Karsinoma Paru
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Karsinoma ParuOleh:Nurbaiti
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Pendahuluan95% berasal dari epitel bronkus (bronchogenic carcinoma)5% bronchial carcinoid, bronchial gland tumor, mesenchymal malignancies (fibrosarcomas, leiomyomas), lymphomasHamartoma
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Bronchogenic Carcinoma/ Bronchial Carcinoma (BC)>> negara industriUsia 55-65 th, := 2:1, 1/3 kasus penyebab kematian pada perokokPrognosis: 5 ysr : 14-45 %
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Patogenesis
- Lanjutan 4 klasifikasi besar BC: squamous ca, adenocarcinoma, large cell undiff.ca, small cell ca.Kepentingan terapi: Small cell lung cancer (SCLC) dan Non Small cell lung cancer (NSCLC)SCLC resposif kemo/dan radioterapi >
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Kalsifikasi WHO (2007)
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LanjutanPerbedaan genetik antara SCLC dan NSCLCSCLC : - mutasi pada gen Rb dan Tp53.- aktivasi p16/CDKN2ANSCLC: -mutasi pada K-RAS onkogen
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Etiologi BCNitrosamine Akumulasi beberapa kelainan genetik jar.normal jar.neoplasma
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Lanjutan
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Gejala klinisTimbul setelah terjadi penyebaran.Batuk kronis, suara serak, nyeri dada, superior vena caval synd, pericardial atau pleural effusion, atelektasis, pneumonia.
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Lanjutan Timbul gejala para neoplastic synd:HypercalcemiaSynd. ChusingSIADH (synd.inapropriated secretion of antidiuretic hormone)Neuromuscular snyd.Clubbing finger, hypertrofi pulmonary osteoarthropathyKelainan darah (tromboplebitis, DIC)
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Makroskopikhttp://images.google.co.id/imgres?imgurl=http://www.som.tulane.edu/classware/pathology/medical_pathology/New_for_98/Lung_Review/Lung_carcinoma/BronchogenicCA-gross.jpg&imgrefurl=http://www.som.tulane.edu/classware/pathology/medical_pathology/New_for_98/Lung_Review/Lung-19.html&usg=__1EI6vw1yFnCq91JMNH2sMZ26BdQ=&h=300&w=396&sz=61&hl=id&start=22&um=1&tbnid=vTHiaS7jnRjtoM:&tbnh=94&tbnw=124&prev=/images%3Fq%3Dbronchial%2Bcarcinoma%26ndsp%3D18%26hl%3Did%26sa%3DN%26start%3D18%26um%3D1
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Squamous Cell Carcinoma>>> pada bronkus, nekrosis sentral cavitas.Menyumbat bronkus atelektasis dan infeksi di bagian distal.
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Mikroskopikhttp://images.google.co.id/imgres?imgurl=http://www.ncbi.nlm.nih.gov/bookshelf/picrender.fcgi%3Fbook%3Dcomponc%26part%3Dch7%26blobname%3Dch7f9.jpg&imgrefurl=http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi%3Fbook%3Dcomponc%26part%3Dch7&usg=___q8WHOIl1NzucGunbZ9XMEfZTbQ=&h=323&w=474&sz=151&hl=id&start=23&um=1&tbnid=ZA4PrSKguIfwhM:&tbnh=88&tbnw=129&prev=/images%3Fq%3Dbronchial%2Bcarcinoma%26ndsp%3D18%26hl%3Did%26sa%3DN%26start%3D18%26um%3D1
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SC, FNAB
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SC, FNAB,IHC p63
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AdenocarcinomaPeripheral lung scar (scar carcinoma)Etiologi : Rokok??Mudah metastasisLesi precancer: atypical adenomatous hyperplasia (AAH)Adeno-carcinoma sequence
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Mikroskopikhttp://images.google.co.id/imgres?imgurl=http://www.ncbi.nlm.nih.gov/bookshelf/picrender.fcgi%3Fbook%3Dcomponc%26part%3Dch7%26blobname%3Dch7f9.jpg&imgrefurl=http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi%3Fbook%3Dcomponc%26part%3Dch7&usg=___q8WHOIl1NzucGunbZ9XMEfZTbQ=&h=323&w=474&sz=151&hl=id&start=23&um=1&tbnid=ZA4PrSKguIfwhM:&tbnh=88&tbnw=129&prev=/images%3Fq%3Dbronchial%2Bcarcinoma%26ndsp%3D18%26hl%3Did%26sa%3DN%26start%3D18%26um%3D1
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Bronchioloslveolar adenocarcinomahttp://images.google.co.id/imgres?imgurl=http://www.ncbi.nlm.nih.gov/bookshelf/picrender.fcgi%3Fbook%3Dcomponc%26part%3Dch7%26blobname%3Dch7f9.jpg&imgrefurl=http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi%3Fbook%3Dcomponc%26part%3Dch7&usg=___q8WHOIl1NzucGunbZ9XMEfZTbQ=&h=323&w=474&sz=151&hl=id&start=23&um=1&tbnid=ZA4PrSKguIfwhM:&tbnh=88&tbnw=129&prev=/images%3Fq%3Dbronchial%2Bcarcinoma%26ndsp%3D18%26hl%3Did%26sa%3DN%26start%3D18%26um%3D1
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Papillary Adenocarcinomahttp://images.google.co.id/imgres?imgurl=http://www.ncbi.nlm.nih.gov/bookshelf/picrender.fcgi%3Fbook%3Dcomponc%26part%3Dch7%26blobname%3Dch7f9.jpg&imgrefurl=http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi%3Fbook%3Dcomponc%26part%3Dch7&usg=___q8WHOIl1NzucGunbZ9XMEfZTbQ=&h=323&w=474&sz=151&hl=id&start=23&um=1&tbnid=ZA4PrSKguIfwhM:&tbnh=88&tbnw=129&prev=/images%3Fq%3Dbronchial%2Bcarcinoma%26ndsp%3D18%26hl%3Did%26sa%3DN%26start%3D18%26um%3D1
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Large Cell CarcinomaSel besar-besar, giant cell, spindel sel, anaplastik, mix. inti sel vesikuler, anak inti jelas, Membentuk pulau-pulau , struktur seperti kelenjar.Prognosis buruk.
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Large Cell Carcinoma
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Mikroskpikhttp://www.pathguy.com/lectures/large_cell_lung_cancer.jpg
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MIkroskopikhttp://images.google.co.id/imgres?imgurl=http://dermatology.cdlib.org/113/letters/urticaria-cancer/3.jpg&imgrefurl=http://dermatology.cdlib.org/113/letters/urticaria-cancer/de.html&usg=__wRmDJyV5Yl8YBTeN-csy9kBmAOY=&h=240&w=320&sz=36&hl=id&start=11&um=1&tbnid=_su7uGN0JUECRM:&tbnh=89&tbnw=118&prev=/images%3Fq%3Dbronchial%2Bcarcinoma%2Blarge%2Bcell%26hl%3Did%26sa%3DG%26um%3D1
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Mikroskpikhttp://images.google.co.id/imgres?imgurl=http://www.willroberts.com/lungcancer/image10.jpg&imgrefurl=http://www.willroberts.com/lungcancer/path.html&usg=__1oHW2VFqblFK6OWf4S7_6xUIH0I=&h=161&w=258&sz=15&hl=id&start=45&um=1&tbnid=hNXNbtQcSqjWDM:&tbnh=70&tbnw=112&prev=/images%3Fq%3Dbronchial%2Bcarcinoma%2Blarge%2Bcell%26ndsp%3D18%26hl%3Did%26sa%3DN%26start%3D36%26um%3D1
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Small Cell Lung CarcinomaGross: abu-abu pucat.Mikroskopik: sel bulat, sitoplasma sedikit, kromatin inti kasar. Nuklear moulding. Mitosis banyak ditemukan. Besar sel ~ 2x limfosit.Nekrosis >
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Small Cell Lung Carcinoma
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Mikroskopik
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SCLC, FNAB, thyroid transcription factor-1 [TTF-1] immunostain
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Prognosis NSCLC lebih baik dibanding SCLC
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Broncial CarcinoidBerasal dari sel kulchitskySel mengandung neurosecretori granulesBagian dari multiple endocrin neoplasiaDewasa muda (40 th)5% dari neoplasma paruAsimptomatik5 ysr 50-95%.
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Tipe bronchial carcinoidTypical Carcinoid - well differentiated carcinoma - Atypical Carcinoid - moderately differentiated carcinoma- Small Cell Carcinoma - poorly differentiated and- Large Cell Neuroendocrine Carcinoma - poorly differentiated
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Makroskopik >> tumbuh kearah lumen bronkusPolipoid atau berupa plak (collar button lesion).Batas tegas
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Makroskpik http://images.google.co.id/imgres?imgurl=http://www.lmp.ualberta.ca/resources/pathoimages/Images-C/000p038a.jpg&imgrefurl=http://www.surgical-pathology.com/atypical_carcinoid.htm&usg=__yrJe23dYT_hJ-nLPFUSXYCv55p4=&h=392&w=616&sz=117&hl=id&start=38&um=1&tbnid=95-fJ0HSURV5fM:&tbnh=87&tbnw=136&prev=/images%3Fq%3Dbronchial%2Bcarcinoma%2Bnuclear%2Bmoulding%26ndsp%3D18%26hl%3Did%26sa%3DN%26start%3D36%26um%3D1
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MikroskopikTerdiri dari kelompokan sel bergerombol, rosetteSel bulat uniformKromatin kasar, mitosis , pleomorfik, fokal nekrosis
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http://images.google.co.id/imgres?imgurl=http://www.lmp.ualberta.ca/resources/pathoimages/Images-C/000p038a.jpg&imgrefurl=http://www.surgical-pathology.com/atypical_carcinoid.htm&usg=__yrJe23dYT_hJ-nLPFUSXYCv55p4=&h=392&w=616&sz=117&hl=id&start=38&um=1&tbnid=95-fJ0HSURV5fM:&tbnh=87&tbnw=136&prev=/images%3Fq%3Dbronchial%2Bcarcinoma%2Bnuclear%2Bmoulding%26ndsp%3D18%26hl%3Did%26sa%3DN%26start%3D36%26um%3D1
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Atypical carcinoidhttp://www.lmp.ualberta.ca/resources/pathoimages/Images-C/000p038a.jpg
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Large Cell Neuroendocrine Carcinomahttp://images.google.co.id/imgres?imgurl=http://www.lmp.ualberta.ca/resources/pathoimages/Images-C/000p038a.jpg&imgrefurl=http://www.surgical-pathology.com/atypical_carcinoid.htm&usg=__yrJe23dYT_hJ-nLPFUSXYCv55p4=&h=392&w=616&sz=117&hl=id&start=38&um=1&tbnid=95-fJ0HSURV5fM:&tbnh=87&tbnw=136&prev=/images%3Fq%3Dbronchial%2Bcarcinoma%2Bnuclear%2Bmoulding%26ndsp%3D18%26hl%3Did%26sa%3DN%26start%3D36%26um%3D1
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AsbestosisPenyakit paru dikarenakan asbestos terhirup dalam jangka waktu lama.Terjadi setelah terekspos lama (10th) Pekerja industri paling beresikoTipe : amphibole/blue asbes (lurus dan tipis) : amphibole, chorocidolite, anthophyllite, tremolite, actinolite ; serpentine/white asbes (melengkung) : chrysolite
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LanjutanAsbestos dapat menyebabkan:pleural effusion Diffuse pleural thickening penebalan pleuraLung cancer perokok terekspos asbetos lebih beresiko. Malignant mesothelioma Pleural plaques
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PatogenesisSerat masuk ke alveoli aktivasi sistim imun inflamasi Inflamasi kronis makrofag merangsang pertumbuhan fibroblast fibrosis dinding alveolus menebal.
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Gejala klinisBatuk Dada sesak Nafas pendek
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Makroskopikhttp://images.google.co.id/imgres?imgurl=http://medlib.med.utah.edu/WebPath/jpeg1/LUNG083.jpg&imgrefurl=http://health-pictures.com/Asbestosis.htm&usg=__ICmDFK5Yp4ZXssaq4giu2a2_Av8=&h=331&w=504&sz=75&hl=id&start=1&um=1&tbnid=chLLx4FrcwJKvM:&tbnh=85&tbnw=130&prev=/images%3Fq%3Dasbestosis%2Blungs%26hl%3Did%26sa%3DN%26um%3D1
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Asbestosis
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Asbestos Bodyhttp://images.google.co.id/imgres?imgurl=https://courses.stu.qmul.ac.uk/smd/kb/pathology/introcoursepics/images/asbesbod.jpg&imgrefurl=https://courses.stu.qmul.ac.uk/smd/kb/pathology/introcoursepics/pathtes1.htm&usg=__kNmmXbJvKuvJZulea5hR3Ns-F9s=&h=604&w=800&sz=125&hl=id&start=41&um=1&tbnid=Z0GBKz_mgphaFM:&tbnh=108&tbnw=143&prev=/images%3Fq%3Dbronchial%2Bcarcinoma%26ndsp%3D18%26hl%3Did%26sa%3DN%26start%3D36%26um%3D1
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Asbestos Bodyhttp://images.google.co.id/imgres?imgurl=http://www.thompsonmechanical.ca/images/asbestos%2520in%2520lungs.gif&imgrefurl=http://www.thompsonmechanical.ca/asbestos.htm&usg=__UExgaY4LQx7FoHl6bdhWBwszJOg=&h=425&w=624&sz=114&hl=id&start=72&um=1&tbnid=zdr4JimyHGsBJM:&tbnh=93&tbnw=136&prev=/images%3Fq%3Dasbestos%26ndsp%3D18%26hl%3Did%26sa%3DN%26start%3D54%26um%3D1
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Malignant Mesotelioma>> dari pleura.>> pada individu terpapar asbes (50%), SV40 (?), negara industriInkubasi 25-40 th.Patogenesis??Gen yang terpengaruh: p16/CDKN2A, neurofibromatosis 2(NF2),
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Lanjutan
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Makroskopik
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Mikroskopik 3 tipe:EpitelioidSarcomatoidbiphasic
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Terima Kasih
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