pengantar klinik 1 (Revisi 2012)

7/29/2019 pengantar klinik 1 (Revisi 2012)

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PATHOLOGY

EXAMINATIONDepartment of Pathology

Medicine Faculty Brawijaya University


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KasusAn. EC/ 2 tahunKeluhan utama: benjolan di kepaladan mata kiri, cepat membesar


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?

DIAG

NOSIS

HISTORYTAKING

PHYSEXAM

LABEXAM

REXAM

PA

EXAM

THERAPY


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CT Scan KepalaBrain Window


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HASIL FNAB pada Lesi diKepala

Rosette


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Makroskopik:Tampak tumor di kepala yang meluas ke pelipis dan zygoma

Mikroskopik:Hapusan hiperseluler terdiri dari sebaran sel-sel ganas berinti bulatkecil-kecil sebagian mengandung nucleoli prominen, sebagiantampak hyperkromatik dengan sitoplasma tipis. Sel-sel tersusunsebagian seperti Rosette dan Sebagian tampak tersebar difus.

Kesimpulan:MALIGNANT SMALL ROUND CELL TUMOR kemungkinanEWING SARCOMA.

DD: 1. NEUROBLASTOMA2. LYMPHOMA MALIGNA

SARAN: Open Biopsi Histo PA


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USG Abdomen

Massa solid heterogen pada suprarenal kiriSugestif Maligna


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Marker VMA : Negatif

WDx: NEUROBLASTOMA Stage IV

Terapi: Kemoterapi dengan Doxorubicin

Hasil: Perbaikan, massa primer dan metastatik pada skull

mengecil, BB bertambah.

Pasien kontrol poli hematologi untuk kemoterapilanjutan.


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Anatomic PathologyExaminations

Histopathologic Ex.- HistoPA routineFrozensection(Vries

Coupe)- Pathology autopsy

Cytologic Ex.- Exfoliative Cytl

:Gyn and non gyn- FNAB


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Histopathology Examination

Specimen from operation ( mastectomy, TAHBSO, appendectomy ,colon resection,nephrectomy, thyroidectomy etc .

Excisional biopsy ( FAM, polyp < 3 cm)

Incisional biopsy ( tumors > 3 cm ).

Curretage ( from uterus , dentigerous cyst, etc ) TURP, TURB

Autopsy specimens.


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Preparation

Complete delivery form : patient identity,specimen type, fixation, location, clinicaldiagnosis, complete clinical information + draw

location and size of tumor, history of the diseaseand lab examination.

Fixation with 10 % formalin.

Specimen label : name, regist number.


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Receive specimens from patient


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Frozen Section

Durante op ,Without fixation.

From : ovary tumor, breast tumor, thyroid tumor, skin

tumor, brain tumor, Hirschsprung disease. Decided benign or malignant, free margins

Operation technic ( therapy management).

GOLD STANDARD DX : histopathology paraffin block


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HASIL VRIESCOUPE :Ganas

(Infiltrating Ductal

Carcinoma)

/


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IMMUNOHISTO/CYTOCHEMISTRY

Indication : standard for tx and prognosis,decided tumor type.

Example : ER/PR, HER2 for Breast Cancer,CD 4,8, 19, 20 for decide Non Hodgkinlymphoma type B or T. Vimentin, LCA, desmin,cytokeratin for differential diagnostic of

malignant small round cell tumor,determine theorigin of tumor cells .


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ImmunohistokimiaCa. Mammae Her2

Positif

ImmunohistokimiaCa. Mammae ER

Positif


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-year-old manPleural fluid

Primary site: unknownlungstomach

Cytological diagnosis:

Primary lung cancer

NapsinCK7 CK20


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FINE NEEDLE

ASPIRATION BIOPSY


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Close biopsy with FNAB

Simple , economical technique.

Can be performed as an outpatient procedure.

Few complications. Multiple sites.

Rapid diagnosis & treatment planning

Highly accurate


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FNAB Procedure

PRECONDITION

Clinical information.

Conventional radiograph / CT scan / MRI/USG of the tumor

Biopsy target can be located with palpation orguided by CT scan/ USG.


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Material and Method

Needle 25 G/27 G/23G

Spuit 10cc.

Object glass.

Alcohol 70 %

Alcohol 95%.


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1. Examine patient and Radiograph


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2. Puncture Tumor

Desinfection.

Tumor fixation with fingers.

Puncture tumor without/with aspiration.


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Make smear-fixation-staining


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FNAB diagnostic : GCT of the Bone

Cli i l Pi A KHA 12 h


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Clinical Pictures: An KHA 12 thn,humeral tumor 6 yr

X h (24/2/11) RS S if l


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X-ray humerus (24/2/11)RS SaifulAnwar, Malang


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pengantar klinik 1 (Revisi 2012)

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