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presentasi referat GIST
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5/25/2018 Gastrointestinal Stroma Tumor (GIST)
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REFERAT
Pembimbing :Dr. Dendy Muhono,
Sp.Rad
Dr. Farid. W. Hafid,
Sp.Rad
Disusun Oleh :
D.S. Putri Nastiti
201210401011051
SMF RADIOLOGI
RSUD JOMBANG
FAKULTAS KEDOKTERAN
UNIVERSITAS
MUHAMMADIYAH MALANG
2014
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Gastrointestinal Stromal Tumors (GIST) 1% dari seluruh kasus tumor gastrointerstinal
Kasus tumor mesenkimal GIT yang paling
sering dijumpai
Lokasi anatomis GIST :gaster (60-70%)
Usus halus (20-25%)
colon dan rectum (5%)
esophagus (
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5000 kasus baru GIST terdeteksi di Amerika Serikat tiap tahun
Islandia, Belanda, Spanyol, dan Swedia : 6.5 sampai 14.5 kasusper 1 juta penduduk
Morbiditas, mortalitas, dan prognosis : tergantung pada
manifestasi klinis dan histopatologis tumor. Rata-rata 5 year
survival rate 28-60%.
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Vague, nyeri abdomen nonspesifik atau discomfort (paling
sering)
Perut terasa penuh atau sensation of abdominal fullness
Massa pada abdomen yang dapat terpalpasi (jarang)
Malaise, fatigue, exertional dyspnea disertai dengan
kehilangan darah signifikan Tanda of peritonitis lokal maupun generalisata (jika ada
perforasi)
Tanda dan gejala obstruktif GIST dapat bersifat spesifik,
tergantung lokasi tumor, antara lain : Dysphagia pada esophageal GIST
Konstipasi, perut kembung, abdominal tenderness pada
colorectal GIST
Obstructive jaundice pada duodenal GIST
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LABORATORIS :
Complete blood cell count
Coagulation profileSerum chemistry studies
BUN and creatinine
Liver function tests and amylase
and lipase values
Type and screen, type and
crossmatchSerum albumin
RADIOLOGIS :
Foto Polos Abdomen (kontras
nonkontras)
CT Scan
USG
MRIPET FDG
EUS
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Foto Polos Abdomen
(non nonkontras)
Nonspecific
May be part of an emergent workup
Abnormal gas patterns, including dilated loops of
bowel or free extraluminal air, may be seen with
bowel obstruction or perforation
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Frequently provides only limitedinformation
Can usually detect GISTs that have
grown to a size sufficient to produce
symptoms
Barium swallow for patients with
dysphagia Barium enema for patients with
constipation, decreased stool caliber, or
colonic manifestations
GISTs appear as an elevated, sharply
demarcated filling defect
The overlying mucosa typically has asmooth contour unless ulceration has
developed
Barium and Air (double contrast)
series :
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CT Scan Abdomen dan Pelvis :
Irregular shape
Heterogeneous density
An intraluminal and extraluminalgrowth pattern
Signs of biological aggression,
sometimes including adjacent
organ infiltration
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Karakteristik CT scan pada tumor
dengan ukuran >10cm :
Irregular margins
Heterogeneous densities Locally aggressive behavior
Distant and peritoneal metastases
Kriteria CT Scan pada tumor dengan
high grade histology dan mortlaitas
tinggi :
Tumor larger than 11.1 cm
Irregular surface contours
Indistinct margins
Adjacent organ invasion
Heterogeneous enhancement
Hepatic or peritoneal metastasis
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Magnetik Resonance
Imaging
Seperti CT Scan, MRI dapat mendeteksi tumor
dan memeberikan informasi mengenai striktur
organ di sekitarnya
Dapat digunakan untuk mendeteksi adanya
tumor nultipel dan metastasis
Sedikit lebih jarang digunakan untuk penegakan
diagnosis GIST, tetapi memiliki tingkat
sensitivitas yang sama
GIST tampak hipointens pada pencitraan
dengan T2-weighted.
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Positron Emission Tomography Scanning dengan 2-[F-
18]-fluoro-2-deoxy-D-glucose :
Untuk mendeteksi metastasis
Monitoring respon pad aterapi ajuvan ( seperti imatinibmesilat )
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Allows localization of lesions and their characterization byultrasonography
Fine-needle aspiration biopsy specimens may be obtained under
sonographic guidance
GISTs typically appear as a hypoechoic mass in the layer
corresponding to the muscularis propria
Complementary with CT More accurate than CT in differentiating benign from malignant
lesions
Allows a more comprehensive evaluation of the mass and the
surrounding structures than CT
Endoscopic Ultrasonography (EUS) :
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Karakteristik EUS pada GIST maligna :
Size larger than 4 cm (the only independent predictor)
Heterogeneous echogenicity
Internal cystic areas
Irregular borders on the extraluminal surfaces
EUS dapat digunakan untuk membedakan GIST gaster dengan leiomyoma,
dengan :
Inhomogenicity
Hyperechogenic spots A marginal halo
Higher echogenicity than the surrounding muscle layer
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Biopsy memberikan definitive diagnosis
Biopsy dibutuhkan pada kasus yang memerlukan terapi
medikamentosa perioperative dan kasus tumor yang tidak
dapat direseksi dengan bedah.
Biopsy tidak perlu dilakukan pada tumor yang dpat direseksi
dengan tindakan bedah dan tidak memerlukan terapimedikamentosa perioperative.
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Kriteria TGM Tumor, Grade, Metastasis
Tumor size (T1, 70 mm; T2, >70 mm; P < .001)
Grade (G1, grades I and II; G2, grades III and IV; P 50 HPFmemiliki perkiraan harapan hidup rata-rata 18 bulan. 80 %
pasien dengan harapan hidup 8 tahun memiliki tumor yang
memunginkan untuk direseksi dan daya mitosis 10/50 HPF.
Klasifikasi risiko (oleh Fletcher et al) :
Very low risk - Smaller than 2 cm and less than 5/50 HPFs
Low risk - From 2-5 cm and less than 5/50 HPFs
Intermediate risk - Either (1) smaller than 5 cm and 6-10/50
HPFs or (2) 5-10 cm and less than 5/50 HPFs
High risk - Includes (1) larger than 5 cm and more than 5/50
HPFs, (2) larger than 10 cm and any mitotic rate, or (3) any
size and more than 10/50 HPFs
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