ASPEK PATOLOGI Kanker Paru.pptx

5/26/2018 ASPEK PATOLOGI Kanker Paru.pptx

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Bahan pemeriksaan paru
http://catalog.nucleusinc.com/enlargeexhibit.php?ID=14970


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PROFESI TERKAIT

PENANGANAN KANKER PARU

Spesialis Paru

Spesialis Radio-diagnostik

Spesialis Patologi Anatomik

Spesialis Bedah thoraks

Spesialis Radio-terapi

Spesialis PD KHOM


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Faktor yang berpengaruh pada

diagnosis keganasan paru

Ketrampilan klinisimendapatkan bahanpemeriksaan

Ketrampilandiagnostik SpPA

Sitologi:sputum; bilasdan sikat bronkhus;TBNA; TTNA; BAL

Histopatologi: TBLB;biopsi core; biopsiinsisi; biopsi eksisi;operasi

Diagnostik: sitologi;histopatologi


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Peran pemeriksaan PA utk

penanganan Kanker Paru

Sitologi Histo-path Potong beku Molekular

Diagnosa X X X

Staging

pra/pst

X X

Bedah X X

Radiasi X X

Kemoterapi X X

Monoklonal X X X


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MODAL TERAPI Kanker

Paru BEDAH stadium I-III

RADIASI stadium III-IV

KEMOTERAPI 1st & 2nd lines

MONOKLONAL 1st line &maintain


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Klasifikasi Kanker Paru menggunakan

Klasifikasi WHO 2004

WHO 1999

SQUAMOUS CELL Ca

SMALL CELL Ca ADENOCARCINOMA

LARGE CELL Ca

WHO 2004

SQUAMOUS CELL Ca

SMALL CELL Ca ADENOCARCINOMA

Adenoca, mixed type

Acinar Adenoca

Papillary Adenoca

Bronchioloalveolar Ca

Solid Adenoca mucin prod

LARGE CELL Ca


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Klasifikasi Kanker Paru menggunakan

Klasifikasi WHO 2004

Bronchioloalveolar Ca

Nonmucinous

Mucinous

Mixed nonmucinous

and mucinous or

indeterminate

Solid adenocarcinoma

with mucin production

fetal adenocarcinoma

mucinous/coloid ca

mucinous cyst ad.ca

signet ring adeno caclear cell ca


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Karsinoma sel skuamosa (SCC)

Histologi Sitologi


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Karsinoma sel kecil(SCLC)

Histologi

Sitologi


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Adenokarsinoma(Adeno)

Histologi

Sitologi


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Karsinoma sel besar(LCC)

Histologi

Sitologi


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Carcinoid

tipik atipik


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Frekuensi jenis histologi

keganasan epitelial paru

Squa

%

Adeno

%

Large

%

Small

%

Vincent, 1977 38 26.5 9.3 19.2

Suemasu, 1978 32.9 41.8 12.7

Hayata, 1980 40.8 39.8 9.6 8.7

Endardjo, 1990 32.3 38.9 1.5 5.6


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Pola gambaran sitologi keganasan

paru (2000-2001 Sept). S. Endardjo 2001

Gambaran sitologi TTB(459) Bronkhus(834)

n % n %

Adenokarsinoma 100 74 72 79

Ka sel skuamosa 33 24 18 20

Ka sel besar 2 1 1 1

Ka sel kecil - -

Karsinoid - -

Total 135 91


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Perspectives in lung cancer

1. Estimated 1.3 million new cases will be

diagnosed annually

2. Adenocarcinoma is the major histological

subtype

3. Increasing the incidence of typical &atypical carcinoid and large cell

neuroendocrine tumors

4. Decreasing the incidence of small cell

carcinoma

Hansen: 2ndInternational Chicago Symposium on Malignacies of Chest and

Head & Neck, October 2001.


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Saluran napas bawah


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Apusan sputum


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Apusan sputum


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Apusan Bilasan Bronkhus


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Apusan Bilasan Bronkhus


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Karsinoma Sel Skuamosa

IMUNOHISTO

- MW Keratin

- Sitokeratin 5/6

- CEA

SITOLOGI

- nekrosis dan sel

debris

- sel terisolasi

- inti sentral ireguler

hiperkromatik

- anak inti kecil 1-2- sitoplasma lebar

- bentuk sel bizarre


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Karsinoma Sel Skuamosa


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Karsinoma Sel Kecil

SITOLOGI

- streaks/baluran sel

- sebaran sel ireguler,

sinsitial, berderet

- N/C rasio tinggi

- nuclear moulding

- inti ovoid, ireguler- kromatin salt and

pepper

- mitosis

IMUNOHISTO

- CD 56

- chromogranin

- synaptophysin


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Karsinoma Sel Kecil


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Adenokarsinoma

SITOLOGI

- sel tunggal, morula,

asini, papiler

- inti bulat/oval ditepi,kromatin halus, anak

inti menonjol besar

- sitoplasma lebar,translusen, vakuol,

musin

IMUNOHISTO

- AE1/AE3

- Cam 5.2

- EMA

- CEA

- CK 7


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Adenokarsinoma


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Karsinoma Bronkioloalveolar


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Karsinoma Sel Besar

SITOLOGI

- gambaran tidak spesifik

- sel bergerombol atau

tersebar- batas selular tidak jelas,

kolompokan tidak teratur

- inti bulat sp tak teratur,

kromatin tdk teratur- anak inti sangat

menonjol

- sitoplasma sedikit dan

basofilik

IMUNOHISTO

- petanda

neroendokrin

- seperti NSCLC


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Karsinoma Sel Besar


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Positivity of sputum cytology

Method Direct

%

Inhalation

%

Saccomano

%

Endardjo

19905.2

Astowo

199516 26

Titin M S2002

4.3 18.3


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Relative survival of lung cancer. England and Wales,

1971-2001 Cancer research UK

0

5

10

15

20

25

30

1971-75 1976-80 1981-85 1986-90 1991-95 1996-99 2000-01*

men - 1 yr

women - 1 yr

men - 5 yr

women - 5 yr

Period of diagnosis

Re

lativesurvival(%)


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Ringkasan

Diagnosa patologi sedapat mungkin

mencantumkan jenis, karena terkait jenis

terapi yang akan diberikan

Mengenal gambaran prakanker guna

membantu menurunkan angka kanker

paru

Documents

ASPEK PATOLOGI Kanker Paru.pptx