KEGANASAN P LEURA

29
Bagian Pulmonologi dan Kedokteran Respirasi FK Unand Sabrina Ermayant KEGANASAN PLEURA

description

Sabrina Ermayanti. KEGANASAN P LEURA. Bagian Pulmonologi dan Kedokteran Respirasi FK Unand. Structure of the Thoracic Cavity. Pleural Anatomy. Lungs are surrounded by thin tissue cal l ed the pleura , a continuous membrane that folds over itself Parietal pleura lines the chest wall - PowerPoint PPT Presentation

Transcript of KEGANASAN P LEURA

Page 1: KEGANASAN  P LEURA

Bagian Pulmonologi dan Kedokteran RespirasiFK Unand

Sabrina Ermayanti

KEGANASAN PLEURA

Page 2: KEGANASAN  P LEURA

Structure of the Thoracic Cavity

Page 3: KEGANASAN  P LEURA

Lungs are surrounded by thin tissue called the pleura, a continuous membrane that folds over itself– Parietal pleura lines the chest wall– Visceral pleura covers the lung (sometimes called the

pulmonary pleura)

Pleural Anatomy

Page 4: KEGANASAN  P LEURA

Schematic diagram of pleural anatomy; s.c.=systemic capillary; p.c.=pulmonary capillary

Page 5: KEGANASAN  P LEURA

selapis sel mesothelial   pavement-like cells melapisi permukaan pleura

sel yang aktif, sensitif & responsif terhadap berbagai rangsangan

dinamik

Sel Mesothelial

Page 6: KEGANASAN  P LEURA

Fungsi : transportasi dan pergerakan cairan dan partikel migrasi leukosit respon inflamasi sintesis sitokin, fc pertumbuhan & matriks ekstraseluler melepaskan fc utk merangsang deposisi dan pembersihan fibrin dan antigen

Sel Mesothelial

Page 7: KEGANASAN  P LEURA

Cairan Pleura Volume: Normal sedikit (+) Noppen et al. 8,4 ± 4,3 ml.

Terdiri dari : protein (tu. albumin,globulin, and fibrinogen) sel (tu. Sel mesothelial , monocytes, and

lymphocytes)

Pd manusia 75% macrophages 25% lymphocytes < 2% mesothelial cels, neutrophils and eosinophils

Page 8: KEGANASAN  P LEURA

Neoplasma Pleura Primer

• benign (jarang)LipomaFibromaEndotheliomasAngiomasCysts

• malignant mesothelioma Secondary

• >> adenocarcinoma paru, GIT, ovarium

Page 9: KEGANASAN  P LEURA

MESOTELIOMA

Page 10: KEGANASAN  P LEURA

Insiden penggunaan asbestos stlh PD -2

[McDonald 1987]

Negara Industri : 2 per satu juta ♀ 10 - 30 per satu juta ♂

♂ = 10 x ♀

Resiko >> daerah galangan kapal

5-7% dari orang yang terpapar asbestos 50% tidak ada riwayat terpapar asbestos

Page 11: KEGANASAN  P LEURA

Occupational Exposure to Asbestos AS >> th 2004 = 2.300 paparan > th

30-60 Eropa Barat >> th 2018 = 9.000 > th

70 Laten period 20 - 40 tahun

Paparan dg gedung yg diisolasi dg asbestos sangat jarang [Hughes et al. 1986; Lilienfield 1991

Insiden

Page 12: KEGANASAN  P LEURA

Manifestasi KlinisGejala Umur 40 – 70 th 2/3 kasus Riwayat terpapar asbestos 20 th

sebelumnya atau lebih Nyeri dada nonpleuritik

menjalar ke abdomen atas / lengan

Sesak nafas >> BB , batuk kering dan

dyspnea bbrp pasien demam tdk

tinggi

Page 13: KEGANASAN  P LEURA

Manifestasi KlinisTanda Tanda –tanda efusi pleura

I = cembung, pergerakan tertinggal Pl = fremitus < Pk = redup – pekak A = Suara nafas -sp (-)

Clubbing finger Atrial fibrillation

Page 14: KEGANASAN  P LEURA

Pemeriksaan Penunjang Ro thoraks 70-95% efusi pleura efusi masif 50% hemitoraks tidak jelas gambaran tumor pleura

Page 15: KEGANASAN  P LEURA

Pemeriksaan Penunjang CT Scan toraks pleura menebal terutama pleura mediastinum irreguler volume hemitoraks yang kena bervariasi 30-42% mengecil

Page 16: KEGANASAN  P LEURA

Pemeriksaan Penunjang Sitologi cairan pleura3 Tipe sel

• Epithelial Type : 50 % of cases most often confused with adenocarcinoma

• Mesenchymal Type : 16 % of cases

• Mixed Type : 34 % of cases

Page 17: KEGANASAN  P LEURA

Pemeriksaan Penunjang Sitologi cairan pleura

Page 18: KEGANASAN  P LEURA

Pemeriksaan Penunjang MRI Bronkoskopi Biopsi pleura

Tertutup Terbuka VATS

Page 19: KEGANASAN  P LEURA

Diagnosis (2) Cardinal Characteristics [Boutin 1998]

• Age between 55 - 65• Previous occupational exposure to

asbestos• Pleural Effusion• C.T. / MRI (with nodular lesions of the

parietal pleura)

Page 20: KEGANASAN  P LEURA

StagingI Confined to ipsilateral pleuraII Involves chest wall,

mediastinum, pericardium or contralateral pleura

III Involves both thorax and abdomen or lymph nodes outside thorax

IV Distant metastasis

Page 21: KEGANASAN  P LEURA

TreatmentThere is no single treatment which has

proven effective...

SurgeryRadiation

ChemotherapyImmunotherapyGene Therapy

Page 22: KEGANASAN  P LEURA

Tumor metastase ke pleura Insiden : penyebab efusi pleura eksudat no 2

setelah parapneumoni efusi

Tumor primer kanker paru kanker payudara 75% limfoma lain2 Ca ovarium, sarcoma, Ca lambung, Ca kolon, Ca pankreas, Ca buli2

dll

Page 23: KEGANASAN  P LEURA
Page 24: KEGANASAN  P LEURA

Manifestasi Klinis Gejala dan tanda efusi

pleura Gejala dan tanda tumor

primer

Page 25: KEGANASAN  P LEURA

Pemeriksaan Penunjang

Ro toraks CT Scan toraks

Sitologi cairan pleura

Biopsi pleura

Page 26: KEGANASAN  P LEURA

Pemeriksaan Penunjang

Tes Immunochemical Adenoca CEA; MOC-3,1; B72,3; Ber-EP4 & BG-8

Tumor marker pd cairan pleura CEA; CYFRA21-1; SCC antigen;SSEA-1

Page 27: KEGANASAN  P LEURA
Page 28: KEGANASAN  P LEURA

Penatalaksanaan Punksi cairan pleura Kemoterapi sistemik Radioterapi Radiasi mediastinal Pleurodesis Indwelling Pleural catheter Pleuro-peritoneal shunt

Page 29: KEGANASAN  P LEURA