTRAK
Biomarka untuk memprediksi metastasis KGB lokoregional sampai saat ini belum akurat. Angka metastasis tersamar pada karsinoma laring bervariasi yaitu 165%. Dibutuhkan biomarka tumor yang dapat memberikan informasi adanya metastasis KGB lokoregional pada pasien KSS laring stadium lanjut tanpa keterlibatan KGB lokoregional (N0), sehingga diharapkan menjadi acuan untuk dilakukan diseksi leher selektif. Beberapa biomarka yang berhubungan dengan agresivitas dan prediksi metastasis yaitu Epidermal Growth Factor Receptor (EGFR), Matrix Metallo-proteinase (MMP)-9, Tissue Inhibitor Metallproteinase (TIMP)-1, Vascular Endothelial Growth Factor (VEGF), Epithel Calcium Adhesi (Ekaderin) dan kolagen tipe IV serta HPV dapat digunakan untuk memprediksi luaran pada status pasien tumor dengan dan tanpa metastasis. Penelitian ini ingin memeriksa peran infeksi HPV sebagai faktor onkogenesis dan kejadian metastasis KGB leher pada keganasan laring berdasarkan biomarka sebagai penetapan diagnosis metastasis KGB lokoregional. Dilakukan Cross-sectional, double blind study dengan pengumpulan data sekunder dari rekam medis di Departemen THT-KL FKUI-RSCM. Pemeriksaan ekspresi biomarka dan status HPV dilakukan terhadap jaringan berupa blok parafin dari pasien karsinoma laring Ekspresi biomarka dilakukan dengan pemeriksaan imunohistokimia, dan identifikasi virus HPV dengan nested PCR, dilanjutkan dengan flow-through hybridization. Didapatkan proporsi HPV KSS laring sebanyak 28,7% dengan infeksi HPV risiko tinggi sebanyak 9,15% dan HPV 16 merupakan tipe yang terbanyak. Analisis multivariat Mantel-Haenszel didapatkan ekspresi tinggi biomarka EGFR, MMP-9 dan VEGF berperan terhadap kejadian metastasis KGB pada KSS laring stadium lanjut tanpa infeksi HPV dengan OR 3,38; 5,14. Keadaan tersebut tidak berperan lagi bila terdapat infeksi HPV Dari penelitian ini didapatkan suatu algoritma penatalaksanaan KSS laring stadium lanjut khususnya untuk penentuan tatalaksana diseksi leher pada N0. Infeksi HPV didapati pada KSS laring stadium lanjut, HPV 16 merupakan tipe HPV yang terbanyak. Biomarka penanda metastasis didapatkan pada EGFR; MMP-9; VEGF dengan kekuatan 2;1;6.

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ABSTRACT
Biomarkers to predict locoregional lymph nodes metastasis is not yet accurate until now. The number of occult metastasis in laryngeal carcinoma varies between 165%. A tumor biomarker that can give information on the existence of locoregional lymph node involvement in patients with or without signs of clinical locoregional lymph node involvement, as guidelines whether selective neck dissection is needed in N0 cases. For patients that need additional treatment biomarkers that are correlated with aggresivity and metastasis prediction such as EGFR, MMP-9, TIMP-1, VGEF, E-cadherin, collagen Type IV and HPV are also needed to predict the outcome of patients with or without lymph node metastasis. This study aimed to investigate the evidence of HPV infection in laryngeal carcinoma and the role of biomarkers EGFR, MMP-9, TIMP-1, VEGF, E-cadherin and collagen type IV, in a late stadium laryngeal SCC observed clinically, especially in N0 and also to predict diagnosis of a locoregional lymph node that has potential for metastasis. Cross-sectional, double blind study with planned data collection was performed in the Department of ENT FKUI-RSCM. Data were taken from Formalin Fixed Paraffin Embedded (FFPE) of laryngeal cancer specimen after laryngectomies. Samples were analysed by nested Polymerase Chain Reaction (PCR) and continuous flow-through hybridizationed for genotyping. Expression of EGFR, MMP-9, TIMP-1, VEGF, Ecadherin, and collagen Type IV as metastasis biomarker were evaluated by immunohistochemistry. Overall HPV proportion in laryngeal cancer was 28.7%. A total of 9,15% laryngeal cancer patients were infected with high risk HPV type and HPV 16 was the most frequently observed. Mantel-Haenszel multivariate analysis found that HPV infection did not play role in neck metastasis eventhough there were positive evidence of metastasis biomarker. In contrast, the absent of HPV infection, positif metastasis biomarker of EGFR and VEGF have risk for neck nodes metastasis with OR 3.38; 5.14 fold consecutively. The algorithm was formed from the PM model to determine the metastasis potential to locoregional lymph nodes of late stadium laryngeal SCC with N0. HPV was found to be the oncogenic factor of the laryngeal SCC and HPV 16 was the most frequently observed type in laryngeal SCC. Biomarkers to predict locoregional lymph nodes metastasis are EGFR; VEGF with strenght 2;1;6.

Abstrak :
Frozen section library : lymph nodes highlights the usefulness of techniques such as touch preparation cytology and fine needle aspiration (FNA) cytology, as well as FNA biopsy. This fascicle also suggests proper handling for subsequent ancillary studies, including flow cytometric, cytogenetic, and molecular studies. Special emphasis is given to the limitations of frozen section diagnosis in lymph node pathology. All chapters are written by experts in their fields and include the most up to date scientific information. This book serves as a very useful resource for physicians in the frozen section room and in intra-operative consultation situations dealing with, and interested in, this very complex field of diagnostic pathology. Frozen Section Library: Lymph Nodes is of great value to pathologists, residents, and fellows who diagnose pathologic processes involving lymph nodes.