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Squamous cell carcinoma of the

lung

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Bronchial epithelium

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95% tumor primer paru berasal dari epitel bronkus ( karsinoma bronkogenik)

Klasifikasi karsinoma bronkogenik

1. Non small cell lung carcinoma (NSCLC) (70-75%)

1. SCC (25-30%)

2. Adenokarsinoma (30-35%)1. Acinar

2. Papilary

3. Solid with mucus production

4. Bronchioloalveolar carcinoma

3. Karsinoma sel besar (10-15%)

2. Karsinoma sel kecil (20-25%) ( neuroendocreine tumor)

3. Pola kombinasi (5-10%)

Prinsip umum tumor paru

1. Pembagian NSCLC dan SCLC adalah untuk untuk tujuan pengobatan

2. SCLC lebih cocok kemoterapi, karena hampir semua SCLC telah bermetastasi saat terdiagnosis,

sedangkan NSCLC tidak berespon terhadap kemoterapi dan sebaiknya ditangani dengan bedah

3. SCLC ditandai dengan mutasi gen TP 53 dan RB, sedangkan NSCLC lebih sering terjadi inaktivasip16/CDKN2, pengaktian K-RAS banyak terjadi pada jenis NSLC yang adenokarsinoma

Penyebab

Genetik, rokok, gas industri, pulusi udara, TB, COPD

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1. Most squamous cell carcinomas arise in the central portion of the lung from the

major or segmental bronchi, although 10% originate in the periphery.

2. Firm, grey-white, 3- to 5-cm ulcerated lesions, which extend through the bronchial

wall into the adjacent parenchyma.

3. Necrosis and hemorrhage.4. Central cavitation is frequent.

5. On occasion, a central squamous carcinoma occurs as an endobronchial tumor.

Makros Appearance

Clinical feature

1. Dyspnea, weight loss, chest pain,hemoptysis, produksi sputum ( gejala umum

tumor paru yang pertumbuhannya di di sentral atau endobroncial

2. Male3. Smoking

4. Mutasi p53, gene RB-1,p16(INK4a), EGFR

5. Arise in segmental or terminal bronchi

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1. The microscopic appearance of squamous cell carcinoma is highly

variable.

2. Well-differentiated squamous cell carcinomas display keratin pearls,

which are eosinophilic aggregates of keratin surrounded by concentric

(onion skin) layers of squamous cells .

3. Individual cell keratinization also occurs, in which a cell's cytoplasm

assumes a glassy, intensely eosinophilic appearance.

4. Intercellular bridges are identified in some well-differentiated squamous

cancers as slender gaps between adjacent cells, which are traversed by

fine strands of cytoplasm. By contrast, some squamous tumors are so

poorly differentiated that they show no foci of keratinization and aredifficult to distinguish from large cell, small cell, or spindle cell

carcinomas.

5. Tumor cells may be readily found in the sputum, in which case the

diagnosis is made by exfoliative cytology.

Microscopic appearance

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Perjalanan SCC

a. Paparan rokok hiperplasia sel goblet

b. Hiperplasia sel basal

c. Metaplasia sel skuamosa

d. Dysplasia skuamosa (ditandai dengan hilangnya polaritas nucleus, pleomorfisme, dan

gambaran mitotik

e. CIS ( membaran basal masih intak)

f. Ca Invasive

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Bronchiolo-alveolar carcinoma

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d

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1. Women

2. Non Smoker

As compared to SCC

1. More peripher

2. Smaller

3. Grow more slowly

4. Less frequent associated with history of smoking

5. Tend to metastasize widely and early

Hyperplasia adenomatosa atypical

K-RAS mutation

Makros

1. occurs in the pulmonary parenchyma in the terminal bronchioloalveolar

2. peripheral portions of the lung either as a single nodule or, more often, as

multiple diffuse nodules that sometimes coalesce to produce a

pneumonia-like consolidation3. parenchymal nodules have a mucinous, gray translucence when secretion

is present but otherwise appear as solid, gray-white areas

Mikros

1. the tumor is characterized by a pure bronchioloalveolar growth pattern with no

evidence of stromal, vascular, or pleural invasion2. growth along preexisting structures without destruction of alveolar architecture. This

growth pattern has been termed "lepidic," an allusion to the neoplastic cells

resembling butterflies sitting on a fence

3. Two thirds of tumors are nonmucinous, consisting of Clara cells and type II

pneumocytes, in which cuboidal cells grow along the alveolar walls); the remaining

one-third are mucinous tumors featuring columnar goblet cells filled with mucus

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Metastatic breast cancer on the

lung

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Metastatic hepatocellular

carcinoma of the lung

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Capillary hemangioma

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Klasifikasi :

1. Hemangioma kapiler (paling sering), regress spontaneously2. Hemangioma kavernosa (port wine stain), do not regress spontaneously

3. Granuloma piogenik (hemangioma kapiler lobularis)

Hemangioma

1. Differensiasi endotel ( penanda endotel : CD31 atw faktor von willebrand)

2. Peningkatan jumlah pembuluh normal atau abnormal yg terisi oleh darah

3. Sulit dibedakan dari malformasi dan hamartoma

Clinical feature

Umumnya lokal, tapi juga bisa mengenai area luas (angiomatosis)

Mayoritas superficial, tapi juga bisa di organ dalam (hati)

Sering di kepala dan leher

Jarang jadi ganas

Biasanya pada bayi dan anak ( membesar kemudian regresi spontan sebelum

pubertas

Multiple hemnagiomatous sindrome terjadi pada von Hippel-Lindau Syndrome

dan Sturge

Weber Syndrome

HEMANGIOMA

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Hemangioma kapiler Sering di kulit, subkutis, dan selaput lendir rongga mulut dan bibir, tapi bisa

juga di hati , limpa, ginjal

Hemangioma kapiler tipe stroberi pada kulit neonatus (hemangioma

juvenilis)

Makros

Beberapa mili sampai centi

Merah terang samapai biru

Datar atw sedikit meninggi

Epitel diatasnya utuh

Mikros

Berlobus, tidak berkapsul

Banyak kapiler berdiding tipis tersusun rapat, biasanya terisi darah, dan dilapisiendotel gepeng

Pembuluh dipisahkan oleh sedikit stroma

Di lumen mungkin ada trombosis

Ruptur pembuluh menyebabkan pembentukan jaringan parut

Kadang ada pengendapan pigmen hemosiderin pada lesi

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Lymphangioma

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Analog dengan hemangioma

Differensiasi endotel

Klasifikasi

1. Limfangioma biasa (kapiler)2. Limfangioma kavernosa (higroma kistik)

Limfangioma kapilerClinical feature

Terutama di kepala, leher, ketiak, tapi bisa juga di organ dalam

Makros

Sedikit meninggi atw bertangkai

Diamter 1-2 cm

Soft, cystic, well demarcated

Mikros

Rongga limfe berlapis endotel ( seperti limfatik normal) dibawah epidermis Limfatik kecil dilapisi lapisan adventisia yang tidak jelas, dan limfatik besar dilapisi

serabut otot yang differensiasi buruk

Rongga limfatik tersisi cairan protein, limfosit dan mungkin eritrosit

Agregat limfoid pada jaringan ikat

Dapat dibedakan dari saluran kapiler karena tidak ada darah didalamnya

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3.2 pa slide