1Jefri EffendiBag. Bedah FK Unsyiah/ RSU ZABanda Aceh

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WILMS' TUMOR

= Nephroblastoma = , umur median 2 th 11 blnKa = Ki, 5 % bilateral15 % + kelainan kongenital : Anomali UG Hemihipertrofia Aniridia

ETIOLOGI : Diduga kongenital3

KLINIS : Flank mass Flank pain Hematuria Hipertensi Anorexia, Nausea, Vomiting Kelainan kongenital lainLABORATORIUM : Hematuri AnemiaTrias4

RADIOLOGIS :

BNO : - Kesuraman salah satu sisi perut - Usus terdesak oleh massa

IVP: Collecting sytem terdesak massa / distorsi

USG: Massa padat dalam ginjal5

PATOLOGI :Campuran Epithelial, Stromal, Blastematous( Immature Mesnchyma )

2 kelompok :- Favorable histology89 %- Unfavorable H 11 %

Prognosa kurang baik7

STAGING ( Menurut NWTS ) :

Terbatas dalam ginjal, eksisi sempurna

Keluar ginjal, eksisi sempurna

Sisa tumor dalam abdomen

Metastase jauh

Bilateral8

DD: Neuroblastoma Teratoma Hamartoma Hidronefrosis Cystic kidneysTERAPI : Radical nephrectomy Chemotherapy : vincristine + Actinomycin D ( adriamycine) Radiasi ; terutama UH6

PROGNOSA9

Renal cell Ca Adeno Ca ginjal Hypernephroma = Clear cell Ca

Pria : Wanita = 2 : 1Sering pada dekade 5 -685% of all renal neoplasms

Penyebab ?Faktor resiko 10GRAWITZ' TUMOR

RISK FACTORS ASSOCIATED WITH RCC

Cigarette smoking (>35%)Hypertension Elevated body weight Medications (e.g., diuretics) Acquired renal cystic disease Occupational exposures (e.g., asbestos, petroleum, cadmium, lead)Genetic predisposition (e.g., von HippelLindau disease) Copyright 2002 by Lippincott, Williams & Wilkins

LOCATION OF POTENTIAL CHROMOSOMAL CHANGES IN RENAL CELL CARCINOMA Tumor Affected Chromosomes Conventional (clear cell) RCC 3p,17 Papillary RCC 3q,7,12,16,17,20,Y Chromophobe RCC 1,2,6,10,13,17,21 Collecting duct carcinoma 1q,6p,8p,13q,21q

Copyright 2002 by Lippincott, Williams & Wilkins

Tanda dan Gejala :Trias :- Gross hematuria- Flank pain- Flank mass

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PARANEOPLASTIC SYNDROMES ASSOCIATED WITH RENAL CELL CARCINOMAErythrocytosis Anemia Hypercalcemia Hypertension Acute hepatic dysfunction Amyloidosis Thrombocytosis Copyright 2002 by Lippincott, Williams & Wilkins

Pemeriksaan PenunjangLaboratorium : - Hematuria- Serum ferritin (meningkat 10%)- Anemia (normocytic normocromic)- Eritropoitin (meningkat 63%)- LED Radiologi :- IVP: distorsi PCS- USG: massa di ginjal- Angiografi: hipervascularisasi- CT Scan/ MRI: massa di ginjal

Axial view of computed tomography scan Three-dimensional computed tomography reconstruction

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Terapi : - Nefrektomi Radikal

Terapi Ajuvan :- Radiasi- Hormonal- Kemoterapi13

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TUMOR BULI-BULI

Tumor yang tumbuh dari epitel buli-buliJenis: - Transitional cell Ca90 % - Epdermoid Ca5 - 10 % - Adeno Ca2 %

Pria : Wanita = 2,7 : 115

Penyebab: Belum jelas

Faktor resiko : Merokok Pekerja yang berhubungan dengan ; Bahan kimia Cat Karet Bensin Kulit Trauma fisik : Infeksi Instrumentasi Batu16

Tanda dan Gejala : Painless, gross hematuria 90 % Polakisuria, dysuria, urgency Nyeri tulang, nyeri pinggang Massa supra pubis17

Diagnosis : Urinalysis : hematuria Sitologi urine : klas IV - V IVP : filling defect dalam buli-buliKomplikasi : Anemia Gagal ginjal kronis18

Penatalaksanaan : TUR Buli Sistektomi partial Sistektomi total Kemoterapi intravesikal Radiasi Kemoterapi19

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