ABSTRAK
Latar Belakang :Karsinoma kolorektal (KKR) merupakan salah satu kanker tersering di duniadan menjadi beban kesehatan global. KKR dapat muncul melalui 4 jalur patogenenis yangberbeda, salah satu di antaranya adalah serrated pathway. Pengaktifan jalur ini mengakibatkanperubahan progresif lesi-lesi prekursor seperti polip serrated, termasuk di dalamnya sessileserrated adenoma (SSA) dan tradisional serrated adenoma (TSA), menjadi karsinoma,diantaranya adenokarsinoma serrated (AS). AS diduga memberikan prognosis yang burukterhadap pengobatan. Gambaran histomorfologi adenokarsinoma serrated lebih banyakdidasarkan pada kemiripan dengan lesi prekursor SSA atau TSA, sehingga sulit dikenali.Penelitian ini bertujuan mengetahui persentasi AS diantara kasus KKR di Departemen PatologiAnatomik FKUI/RSCM, dan mengetahui gambaran histomorfologi yang bermakna dalammenandakan AS.Bahan dan Metode :Dilakukan review slide dari kasus-kasus KKR yang tercatat di arsipDepartemen Patologi Anatomik FKUI/RSCM. Penilaian histomorfologi dilakukan berdasarkankriteria yang diajukan oleh Tuppurainen et al, meliputi epithelial serration, sitoplasmaeosinofilik, inti vesikuler, anak inti nyata, nekrosis, produksi musin, dan adanya cell balls. Kasusdikategotikan ke dalam ?Pasti? dan ?Samar? AS, serta ?Klasik?. Dilakukan juga penilaian faktorprognostik, berupa invasi limfovaskular, invasi perineural, infiltrasi limfosit, dan tumor budding.Hasil :Didapatkan 41 kasus (35%) tergolong kategori ?Pasti? AS, 11 kasus (9.4%) tergolong?Samar? AS, dan sisanya sebanyak 65 kasus (55.6%) tergolong kategori adenokarsinoma?Klasik?. Didapatkan pula bahwa kriteria histomorfologi yang dapat dijadikan penanda serratedadalah epithelial serration (p=0.029), anak inti nyata (p=0.041), dan nekrosis <10% (p=0.014).Selain itu, didapatkan pula bahwa faktor-faktor yang berhubungan dengan morfologi serratedadalah yaitu lokasi tumor (p=0.010), infiltrasi limfosit (p=0.000), dan tumor budding (p=0.012).Kesimpulan :Adenokarsinoma serrated ditemukan 35% dari kasus-kasus adenokarsinoma kolondi Departemen Patologi Anatomik FKUI/RSCM. Gambaran histomorfologi yang menandakanadenokarsinoma serrated adalah adanya epithelial serration, anak inti nyata, dan nekrosis yangsedikit.Kata Kunci :Adenokarsinoma serrated, serrated pathway, histomorfologi, karsinomakolorektal.
ABSTRACT
Background: Colorectal carcinoma (CRC) is one of the most common cancers in the world andbecome a global health burden nowadays. CRC may arise through 4 different pathways, one ofwhich is serrated pathway. Activation of this pathway results in progressive changes of precursorlesions such as sessile serrated adenomas (SSA) and traditional serrated adenomas (TSA), intocarcinoma. One type of carcinomais serrated adenocarcinoma (SA), in which known to give apoor prognosis to patient. Histomorphology overview shows that SA has similarity with SSA orTSA, making it difficult to recognize. This study aims to determine the percentage of the SAamong cases of CRC in Department of Anatomical Pathology Faculty of Medicine UniversitasIndonesia/Cipto Mangunkusumo Hospital, and to know histomorphological features that aremeaningful in indicating SA.Materials and Methods: CRC cases were collected from archive, and review slide wasconducted using morphological criteria proposed by Tuppurainen et al. This criteria includesepithelial serration, eosinophilic cytoplasm, vesicular nuclei, prominent nucleolei, necrosis,mucin production, and cell balls. Case were categorized into the "Definite" and "Pausy" SA, aswell as the "Classic". Assessment of prognostic factors, such as limfovascular invasion,perineural invasion, infiltration of lymphocytes and tumor budding, were also conducted.Results: There were 41 cases (35%) belong to the category of "Definite" SA, 11 cases (9.4%)classified as "Pausy? SA, and 65 cases (55.6%) belong to the category of "Classic"adenocarcinoma. Histomorphological analysis found that criteria showing significancy to SAwere epithelial serration (p = 0.029), prominent nucleolei (p = 0.041), and necrosis <10% (p =0.014). Several factors showed relation to serrated morphology were location of the tumor (p =0.010), infiltration of lymphocytes (p = 0.000), and tumor budding (p = 0.012).Conclusion: Serrated adenocarcinoma were found approximately 35% among cases of colorectaladenocarcinoma in the Department of Anatomical Pathology, Faculty of Medicine/CiptoMangunkusumo Hospital. Histomorpoholigical features that indicates SA includesepithelial serration, prominent nucleolei, and scanty necrosis.Keywords: Serrated adenocarcinoma, serrated pathway, histomorphological features, colorectalcarcinoma |
