Karsinoma ParuOleh:Nurbaiti

Pendahuluan95% berasal dari epitel bronkus (bronchogenic carcinoma)5% bronchial carcinoid, bronchial gland tumor, mesenchymal malignancies (fibrosarcomas, leiomyomas), lymphomasHamartoma

Bronchogenic Carcinoma/ Bronchial Carcinoma (BC)>> negara industriUsia 55-65 th, := 2:1, 1/3 kasus penyebab kematian pada perokokPrognosis: 5 ysr : 14-45 %

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 >

Kalsifikasi WHO (2007)

LanjutanPerbedaan genetik antara SCLC dan NSCLCSCLC : - mutasi pada gen Rb dan Tp53.- aktivasi p16/CDKN2ANSCLC: -mutasi pada K-RAS onkogen

Etiologi BCNitrosamine Akumulasi beberapa kelainan genetik jar.normal jar.neoplasma

Lanjutan

Gejala klinisTimbul setelah terjadi penyebaran.Batuk kronis, suara serak, nyeri dada, superior vena caval synd, pericardial atau pleural effusion, atelektasis, pneumonia.

Lanjutan Timbul gejala para neoplastic synd:HypercalcemiaSynd. ChusingSIADH (synd.inapropriated secretion of antidiuretic hormone)Neuromuscular snyd.Clubbing finger, hypertrofi pulmonary osteoarthropathyKelainan darah (tromboplebitis, DIC)

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

Squamous Cell Carcinoma>>> pada bronkus, nekrosis sentral cavitas.Menyumbat bronkus atelektasis dan infeksi di bagian distal.

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

SC, FNAB

SC, FNAB,IHC p63

AdenocarcinomaPeripheral lung scar (scar carcinoma)Etiologi : Rokok??Mudah metastasisLesi precancer: atypical adenomatous hyperplasia (AAH)Adeno-carcinoma sequence

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

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

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

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.

Large Cell Carcinoma

Mikroskpikhttp://www.pathguy.com/lectures/large_cell_lung_cancer.jpg

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

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

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 >

Small Cell Lung Carcinoma

Mikroskopik

SCLC, FNAB, thyroid transcription factor-1 [TTF-1] immunostain

Prognosis NSCLC lebih baik dibanding SCLC

Broncial CarcinoidBerasal dari sel kulchitskySel mengandung neurosecretori granulesBagian dari multiple endocrin neoplasiaDewasa muda (40 th)5% dari neoplasma paruAsimptomatik5 ysr 50-95%.

Tipe bronchial carcinoidTypical Carcinoid - well differentiated carcinoma - Atypical Carcinoid - moderately differentiated carcinoma- Small Cell Carcinoma - poorly differentiated and- Large Cell Neuroendocrine Carcinoma - poorly differentiated

Makroskopik >> tumbuh kearah lumen bronkusPolipoid atau berupa plak (collar button lesion).Batas tegas

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

MikroskopikTerdiri dari kelompokan sel bergerombol, rosetteSel bulat uniformKromatin kasar, mitosis , pleomorfik, fokal nekrosis

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

Atypical carcinoidhttp://www.lmp.ualberta.ca/resources/pathoimages/Images-C/000p038a.jpg

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

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

LanjutanAsbestos dapat menyebabkan:pleural effusion Diffuse pleural thickening penebalan pleuraLung cancer perokok terekspos asbetos lebih beresiko. Malignant mesothelioma Pleural plaques

PatogenesisSerat masuk ke alveoli aktivasi sistim imun inflamasi Inflamasi kronis makrofag merangsang pertumbuhan fibroblast fibrosis dinding alveolus menebal.

Gejala klinisBatuk Dada sesak Nafas pendek

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

Asbestosis

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

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

Malignant Mesotelioma>> dari pleura.>> pada individu terpapar asbes (50%), SV40 (?), negara industriInkubasi 25-40 th.Patogenesis??Gen yang terpengaruh: p16/CDKN2A, neurofibromatosis 2(NF2),

Lanjutan

Makroskopik

Mikroskopik 3 tipe:EpitelioidSarcomatoidbiphasic

Terima Kasih

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