Dr Aleq-tumor Leher
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Transcript of Dr Aleq-tumor Leher
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TUMOR LEHER
dr. Mochamad Aleq Sander, M.Kes., Sp.B., FINACSBagian UPF Ilmu Bedah
Fakultas Kedokteran – Universitas Muhammadiyah Malang
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TUMOR LEHER (BENJOLAN ABNORMAL DI LEHER)
TumorLeher - dr. Mochamad Ale !ander" M.Kes." !#.B
* KELAINAN KONGENITAL
* INFEKSI / INFLAMASI
* NEOPLASMA
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KELAINAN KONGENITAL
* SISA CELAH INSANG II
* KISTA DUKTUS TIROGLOSUS
* HIGROMA COLLI
* KISTA DERMOID* STRUMA KONGENITAL
TumorLeher - dr. Mochamad Ale !ander" M.Kes." !#.B
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Kista Branchial Kista Ductus Thyroglosus
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INFEKSI / INFLAMASI
* LIMFADENITIS ASPESIFIK
* LIMFADENITIS SPESIFIK
* ABSES
TumorLeher - dr. Mochamad Ale !ander" M.Kes." !#.B
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NEOPLASMA
* TUMOR TIROID
* TUMOR KELENJAR LUDAH
* TUMOR JARINGAN LUNAK
* TUMOR KULIT* TUMOR SISTEM LIMFORETIKULER
TumorLeher - dr. Mochamad Ale !ander" M.Kes." !#.B
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Soft Tissue Tumor Leher
Tumor Tiroid Tumor Parotis
SCC coliTumorLeher - dr. Mochamad Ale !ander" M.Kes." !#.B
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TUMOR KELENJAR TIROIDEpidemiologi
Tumor Endokrn !"r#$n%$k
In&d"n& ↓↓
USA (') +,-'. /d 0 1+2 - '. /d
An3k$ 4 5 6 d$r &"mu$ k$&u&Indon"&$ k$&u& !umor 3$n$& no. !"r#$n%$k
P"m$7$m$n $n$!om %3 m$kn #$k 5 d!un8$n3 o-
/"rk"m#$n3$n IPTEK /"m#"d$7$n !rod m8d &"m$kn
&"m/urn$ $n3k$ mor#d!$& 5 mor!$9!$& m$kn ↓
Struma Endemik 10% penduduk di suatu daerah menderita struma
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Lok$& 9"7"r $n!"ror
1 Lo#u& d7u#un3k$n o- &!7mu&
K$d$n3 9o#u& /r$md$9& (5) B"r$! 5 1 3r 0 :$rn$ ;ok9$! 0 k"n%$9
Nu!r& $. !rod"$ &u/.+ n. !rod"$ &u/.+ n;$9 /o&!.
N"r>u& n. 9$r%n3"u& r"kur"n& = n. 9$r%n3"u& &u/.
ANATOMI
TumorLeher - dr. Mochamad Ale !ander" M.Kes." !#.B
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Posterior dari sisi medialnya ada
kelenjar paratiroid, n. rekuren
laringeus & esofagus.
Esofagus belakang trakea &
laring
N. rekuren laringeus di sulkustrakeoesofagus.
!iroid sisi posterior melekat erat
pada trakea & laring mll "ig.
suspensorium dari #erry.
Ekstensi posterior dari tiap lobus $
Tu$ercles o% &uckerkandl
TumorLeher - dr. Mochamad Ale !ander" M.Kes." !#.B
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KLASIFIKASI HISTOPATOLOGIK
(del REGATO)
JINAK? ADENOMA
@ FOLIKULER
@ OKSIFIL
@ ATPIK
GANAS?
A. KARSINOMA BERDEFERENSIASI BAIK
@ PAPILIFER @ FOLIKULER
@ CAMPURAN PAPILIFER = FOLIKULER
@ OKSIFIL (HURTLE CELL CA)
TumorLeher - dr. Mochamad Ale !ander" M.Kes." !#.B
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B. KARSINOMA BERDEFERENSIASI BURUK
@ SMALL CELL
@ SPINDLE CELL = GIANT CELL
C. KARSINOMA MEDULARE
D. LAIN LAIN
@ KARSINOMA EPIDERMOID
@ LIMFOMA MALIGNA
@ PLASMASITOMA
@ SARKOMA
TumorLeher - dr. Mochamad Ale !ander" M.Kes." !#.B
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ETIOLOGI
M$&7 #"9um dk"!$7u
Ad$
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GEJALA KLINIS
B"n8o9$n d 9"7"r $n!"ror %3 ku! #"r3"r$k #9$ m"n"9$n
B"n8o9$n d 9"7"r 9$!"r$9
B"n8o9$n /d !93 k$9>$r$+ k9$>ku9$+ &!"rnum+ d99
S"&$k n$/$&+ /"ru#$7$n &u$r$ (&"r$k)+ = 33 m"n"9$n
Fr$k!ur /$!o9o3&
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Umur 1 !7n - !7n
J"n& &"
Nodu9 &o9!"r Kon&&!"n& k"r$&
Ad$ /"r9"n3k"!$n d3n 8$rn3$n &"k!$rn%$ (n
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DASAR DIAGNOSIS
PEE'(S))N ("'N'S&
PEE'(S))N PEN*N+)N
TumorLeher - dr. Mochamad Ale !ander" M.Kes." !#.B
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PEMERIKSAAN PENUNJANG
Fo!o STL (So
Sdk !u9$n3 97$! m"!$&!$&& LAB !umor m$rk"r? k$9&!onn = !ro39o#u9n
TumorLeher - dr. Mochamad Ale !ander" M.Kes." !#.B
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DIAGNOSIS "ANDING
TIROIDITIS SUB AKUTA
TIROIDITIS REIDEL
TIROIDITIS HASHIMOTO
ADENOMA PARATIROID
KARSINOMA PARATIROID
TUMOR METASTASIS
TumorLeher - dr. Mochamad Ale !ander" M.Kes." !#.B
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!IRI KLINIS !A PAPILIFER TIROID
In&d"n& /un;$k d"k$d" 2
A&m/!om$!k #"r!$7un!$7un
Nodu9 &o9!"r (&"rn3 mu9!
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!IRI KLINIK !A FOLIKULER
d d$"r$7 d"
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!IRI KLINIK !A MEDULARE TIROID
A&$9 C C"99
F$m9$9
Produk Kalsitonin
S"rn3 #"r&$m$1 n"o/9$&m$ "ndokrn %3 9$n %3 mr/k
#$3$n d$r SISTEM APUD ( AMIN P!C"S#!
"PTAK AND DCA!B#$%LATI#N & Fr"ku"n& r"9$!
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!IRI KLINIK !A ANAPLASTIK TIROID
Tum#u7 ;"/$! d$r S!rum$ %3 &d7 9$m$ $d$
T$nd$1 /"n"k$n$n JELAS
K"r$&+ #"r#"n8o9+ = !"r
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PENGELOLAAN
TERAPI PEM"EDAHAN
'. ISTHMOLOBEKTOMI
1. TIROIDEKTOMI SUB TOTAL
. TIROIDEKTOMI NEAR TOTAL
2. TIROIDEKTOMI TOTAL
. TIROIDEKTOMI TOTAL 5 DISEKSI LEHER
RADIKAL (RND)
TumorLeher - dr. Mochamad Ale !ander" M.Kes." !#.B
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RADIOTERAPI
'. RADIASI INTERNA d3 I#$#
1. RADIASI EKSTERNA
T% HORMONAL &KHEMOTERAPI
'. Hormon$9@ u- Su#&!!u&@ u- Su/r"&@ Pr"/$r$!? T%r$ (&? !rok&n 0 :$rn$ !$#9"! pi' )
1. K"mo!"r$/ r"&/on m$&7 kur$n3
TumorLeher - dr. Mochamad Ale !ander" M.Kes." !#.B
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JENIS
HISTOLOGIK
HARAPANHIDUP(%)
5TH 10TH 15TH 20TH
PAPILIFER 94 92 88 81
FOLIKULER 86 78 72 61
MEDULARE 61 37 ANAPLASTIK 7
PROGNOSIS
TumorLeher - dr. Mochamad Ale !ander" M.Kes." !#.B
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TUMOR KELENJAR LUDAH
TumorLeher - dr. Mochamad Ale !ander" M.Kes." !#.B
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ANATOMI
K"9"n8$r Lud$7 !dd dr?
'.M$%or
1.Mnor
KELENJAR LUDAH MAOR?
'. G9d P$ro!&
1. G9d Su#m$nd#u9$r&
. G9d Su#9n3u$9&
KELENJAR LUDAH MINOR? T"r&"#$r d &"9uru7 muko&$ #uk$9+ 9d$7+
oro
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PER"EDAAN TUMOR KELENJAR LUDAH
JINAK & GANAS
TumorLeher - dr. Mochamad Ale !ander" M.Kes." !#.B
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TERAPI
Fr&! ;7o;" OPERASI 5 /r"&"r>$& &$r$< &"k!$rn%$
M$;$m !"r$/ #"d$7?
'. P$ro!d"k!om Su/"r
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KOMPLIKASI OPERASI
L"& n"r>u& II+ n. 9n3u$9&+ n. 7/o39o&u&+ d99
F&!u9$ k"9"n8$r 9ud$7
R"kur"n& R$&$ /"nu7 d !"9n3$
Sndrom$ FRE (Sndrom$ Aur;u9oT"m/or$9)
16 K$&u& /$ro!d"k!om
Tm#u9 #9n /o&! o/
G? 7/"r"m&+ 7/"r7dro&& d /r"$urku9"r /$&;$ r$n3&$n3$n
k"9"n8$r 9ud$7TumorLeher - dr. Mochamad Ale !ander" M.Kes." !#.B
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PROGNOSIS
JINAK BAIK
GANAS !3! H&!oPA
"$r& Sur>>$9 R$!"?
Tumor G$n$& C$m/ur ? 26
C$ Muko"/d"rmod 737 3r$d" ? 216
C$ Ad"nod K&!k ? 6