Patologi Anatomi Tumor Sistim Pencernaan
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Transcript of Patologi Anatomi Tumor Sistim Pencernaan
7/23/2019 Patologi Anatomi Tumor Sistim Pencernaan
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Histopatologi Neoplasma Sal Cerna
Noza Hilbertina
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Referensi
• Robbins and cotran : Pathologic Basis ofDisease, 8th ed
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Squamous cell carcinoma rongga m!l!t"
• Patogenesis :m!ltifa#torial $ ro#o#,
al#ohol, hp%, ri&
#el!arga instabilitas
genomi# herediter",radiasi a#tini#
caha'a matahari" dll
• Dia&ali lesi
premalignant
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Morfologi :• t! di %entral lidah, dasar m!l!t, bibir
ba&ah, palat!m l!na#, ginggi%a• ben(olan, #en'al, pla# spt m!tiara,
%err!co!s ) !lserasi, batas irrig!lar • displasia ) Ca insit! ) Ca in%asif • &ell diff ) anaplasti#
• mtts lo#al : #gb cer%i#al• mtts (a!h : #gb mediastin!m, par!, hepar,
t!lang
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Adenocarcinoma Esofagus
• pd barrett esofag!s dan *+RD lama• risi#o lbh besar pd displasia, mero#o#,
obesitas, th radiasi
• risi#o - pd diet #a'a b!ah dan sa'!r segar • patogenesis : esofag!s barrett )
per!bahan geneti#, epigeneti# a#!isita
(ang#a &a#t! lama ) adenocarcinoma• pada ./ distal esofag!s ) in%asi #e
#ardia gaster
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• dini : t!mor brp lesi datar dg m!#osa 'ginta# ) massa 'g lbh besar 01cm ata!
massa infiltratif dif!s , !lserasi, penetrasi
dlm2
• Mikro : barrett esofag!s dide#at massa
t!mor
• m!cin, bt# #elen(ar tipe intestinal• ## tipe sel signet 'g infiltratif dif!s
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Squamous cell carcinoma Esofagus
• 0 31 thn, la#i4la#i 35 dibanding &anita• fc risiko : al#ohol, temba#a!, in(!ri ca!sti#,a#alasia, sind pl!mmer %inson dan seringmeng#ons!msi ma#anan terlal! panas
• 00 pd ./ tengah esofag!s• dim!lai dr lesi insit! : pla# p!tih ab!, #ecil,
tebal ) polipoid, e#sofiti#, menon(ol danmen'!mbat l!men ata! !lseratif, dif!s
infiltratif men'ebar #e dlm dinding esofag!s) menebal, #a#!, l!men men'empit )in%asi (ar s#tr
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• sering terdiagnosis stlh t!mor sgt besardan tlh mengin%asi dinding esofag!s
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Adenocarcinoma gaster
• *e(ala a&al mirip dg gastritis #roni# :dispepsia, disfagia dan m!al• Sering ditem!#an pd std lan(!t• insiden - ter#ait ling#!ngan dan diet
• Patogenesis : #ombinasi geneti# danling#!ngan
• m!tasi germline CDH., peng#ode +4cadherin ) familial #an#er gaster ) tipediff!sa
• 6!tasi 74catenin ) #an#er gaster tipeintestinal
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• Morfologi : t! di antr!m, #!r%at!ra minor • tipe intestinal : membent!# ton(olan, ters!s!natas str!#t!r gland!lar, sel mgdg %ac!ola m!cinpd ape# dan l!men #elen(ar
• tipe diff!sa : t!mb!h infiltratif, signet4ring cells%ac!ola m!cin besar 'g mendorong inti sel #eperifer"
• m!cin e#strasel!lar ) m!cin la#es
• rea#si desmoplasti# ) dinding gaster #a#!
• Fc prognostik : #edalaman in%asi, #gb 'gterlibat, mtts (a!h
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*astrointestinal stromal t!mor
• t!mor mesen#imal tersering, 0 19 n'a digaster
• Patogenesis : m!tasi c4;<, PD*=R>
• >sal dari sel interstisial Ca(al di m!s#!larispropria 'g mer!pa#an pacema#er !
peristalti# !s!s
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6orfologi :• soliter, batas tegas, flesh' mass, dilapisi o
m!#osa 'g inta# ata! !lseratif
• ters!s!n atas sel4sel spindel tipe selspindel" ata! sel men'er!pai sel epitel
tipe epithelioid", bisa (g camp!ran
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>denocarcinoma #olon
• #eganasan tersering pd sal cerna• berh!b erat dg fc diet : rendah serat, tinggi#ho dan lema#
• patogenesis : heterogen, abnormalitas
geneti# dan epigeneti#• ?al!r >PC7 catenin berh!b dg @N< dan
se#!en adenoma ) adenocarcinoma• (al!r microsatelite instabilit' berh!b dg
defe# DN> mismatch repair • peristi&a epigeneti# : meth'lation4ind!ced
gene silencing
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6orfologi :• distrib!si di sep(g #olon• pro5 #olon : polipoid, e#sofiti#, t!mb!h
meman(ang, (arang men'ebab#an
obstr!#si• distal #olon : t!mb!h ann!lar, #onstri#si
dan pen'empitan l!men•
t!mor tdr dr sel4sel #ol!mnar tinggi,displasti# dg in%asi #e stroma s#trn'a )desmoplasi, ## ada m!cin, signet ring cell) prognosis (ele#
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•fc prognosti# penting :#edalaman in%asi dan
metastasis #e #gb
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Hepatocell!lar carcinoma
• 8A9 ter(adi di negara ber#embang dginfe#si HB 'g tingi spt asia tenggara danafri#a
• fc etiologi $ infe#si %ir!s #roni# HB,
HC", al#oholisme #roni#, steatohepatitisnon al#oholi#, #ontaminasi ma#ananaflato#sin" dan fc lainn'a
• si#l!s ber!lang #ematian dan regenerasisel spt pd hepatitis #roni# ) patogenesis!tama
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morfologi :• ma#ros bs !nifo#al, m!ltifo#al, diff!s
infiltratif ) hepar membesar ata! gbrn
sirosis• &arna lbh p!cat dibanding hepar di
s#trn'a, ## &arna #ehi(a!an
• #ecendr!ngan #!at !nt!# !nt!#mengin%asi str!#t!r %as#!lar ) mtts
intrahepati# ) nod!l satelit
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•mtts #el!ar hepar t! mlli in%asi %as#!lar, bs (glimfogen
• &ell differentiated sel t!mor ters!s!n
trabe#!lar, asinar, pse!dogland!lar" )
!ndifferentiated pleomorfi#, b'# sel anaplasti#,giant cells, mirip spindle cell sarcoma
• =ibrolamellar ca : !sia m!da A43 thn", td#
p!n'a pen' hepar #ronis, prognosis lbh bai#,
ber!pa t!mor t!nggal, besar, #eras scirro!s"
• >=P ser!m pd 19 pasien HCC
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#ematian biasan'a o# :• #ahe#sia
• perdarahan sal cerna, %arices esofag!s
• gagal hepar dg #oma hepati#• perdarahan 'g fatal o# r!pt!r t!mor
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Cholangiocarcinoma CC>"
• #eganasan hepar #e d!a tersering• #eganasan biliar' tree 'g berasal d!#t!s
bilier didlm dan dil!ar #and!ng emped!
• fc risi#o : primar' sclerosing cholangitis,congenital fibropol'cstic disease pd
sistem bilier, HC, paparan thorotrast dl
dig!na#an pd radiografi tract bilier",
opisthorchis sinensis
• intrahepati# dan e#strahepati# 9"
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• diagnosis)#ematian intrahepatic"222E bln• morfologi :
• ekstrahepatik : lesi #ecil, padat, nod!l
didlm dinding d!#t!s bilier, ## dif!sinfiltratif, papillar', polipoid
• adenocarcinoma, ## sF!amo!s cell
carcinoma, b'# stroma fibrosa disertaiproliferasi epitel
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• intrahepatik : pd hepar nonsirosis, t!mb!hsepan(ang tract portal intrahepatic, ##
t!mb!h nod!l massif, in%asi %asc!lar dan
proliferasi disepan(ang limfati# portal )
metastasis intrahepatic massif
• tipe adenocarcinoma &ell4moderatel' diff,
stroma s#lerosis desmoplasti#", str!#t!r
t!b!lar 'g (elas dilapisi oleh sel #!boidal,#ol!mnar ) t!mor sangat #eras
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arian camp!ran :• HCC, CC> massa t!mor terpisah didlmhepar 'g sama
• HCC, CC> tercamp!r dg tempatpertem!an 'g dpt diidentifi#asi
• HCC, CC> tercamp!r pd le%el mir#os#opi#
• %arian camp!ran ini dpt terbent!# dr sel
pre#!rsor bipotensial sel o%al" 'g mamp!menghasil#an hepatosit dan sel epitel d!ctbilier
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• S+;>N