a kuliah reprodmei2014

5/24/2018 A Kuliah Reprodmei2014

1/92

REPRODUKSI

LaboratoriumBagian Ilmu Patologi Klinik

Fakultas Kedokteran

UKRIDAMei 2014

Sanarko Lukman Halim

1


2/92

1. Fungsi Reproduksi

Fungsi reproduksi & kehamilan diatur oleh hormon-

hormon yang sangat kompleks:

Testis: Testosteron

Ovarium: Estradiol, Progesterone

Pituitary: Follicle Stimulating Hormone (FSH)Luteinizing Hormone (LH)

Hypothalamus: Gonadotropin Releasing

Hormone (GnRH)feed back

Placenta: Estrogens & Progesterone

2


3/92

Pada pria kalau sperma normal tidakperludiperiksa lebih lanjut hormonnya.

semen: cairan+spermatozoa.

Cairan ini pada pria harus alkalis karenaspermatozoa tidak bisa berenang pada suasanaasam.

Reproduksi diatur oleh hormon. Testosteron

pada pria dan wanita bermacam-macam Klinefelter syndrome mungkin bisa punya

anak karena masih ada sel sperma

3


4/92

Hormon ada feed back ke otak. Contohnya

thyroid hormon. Dia di stimulasi oleh thyroid

stimulating hormone. Kalau tyroxine sudah

cukup maka otak tidak memproduksi TSH lagi.Begitupula sexhormone.

Hipotalamus ada GNRH(gonadotropin releasing

hormone.) pada hiposfise anterior adaFSH(folicle stimulating hormone).

FSH dipakai juga oleh pria walau tidak ada folikel

4


5/92

Pada wanita menopause maka ovarium tidak

memprouksi estrogen karena mulai atrofi.

Estrogen disingkat E2.

E2 pada menopause>LH>>

Pada yabng mens nya tidak teratur diperiksa

FSH,LH dan E2 untuk tahu hormonnya.

5


6/92

Plasenta ada juga estrogen dan progesterone.

IgG bisa masuk pada plasenta. Sedangkan IgMtidak dapat melalui plasenta.

Pada bayi baru lahir kemudian ada penyakit,untuk tahu ini penyakit dr ibu atau anak makadiperiksa IgM. Kalau ada IgM brt infeksi pada

bayi. Ini penting untuk pengobatan. Pada bayi bila TSH tinggi maka T4 nya tidak

terproduksi. Begitu juga pada orang dewasa

6


7/92

The Pituitary-Gonad Axis

7


8/92

2. Evaluasi Laboratorium

Fungsi Reproduksi:

Pria:Analisa SpermaHasil normal pemeriksaan lanjut tidak perlu.Bila hasil abnormal:perlu evaluasi hormon: Testosteron, FSH, LH.

Indikasi disfungsi reproduksi wanita:

Haid menandakan ada ovulasi.

Amenore dan infertilitasEvaluasi laboratorium:hCG, prolactin, thyroid-stimulating-hormone (TSH),free-thyroxine(fT4), FSH dan LH.

8


9/92

Pada wanita tuba harus paten agar bisa hamil.

Jadi jika terjadi konsepsi, harus bisa ke uterus.

Jika tidak di uterus berkembangnya maka ini

dinamakan kehamilan ektopik. Ini bisa

berbahaya

9


10/92

Kasus ujian adalah infertilitas.

SOAL:

Perut membesar apa ini hamil ataukeganasan?

10


11/92

3. Disfungsi Reproduksi

Indikasi disfungsi reproduksi wanita:amenore, infertilitas

Evaluasi laboratorium:

hCG, prolactin , thyroid stimulating hormone

(TSH), free thyroxine (fT4)

FSH, LH, androgen

Lab tidak diperiksa semuanya. Tergantung

pengalaman dokter

11


12/92

4. Infertilitas primer Definition: One year of unprotected intercourse

without pregnancy

1: No previous pregnancies

2: Previous pregnancy (not necessarily live birth)

Fecundability: Probability of achieving pregnancywithin a menstrual cycle

20-25% for normally fertile couples

90% of couples should conceive within one year

10-15% of couples experience infertility

Assisted Reproductive TechnologyLaboratorium: Estradiol, Progesterone, hCG

12


13/92

Pada pasangan infertil pertama periksa

sperma pria. Kalau normal periksa wanita. Tapi

jangan terburu buru karena 15% pasangan

normal belum punya anak pada usiapernikahan 1 tahun

13

5 K h il


14/92

5. KehamilanIndikasi waktu ovulasi ditentukan dengan tes

urin LH surge ->kemungkinan hamil>>

Awal kehamilan ditentukan dengan tes hCG serum,yang meningkat sekali pada kelanjutan kehamilan.Serum >cepat dari urin. Biasanya pada praktek bayitabung.Untuk praktisnya urin -hCG periksa pd missmenstrual period

hari pertama tidak haid.Konsentrasi hCG yang sangat tinggi (pada

pengenceran urin 1: 200 positif) indikasiadanya mola hidatidosa yg bisa jd coriocarsinomaEclampsia/preeclampsia: (keadaan gawat)

hipertensi,proteinuri

tes protein urin 14


15/92

Dulu untuk menentukan masa subur denganmengukur suhu basal. Jika ada peningkatan inidisebut masa subur.

Sekarang ada LH surge. Kalau meningkat berarti

ada ovulasi HCG bisa dipakai untuk tumor marker juga

hCG ga boleh pada urin suhu lemari es danperiksa pada pagi karena konsentrasi palingtinggi.

Eklamsia dan preeklamsia kalau sudahmelahirkan gejala proteinuria hilang.

15


16/92

Operasi caesar itu perlu tahu golongan darah,

hb dan faktor resusnya.

Eklamsia: ada gangguan pada ginjal karena

proteinuria.

Pada bayi kuning itu bilirubin indirek dan pada

urin bilirubin negatif

16


17/92

6. Screening Birth Defect

Trimester pertama-kedua screening

birth defects: chromosomal aneuploidy,

neural tube defects(tulang belakang terbuka karena

kekurangan asam folat). Sindroma Down(kebanyakan

pada wanita usia >35 th. Tp usia muda juga bisa. Infant

stimulating progres-> jika diketahui beresikosyndromdown akan di th/ agar ga jadi syndrome down.)

7. Monitor fetal-hemolyticdisease dengan tes

kadar bilirubin cairan amnion.(bs meninggal karena

ginjal dan hati belom max fungsinya. dan akan timbul

hemoglobinuria)

8. Fetal-lung-maturity: estimasi surfactant paru cairan

amnion: rasio lecithin/sphingomyelin 17


18/92

Pada janin, jika sudah terjadi hemolitik, masihbisa hidup karena ibu bisa mengeliminasibilirubin yang tinggi dari janin. Biasanya di cairan

amnion bilirubin akan meningkat. Pemeriksaanini dinamakan amniosentesis.

Respiratory distress syndrome: kekurangansufaktan pada waktu lahir sehingga susah nafas

sehingga bisa terjadi gagal nafas. Ini terlaluspesialistik tetapi penting diketahui jika diundangkeluar negri bisa saja di tanya.

18


19/92

9. Toxemia of

Pregnancy(eklamsia)

Hypertensi

Proteinuria tes protein dalam urin

10. Preterm delivery risk

(melahirkan sebelum waktunya)untuk mengetahuinya periksa Fetal

fibronectin cervicalsecretions 19


20/92

Regulasi Reproduksi Pria

20


21/92

Pada pria yang tidak mau punya anak bisa di

vasectomi sehingga sperma tidak dapat keluar.

21


22/92

HormonesFollicle-stimulating hormone (FSH) stimulates

spermatogenesis

Interstitial Cell Stimulating Hormone (ICSH) stimulatesthe production of testosterone

testosterone stimulates the development of malesecondary sex characteristics & spermatogenesis.

Testosterone dipakai untuk penilaian laki2 padapraktek.

Terapi testosteron meningkatkan ca prostat

22
http://www.adoptionnetwork.com/birthmothers/default.aspxhttp://www.adoptionnetwork.com/birthmothers/default.aspx


23/92

Pengaturan Reproduksi Wanita

23


24/92

Ovarium ada 2 kanan dan kiri.

Telur hanya bisa dibuahi oleh 1 sperma.

Haid merupakan masalah yang kompleks karena

nilai hormonnya berlainan sehingga perludiketahui pada hari keberapa setelah haid atausebelum haid. Karena nilai rujukan tergantungpada hari keberapa.

LH tinggi->ovulasi.

Pada mau menopause lebih sulit karena haid gateratur maka nilai saja FSH LH dan E2 nya.

24


25/92

25


26/92

Haid

26

K h il


27/92

Kehamilan

27


28/92

Endometriosis: nyebabkan kehamilan terganggu.

Kehamilan extrauterine: sangat bahaya karenaperdarahan tidak baik sehingga bisa mati janin

nya. Ini tergantung oleh endometriosis. Darah yang

keluar waktu haid di dalem pelvis. Kalau adajaringan ikat bisa mengganggu patensi tuba.

hCG awalnya ningkat lalu ada fase plateu. Kalauterus meningkat ini mungkin molahidatidosaatau koriokarsinoma.

28

Plasenta


29/92

Plasenta

Interlocking fetal and

maternal tissues

Performs digestive,

respiratory, and

urinary functions for

the fetus

Materials exchangedacross membrane

that separates

bloodstreams Figure 44.13Pa e 79129


30/92

Latex Agglutination

30


31/92

Home Pregnancy Test Kits:PERHATIKAN KONTROL. KALAU KONTROL ga ada

BERARTI HASIL TIDAK DIPERCAYA

31

INTERPRETASI


32/92

INTERPRETASI

Negative ResultHCG is not present at detectableconcentrations

Positive ResultPregnancy

32

False Positives


33/92

False Positives

Drugs: Antiparkinsonian,anticonvulsants, phenothiazines.

Medical Conditions: Tumors, Recentcompleted pregnancy or miscarriage.Kalau ada abortus hCG jg masih +.

False Negativestoo early, Urine not at room temp.Medical Conditions: Tumors, Recent

completed pregnancy or miscarriage.False NegativesTesting too early,

Urine not at room temp. 33

Hormones and male reproductive function


34/92

Hormones and male reproductive function

FSH (Follicle stimulating hormone)

Targets sustentacular cells to promote

spermatogenesis

LH (leutinizing hormone)

Causes secretion of testosteroneand other

androgens

GnRH (Gonadotropin releasing hormone)

Testosterone

Most important androgen34

D fi i i I f tilit i


35/92

Definisi Infertilitas primer

Infertilitas adalah tidak adanya

kehamilan setelah hubungan suami-isteri selama satu tahun dengan teraturtanpa mengunakan kontrasepsi

Infertility affects 15-20% of couples, or 11million reproductive age people in the U.S.

35

F i Ut K l j P i /


36/92

Fungsi Utama Kelenjar Pria/Major Functions of Male Glands

1. 1. Activating spermatozoa

2. 2. Providing nutrients spermatozoa

need for motility

.33. Propelling spermatozoa and fluidsalong reproductive tract:

mainly by peristaltic contractions

.44. Producing buffers:to counteract acidity of urethral and

vaginal environments

36


37/92

Semen = Sperm + Secretions

Secretions from epididymis aid spermmaturation

Seminal vesicle secretes fructose and

prostaglandins Prostate-gland secretions buffer pH in

the acidic vagina

Bulbourethral gland secretes mucus

Servix ada yang memiliki antibodi terhadap

sperma.37


38/92

Pemeriksaan Dasar Analisa Sperma

The analysis must include:

Volume measurement:kalau vol dikit ga bisabuat hamil.

Concentration determination

Motility assessment: kalau dia ga bisa maju ga

sampai-sampai

Morphology assessment:ada yang kepalabesar

Anti-sperm antibody screen Identification of other cells:ada SDM,trichomonas,

leukosit

38

Indikasi Analisa Sperma


39/92

Indikasi Analisa Sperma

1. Assessment of fertility (2-3 samples; 7 days to

3 months - best 2 weeks)2. Forensic purposes (DNA): sekarang bisa

diperiksa DNA dari mukosa mulut jg.

3. Effectiveness of vasectomysamples 1 month apart negative.

Setelah disambung ulang sperma positif

4. Suitability donorfor artificialinsemination(untuk bayi tabung.)

39

Persiapan sampel


40/92

Persiapan sampelBy masturbation.

Requires a period of abstinenceprior(3 d)gaboleh ejakulasi selama 3 hari

Must be delivered warmto thelaboratory.sebaiknya di lab dikeluarkannya. Kalaudi negara dingin sperma dimasukin ke dalamjaket agar tidak mati semua.

Can either be produced on site.

Or at home if able to be delivered.2 samples usually needed.

Compared against the

WHO criteria. 40


41/92

Pengambilan Sampel Sperma 1/2

Name Period of abstinence - 2-7days

Time of collection + analysis recorded

Entire ejaculate and not coitus interruptus in a widemouth container

Delivered within 1 hour of collection

Avoid temperature extremes

Ejakulasi retrogard:karena kelainan otot, sperma masukvesika urinaria. Di urin terdapat sperma.

41


42/92

Pengambilan Sampel Sperma 2/2

If results of 2-3 assessments differ greatly,

additional samples must be analyzed.

If a sperm function test is to be performed, the

sperm must be separated from fluid within 1 hour

of ejaculation.

For vasectomy evaluation, only the presence of

sperm, viable or nonviable is enough.

42


43/92

Analisa Sperma meliputi pemeriksaan:

Makroskopik

Viscosity:dengan

jarum bisa dilihat

sampai berapa

tinggi ga putus coagulation +

liquifaction

volume

pH

Mikroskopik concentration/count

motility

morphology

viability

Motility &Viability must be

performed

within 1 - 2 hrs of

collection.koleksi ga boleh pake

kondom 43

P ik M k k ik


44/92

Pemeriksaan Makroskopik

Volume: in graduated cylinder to thenearest

0.1 ml or centrifuge tube free of

contamination. Viscosity: 5ml pipette or plastic pipette

normal, more viscous, very viscous

pH: important parameter of motility andviability 7.2-8.0; measured by

pH paper.

Lihat Petunjuk Pemeriksaan Praktikum

44



45/92


Semen is viscous, yellow grayish.

Forms gel-like clot immediately.

Liquefies completely in 5-60 minutes; this must

be complete before further testing (mix before

further testing).

Appearance: homogenous white-gray

opalescence.

Brown/red in hematospermia

less opaque if low sperm concentration

Dense white turbid if inflammation and high WBC

45

P ik ik k ik


46/92

Pemeriksaan mikroskopik Wet mount:

approximate count

sperm agglutination pattern

viability

motility

morphology

Preparation:

mix

drop on glass slide and apply coverslip

Important: volume (10ul) of semen and thedimensions of the coverslip (22x22) bestandard so that we have fixed depth (20um).

Observe 10-20 using 40x-60x

If number vary from field to field; not mixed46

Sel yang Terlihat


47/92

Sel yang Terlihat

Normally seen: Mature cells make up the greatest percentage of cells

Epithelial cells of genital tract: many in urethritis

Immature germ cells

WBC

Abnormally seen:

Gross bacteria

Trichomonas

Candida

47

Motilitas


48/92

Motilitas

While estimating count

No stain

Count 200 total sperm and then the motile

Calculate the percentage

>50% motile

48

Aglutinasi


49/92

Aglutinasi

Reported when motile sperm stick to each

other in a definite pattern.Head-head

Tail-tail

Head-tail

Immunological cause of infertility

Done on several HPF

49

Spermatozoon Structure


50/92

`

Spermatozoon Structure

Figure 19-4

DNA

50


51/92

51

Jumlah Sperma


52/92

Jumlah Sperma

Decreased:

vasectomy (should be 0 after 3-6 months) Varicocele(testis terjadi varises->suhu>>-

>sperma mati)

primary testicular failure (Klinefelters:makadisuntuk testosteron.)

secondary testicular failure

congenital vas obstruction retrograde ejaculation

endocrine causes (prolactinemia, lowtestosterone)

52


53/92

Common Descriptive Labels

Oligozoospermia(poor count)

Asthenozoospermia

(poor motility)

Teratozoospermia

(abnormal morphology)

Azoospermia

Sperm concentration


54/92

Ringkasan tentang infertilitas

From the above data, it seems that serumprogesterone for detection of ovulation,

hysterography for tubal patency and

semen analysisare the basic essential tests for

diagnosis of infertility.

54


55/92

Penyebab Infertilitas

Tubal pathology 35%

Male factor 35%

Ovulatory dysfunction 15%

Unexplained 10%

Cervical/other 5%

55


56/92

Sabar In normal young couples:

25% conceive after one month

70% conceive after six months

90% conceive by one year

Only an additional 5% will conceive in an

additional 6-12 months

56

Faktor Pria


57/92

Faktor Pria

Male partner should be evaluated simultaneously

with female

Causes of male infertility:

reversibleconditions (varicocele, obstructive

azoospermia)

not reversible, but viable sperm available (ejaculatory

dysfunction, inoperative obstructive azoospermia)

not reversible, no viablesperm (hypogonadism)

genetic abnormalities testicular or pituitary cancer

57

S C


58/92

Sperm Count

Decreased:

vasectomy (should be 0 after 3-6 months)

varicocele

primary testicular failure (Klinefelters)

secondary testicular failure

congenital vas obstruction

retrograde ejaculation

endocrine causes

(prolactinemia, low testosterone)

58

f


59/92

Limitations of the procedure :

Delayed examination of the specimen Collection in improper container

Exposure of the specimen to temperature

extremes during transport

Abnormally low sperm count allowing for

evaluation of less than 200 spermatozoa

Use of dirty or contaminated supplies

59

Nilai Rujukan/Reference Ranges


60/92

Nilai Rujukan/Reference Ranges

Volume 2.0-6.0 ml

pH 7.2-8.0 **

Count >20 million/ml

Total count > 40 million Morphology > 30% normal form

Viability > 75%(50% in other)

WBC< 1million/ml

RBC none**sperm cannot swim in acidic environments

60

Common Descriptive Labels


61/92

p

harus faham

Oligozoospermia

(poor count)

Asthenozoospermia

(poor motility)

Teratozoospermia

(abnormal morphology)

Azoospermia

Sperm concentration


62/92

Evaluasi fungsi Reproduksi Wanita

62


63/92

Menopos: FSH & LH E2

Tes hormon wanita perhatikan fase

haid

ADAM SyndromeAndrogen Deficiency in the Aging Mananalog dengan Andropause

63


64/92

Uji Tapis Sindroma Down

Screening sebelum usia kehamilan 20 mg

Trimester pertama antara mg 12-13:diperiksa

-subunit hCG &plasma associated plasma protein (PAPP-A)

fetal chromosomal abnormalities.Ambil darah bisa dari umbilikus sekarang.

64


65/92

Clinical Features

Central hair whorl (cowlick)

Flat occiput (back of the head)

Upslanting eyes

Epicanthal folds (folds around the corner of the eye)

White spots in the iris of the eye (Brushfield spots)

Upturned nose

65

Uji Tapis NTD


66/92

Uji Tapis NTD

Neural Tube Defects

Malformasi kongenital yg sering terlihatUSA 1 per 1000 kehamilan

NTD kegagalan menutupnya neural tube pd hari

ke 27 selelah konsepsi

Di USA pada trimester kedua diperiksa

Serum -fetoprotein (MSAFP)

Diperiksa pada trimester 2

66


67/92

Example of Closed Unrepaired NTD

67


68/92

Erythroblastolis Fetalis

Hemolisa darah fetus : aneminormoblastic

hyperplasia normoblastik (erythroblastosis)

kurang oksigen->gagal jantung-hydrops

intrauterine death

Hemoglobinunconjugated bilirubin

cairan amnionspectral analysis 450 nm

Hydrops bisa terjadi pada thalasemia juga.

68


69/92

BIL>26uG akan merusak otak. Normal pada

hari ketiga ada peningkatan tp kl lebih dari

rujukan dinamakan kern ikteris

69


70/92

Gestational Diabetes

Intoleransi glukosa pada ibu hamil .

( Lihat kuliah tentang Diabetes)

Diagnosa dan terapi segera utk

mencegahkomplikasi pada ibu dan janinseperti eclampsia, fetal congenital

malformation, fetal makrosomia .

70


71/92

Fetal Lung Maturity

Fetal Lung maturity produksi surface activephospholipid compound yg disebut surfactant.

Effective gas exchange

Prevent alveolar collapsDefisienRespiratory Distress Sydr(RDS)

Lecithin/sphingomyelin ratio ( L/S test)

71

Preeklampsia/Toxemia of Pregnancy


72/92

Preeklampsia/Toxemia of Pregnancy

Preeclampsia adalah sindrome dengan

hipertensi (Sist >140 mm Hg, atau Diast > .90

mm Hg) dgn proteinuria > 0.3 g/l urin 24 jam

pada kehamilan > 20 minggu.

72


73/92

Infeksi pada Kehamilan

Infeksi viral, bakterial dan parasit berpengaruhpada kesehatan ibu dan janin. (Lihat kuliahmirobiologi, penyakitKulit Kelamin, parasitologi).

HIV, virus hepatitis (A, B,C), virus rubela, virusvarisela, virus sitomegalo, klamidiatrakhomatis, group B streptococcus, Neisseriagonorrhoeae, sifilis, tuberculosis,toksoplasmosis dan malaria .

73


74/92

Kelainan Hematologi/Koagulasi

Kelainan hematologi dapat berpengaruh

buruk pada ibu dan janin.

Ibu anemi: nutrisional, hemoglobinopati(talasemia), trombositopenia, trombotik

trombositopenia,

Koagulopati ibu (DIC, penyakit von

Willebrand)

74


75/92

Causes of female infertility

Pelvic factor 50%

Ovulary disorder 30%

Other 15%

Immunology factor 5%

75

Thyroid disease and infertility


76/92

Thyroid disease and infertility

Hypothyroidism

Pre-pubertal

Delayed sexual maturation, or rarely,

precocious puberty Post-pubertal

TSH may have leuteotropic effect

Hyperthyroidism

Amenorrhea

76

Endometriosis


77/92

Endometriosis

Appearance of endometrial tissue in the

pelvic cavity.

Origin is uncertain

One of the most common diseases of

menstruating women

Involved in 20-50% of infertility cases

77

Anti-sperm autoantibodies


78/92

p

1955: Rumke and Hellinga demonstrate association

between humoral autoantibodies to sperm andunexplained infertility

Results were controversial, and hampered by inadequateanalytical techniques

Humoral antibodies do not effect fertility unless theyexist in the reproductive tract

Antibodies must be demonstrated on the spermsurface

78

ff f b d


79/92

Effect of sperm autoantibodies

Spontantous agglutination

Motility/penetration

Binding to tail

Disruption IgG mediated complement fixation (tail)

Seminal fluid contains complement inhibitors, somembrane attack occurs in the femalereproductive tract

79


80/92

Anti-sperm antibodies in the female

Clinically significant only in high titers (in serum)

Anti-sperm antibodies may exist in vaginal

secretions or cervical mucus even when humoral

antibodies are not detected

80

f l d f l


81/92

Diagnosis of immune-related infertility

Post-coital test

Evaluates sperm viability in the cervical mucus

Humoral antibodies

Not diagnostic

Demonstration of antibodies on the sperm

surface

81

Desirable characteristics of tumor


82/92

Desirable characteristics of tumor

markers

Easy to measure

Specific for tumor

Always present with tumor

Tapi tidak spesifik dan tidak dianjurkan

pada pasien tanpa gejala

82

T f


83/92

Test performance

The sensitivity is 98.0%The specificity is 85%

Liver cancer has anincidence of 1.5:100,000

83

U f k


84/92

Use of tumor markers

Screen for disease???

Diagnosis of symptomatic patients

Staging

Prognostic indicators

Detect recurrence of disease

Monitoring response to therapy Radioimmunolocalization

84

P t t


85/92

Prostate cancer

2ndmost common cancer (19%), and 2ndleading causeof cancer death, in men

Sensitivity of PSA (at 4.0 g/L) is 78%; specificity isapproximately 33%.

PSA concentration correlates with clinical stage ofcancer

PSA is used to monitor therapy

Meningkat juga pada BPH. Makanya klinis berperan.Kalau cancer meningkat tinggi sekali bisa 500-1000

Prostate-specific antigen

85

hCG


86/92

hCG

Awal kehamilan Glycoprotein secreted by the syncytiotropoblastic

cells of the placenta

subunit is shared with LH, FSH, TSH subunit is specific to hCG

Assays can measure intact (sandwich) or bothintact and subunit Cancer patients produce both intact hCG and

subunit

86

Use of hCG


87/92

Use of hCG

EarlyPregnancy

Elevated with virtually all trophoblastic tumors C/P Hyatidiformmole

Choriocarcinoma

Elevated in 70% of nonseminomatous testiculartumors

87

Alpha-Fetoprotein


88/92

Major fetal protein (70 kd glycoprotein) Synthesized in the yolk sac, fetal liver, GI tract, kidney

Structurally related to albumin

Used as a marker for neural tube defects

Moderate elevations in liver disease(hepatitis/cirrhosis)

Concentrations >1000 g/L are associated withhepatocellular carcinoma

Lower cutoff is used for screening 88


89/92

Carcinoembryonic antigen

Family of up to 36 large, cell-surfaceglycoproteins

Elevated in . . .

70% of colorectal cancers

45% of lung cancers

50% of gastric cancers

40% of breast cancers 55% of pancreatic cancers

25% of ovarian cancers

40% of uterine cancers

89

U f CEA


90/92

Use of CEA

Elevated in non-malignant conditions:

Cirrhosis, emphysema, rectal polyps, benignbreast disease, ulcerative colitis

Most useful in staging and

monitoring recurrence ofdisease

90

B t


91/92

Breast cancer

Most common malignancy in U.S. women(7% of women develop breast cancer by age

70)

Episialinis expressed by mammaryepithelium

CA 15-3, CA 549, and CA 27.29 arethree distinct epitopes on episialin

91

CA 125


92/92

High MW glycoprotein recognized Isolated

from a serous ovarian tumor

Elevated in 50% of stage I ovarian cancer

Elevated in 90%+ of stage II, III, and IV

Overall, sensitivity 95%; specificity 82%; PPV78%; NPV 91%.

Pada Ca ovarium bisa untuk prognosis darikeganasan jika sudah di terapi. Jika timbullagi maka berarti ada kekambuhan.

a kuliah reprodmei2014

Documents