119-137 Dr Agus Sel Squamosa Carsinoma
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Transcript of 119-137 Dr Agus Sel Squamosa Carsinoma
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NEOPLASMA MALIGNA
Squamous cell carcinoma Karsinoma epidermoid dengan pertandukan
Common, derived from keratinocytes in epidermal layer
Usually men, associated with sun exposure (UV light may induce p53 mutations and diminish
surveillance function of Langerhans cells in epidermis),
PUVA treatment for psoriasis, arsenic, tars/oils, chronic ulcers, draining osteomyelitis, old burn scars, necrobiosis lipoidica, hidradenitis suppurativa,
ORALBIOMEDIS PATOLOGI ANATOMI
By dr. Agus Suharto, Sp. PA, edited by CR #01
II. Diseases of the Salivary Glands
A. Sialadenitis
B. Acute parotitis
C. Sjogren syndrome
D. Mucocele
E. Ranula
F. Tumors of the salivary gland
I. Diseases of the Mouth & Jaw
A. Congenital DisordersB. Inflammatory disorders
C. Tumors and tumor-like conditions
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ionizing radiation Risk factors: immunosuppression (post-transplant or HIV), xeroderma pigmentosa (disorder with diminished capacity for
DNA repair after UV light exposure, due to gene at 9q22.3;
associated with squamous cell, basal cell carcinoma and
melanoma),
lack of pigmentation in skin, actinic keratosis (precursor lesion), epidermodysplasia verruciformis; very rare in blacks
5% are node positive at diagnosis; metastatic rate is 5-10% intransplant patients, who do poorly with metastatic disease
Slow growing, locally invasive but rarely metastasizes outside nodes(but see above); most common site is lung
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Metastases more likely in tumors that originate in scars or ulcers
Positive stains:
high molecular weight keratin,
SQUAMOUS CELL CARCINOMA
Prognosis : excellent; metastases uncommon if tumor < 1.5 cm deep; 5%metastasize if 2 cm or more and definite dermal invasion
Good prognostic factors :
low stage, no/superficial dermal invasion, small vertical tumor thickness (< 4 mm), well differentiated, short duration, location other than scalp, ears, lips, nose, eyelids or soft tissue (which
readily invade subcutaneous tissue)
Treatment:
surgical excision with adequate margins; also curettage, electrodesiccation,
cryotherapy, radiation therapy
Gross : often white plaque (leukoplakia); may have induration, ulceration,
hemorrhage
Micro :atypia at all levels of epidermis; 80% are well differentiated with keratin
pearls, intercellular bridges and no/rare keratohyaline granules; invade dermis by
definition;
may contain non-neoplastic melanocytes that transfer melanin to tumorcells; occasionally clear cells, rarely signet ring cells
Spindle, adenoid and verrucous variants are described separately Other variants are acantholytic (pseudoglandular, tumor clefts produed by
acantholysis of tumor cells) and pseudoangiosarcomatous (clefts separate
neoplastic lobules)Low grade (well differentiated) : cell differentiation, uniform cell size, intact
intercellular bridges, no/rare mitotic figures, no/mild pleomorphism
High grade (poorly differentiated): little cell differentiation, pleomorphism with
spindle cells, necrosis, marked mitotic activity, deep invasion
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EMA, involucrin, p53 (50%), variable CEA
Negative stains:
Ber-EP4, usually CK7 and CK20 (head and neck tumors, Mod Path2004;17:407)
Diagnosis Differential : keratoacanthoma (for well differentiated tumors)
Squamous Cell Ca
Squamous cell carcinoma (HE) x 75
Squamous cell carcinoma (HE) x 150
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Selected cases of squamous cell carcinoma: (a) a representative case of
moderately differentiated squamous cell carcinoma (H&E, X 40); (b)
intranuclear staining for human telomerase reverse transcriptase activity (X200); (c) intracytoplasmic COX-2 stain (X 200); (d) strong intranuclear p53
expression (X 400).
Selected cases of keratoacanthoma: (a) a representative case of earlykeratoacanthoma with overhanging lips and central horn-filled crater (H&E,
40); (b) negative for telomerase activity ( 400); (c) basal staining for p53 (
100); (d) negative COX-2 stain ( 200).
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Histopathologic criteria to differentiate early keratoacanthoma from a well
to moderately differentiated squamous cell carcinoma (Ackerman et al and
Cribier et al)
Keratoacanthoma Squamous cell carcinoma
Exoendophytic lesion with a central horn-
filled crater
Predominantly endophytic with
no horn-filled crater
Overhanging 'lips' of epithelium No epithelial 'lips'
Rarely ulcerated Commonly ulcerated
Abundant pale staining cytoplasm of
keratinocytes
Less common
Intraepithelial abscesses within the lesion Rare
Acantholytic cells within the
intraepithelial abscesses often
Acantholytic cells form without
associated neutrophils
Gland-like formations rare Pseudoglandular formations
often
Lack of anaplasia Common
Sharp outline between tumor nests and
stroma
Indistinct
Absence of stroma desmoplasia Present
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BASAL CELL CARCINOMA
Disebut basal cell carcinoma karenayang mengalami perubahan adalah sel
epitel basal, kan epitel itu ada
beberapa jenis (epitel propium,
granulosum, spinosum dan basale)
Most frequent form of skin cancer Usually sun exposed skin (not mucosal
surfaces), in proportion to number of
pilosebaceous units present
Rosai claims these tumors attempt todifferentiate toward pilosebaceous
units, but often this is not readily
apparent
Often multiple tumors Usually older adults Slow and indolent, untreated cases may invade subcutis, skeletal muscle
and bone; facial tumors may invade skull, nares, orbit or temporal bone;
only 100 metastatic cases described, often associated with basal cell
nevus syndrome or basosquamous histology, on sunlight-protected skin
Metastases are rare; 60% to regional lymph nodes, also lung, liver, bone Risk factors: fair skin, blue eyes, immunosuppression (higher incidence,
more aggressive tumors),
xeroderma pigmentosum
Basal cell carcinoma (HE) x 75
Basal cell carcinoma ini disebut juga
dengan karsinoma basoselulare.
Semua karsinoma basoselulare ini
sifatnya progresif, prognosisnya
jelek, dan membutuhkan terapi
radiasi (kemoterapi). Mudah
metastasis, namun untuk metastasis
membutuhkan banyak proses.
Metastasisnya dapat melalui limfe,
pembuluh darah, dll. Jikametastasisya di pembuluh darah,
maka akan membuat pembuluh
darah baru (neovaskularisasi) oleh
karena itu, saat ini banyak
dikembangkan obat-obatan untuk
mencegah pembentukan pembuluh
darah baru, yaitu Anti VEGF
(Vaskuler Endotelial Growth Faktor)
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Also associated with nevus sebaceus of Jadassohn, chronic venous stasis of lower leg, arsenic, X rays, skin injury, chickenpox scars, tattoos, hair transplant scars, immunosuppression
Less common in children or young adults, sunlight-protected skin; rarelycoexists with benign nevus
Basal cell carcinomaDisebut juga dengan ulkus rodent.
Gambaran histologis tepinya seperti pagar (palisade)
MALIGNANT MELANOMA
Melanoma
Pada dasarnya pewarnaan pada kulit itu disebabkan oleh dua factor ada
factor instrinsik dan ekstrinsik. Kalo yang ekstrinsik contohnya karena
paparan sinar UV, sedangkan kalo instrinsik adanya pigmen melanin.
Keabnormalan melanin ini mula-mula akan jinak (melanoma) tapi lama-
kelamaan akan berubah ganas dan menjadi malignan melanoma. Sel-selnya
banyak yang anaplasi (polimorfik dan atipi). Malignan melanoma yang terjadi
pada daerah sel yang tidak ada melaninnya disebut juga dengan amelanotic
melanoma. Keganasan malignat melanoma ini tergantung dengan
kedalaman invasinya.
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Incidence increasing worldwide - 48,000 cases and 9,200 deaths in US in2000
Usually due to sun (UV light) exposure
Warning signs : change in color of pigmented lesion, enlargement of existing
mole, itching or pain in preexisting mole, development of new pigmented
lesion in adult life, irregular borders in pigmented lesion, variegation of color
in pigmented lesion
Head and neck, lower extremities (particularly in women); rarelysubungual (melanotic whitlow), palm, sole. Also oral and anogenital
mucosa, esophagus, meninges, eye
Populations at higher risk: whites with fair skin, red hair, tendency toburn or freckle from sun exposure, large number of melanocytic nevi,
xeroderma pigmentosum, familial dysplastic nevi, melanosis, vitiligo,
possibly neurofibromatosis type I
Up to 10% may be familial due to CMM1 gene at 1p36 Blacks have low risk, their common melanoma sites are palms, soles, nail
beds or mucous membranes
Usually after puberty, occasionally children - all have same morphology 5% are multiple, although prognosis is related to type and stage of largest
lesion, not number of lesions; must distinguish multiple lesions from hot
nevi / nevus activation
Achilles tendon tumors are often spindled Tend to grow laterally and deep; common metastases to regional lymph
nodes, also liver, lungs, GI tract, bone, CNS, heart (50% at autopsy), skin
(satellite tumors within 2 cm of primary tumor), other sites
Overall 5 year survival is 60% Poor prognostic factors:
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increased Breslow (vertical) thickness in primary tumor, high stage (TNM), males (do worse than females), high mitotic rate, ulceration, microscopic satellites (tumor nests 50 microns or larger and
separated from main tumor mass),
deeper level of invasion for T1 tumors, higher % tumor area/volume in sentinel node, increased density of dendritic leukocytes in nodal paracortex
(associated with risk of tumor in non-sentinel nodes, recurrence and
death, Mod Path 2004;17:747)
Overall behavior is variable, with occasional late deaths or long survivaleven with widespread satellite nodules
Melanoma
S100:nuclear and cytoplasmic, 90%+ sensitive but not specific (although usually
negative in tumors considered in the differential)
HMB45:less sensitive but more specific than S100; negative in desmoplastic
melanoma
MelanA/Mart1:sensitive, but also stains steroid-producing cells in ovary, testis, adrenal
cortex
Tyrosinase:
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sensitive, but also stains peripheral nerve sheath and neuroendocrine tumors
Microphthalmia transcription factor:sensitive, but also stains dermatofibroma and smooth muscle tumors;
negative in spindle cell / desmoplastic melanoma
NKI-C3 and NSE: nonspecific Negative stains: p53
Malignant Melanoma
Lesions are irregular in contour and
pigmentation. Macular areas correlated with the
Nevus Pigmentosus
Melanomasteps of tumor progression in dysplastic nevi
Melanocytic hyperplsia, B. Junctional nevus, C. Dysplastic nevus (compound
nevus with abnormal architectural and cytologic freatures, D. early melanoma
(radial growth phase melanoma large dark cells in epidermis), E.advancedmelanoma (vertical growth phase)
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radial growth phase, while raised areas usually correspond to nodular
aggregation of malignant cells in the vertical cell growth
Malignant Melanoma
Irregular nested and single cell
growth of melanoma cells within
the epidermis and an underlying
inflammatory response within
the dermis.
Malignant Melanoma
vertical phase growth
Nodular aggregates of infiltrating cells
Beberapa gambar
disamping adalah
gambaran histologis
perbesaran lemah
maupun kuat, kan di
praktiukum udah yaa,
jadi recall aja materi
praktikum nya
Malignant Melanoma
radial growth phase of melanoma
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Malignant Melanoma
High-power view of malignant melanoma cells
Nodular malignant melanoma (HE) x 10
Superficial spreading melanoma (HE) X 100
MALIGNANT MELANOMA
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Undifferentiated carcinoma
Pada dasarnya, carcinoma terdapat tida macam differensiasi,
diferensiasi baik, sedang, dan buruk.Nasopharynx
Inflammation Acute Chronic
Neoplasm
Juvenile angiofibroma Undifferentiated carcinoma
a McIvor mouth gag is applied and a
left nasopharyngeal mass is visible
behind the soft palate and left
posterior pillar. The final diagnosiswas lymphoepithelioma
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Nasopharingeal Ca, non-keratinizing, undiff.
Sering disebut juga
NPC (Nasopharink
Carcinoma)
Sel ini murni berasal
dari sel epitel yang
mengalami
keabnormalan, tetapi
gambaran histologis
banyak terlihat
sebukan limfosit yang
berfungsi membunuh
sel-sel tumornya,
hiperkromatid
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EBV
(IH; LMP-1) x 600
Anaplastic (undifferentiated) Carcinoma
Metastasic tumor
LARYNX: benign vs malignant
Gambaran disamping adalah
gambaran histologis dari
undifferentiated carcinoma
yang terinfeksi Epstein Bar
Virus, dilihat dengan
menggunakan pewarnaan
LMP (Laten Membran
Protein)
Pada NPC ini, carcinomanya
tersembunyi, pada saat
pemeriksaan AJH (Aspirasi
Jarum Halus) dia tidak
terlihat, namun NPC ini
mudah bermetastasis
Pada gambaran histologis
terlihat gumpalan sel tumor
yang dikelilingi oleh limfosit
Pada penyanyi dengan suara
seriousa biasanya ada nodus
singer, sedangkan papilloma yang
terdapat diplica vokalis itu
merupakan infeksi dari HPV
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Adenoid cystic carcinoma
Most characteristic appearance consists of cribriform pattern with
masses of small, dark-staining cells arrayed arround cystic spaces
Laryngeal papillomatosisLaryngeal Carcinoma
Gross: fungating/papillar
Adenoid cystic carcinoma ini, memiliki gambaran histologis pada
otot luriknya terdapat abnormalitas/tumor. Tumor epithelial ini
tersusun Kribiformis seperti jaringan. Lumen ini memiliki massa
mucoid sehingga disebut mucoepidermoid tumor.
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Mucoepidermoid tumor (Palatal gland)
Mucoepidermoid tumor (Low grade)
Comprised of
mucus-producing and epidermoid omponents
and cells intermediate between the two
Mucoepidermoid tumor (moderate grade)
Mucoepidermoid tumor (High grade)
Jadii, jangan lupa yaa
teman-teman tentang
terminology pada tumor
dan kanker, kalo
ditulisan belakangnya :
..oma : jinak
.carcinoma : ganas dari
sel epitel
.sarkoma : ganas dari
sel mesenkimal