1 tumor payudara
TRANSCRIPT
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TUMOR PAYUDARATUMOR PAYUDARA
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A. NormalB. Laktasi
A. PremenopauseB. Pascamenopause
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FREKUENSI LESI PAYUDARAFREKUENSI LESI PAYUDARA
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GAMBARAN KLINIS LESI PAYUDARAGAMBARAN KLINIS LESI PAYUDARA
Tabel. Kemungkinan sebab lesi patologis beserta gejala dan tanda klinis pada berbagai umur Sebab patologis Gejal klinis
25 tahun 25-35 tahun 35-55 tahun . 55 tahun Benjolan mobil Benjolan berbatas tidak tegas Benjolan padat/keras Discharge puting: 1. Jernih 2. Berdarah Ulserasi, eksema puting
Fibroadenoma Jarang Jarang Jarang Jarang Adenoma puting
Fibroadenoma Fibroadenosis Sclerosing adenosis Karsinoma Jarang Jarang Adenoma puting
Fibroadenoma Tumor filodes Perubahan fibro-kistik Karsinoma Ektasia duktus Papilloma duktus Penyakit Paget Adenoma puting
Tumor filodes Jarang Karsinoma Nekrosis lemak Ektasia duktus Papilloma duktus Penyakit Paget Adenoma puting
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MAKROSKOPIS MAKROSKOPIS PERUBAHAN FIBROKISTIK PERUBAHAN FIBROKISTIK ””BLUE DOME CYSTBLUE DOME CYST””
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GAMBARAN HISTOLOGIS PERUBAHAN FIBROKISTIKGAMBARAN HISTOLOGIS PERUBAHAN FIBROKISTIK
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AA, , Hiperplasi sedang (florid)Hiperplasi sedang (florid)B. Hiperplasi atipikB. Hiperplasi atipik
Perubahan fibrokistik …Perubahan fibrokistik …
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Sclerosing adenosisSclerosing adenosis
Perubahan fibrokistik …Perubahan fibrokistik …
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MIKROSKOPIS GINEKOMASTIAMIKROSKOPIS GINEKOMASTIA
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GAMBAR MAKROSKOPIS DAN GAMBAR MAKROSKOPIS DAN MIKROSKOPIS FIBROADENOMA MIKROSKOPIS FIBROADENOMA MAMMAE MAMMAE
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A.A. Tumor phyllodesTumor phyllodesPapilloma duktus besarPapilloma duktus besarPapilloma duktus kecilPapilloma duktus kecil
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Karsinoma inflamasiKarsinoma inflamasi
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PENYAKIT PAGETPENYAKIT PAGET
umur lebih tuaumur lebih tuakarsinoma intraduktal karsinoma intraduktal mengenai duktus ekskretorius mengenai duktus ekskretorius utama meluas dan infiltasi ke utama meluas dan infiltasi ke kulit puting dan areola kulit puting dan areola kering, pecah, ulserasi, kering, pecah, ulserasi, hiperemia, edemahiperemia, edemagambaran gambaran khaskhas: invasi : invasi epidermis sel Pagetepidermis sel Pagetsel Paget: sel besar, tunggal sel Paget: sel besar, tunggal atau berkelompok, inti atau berkelompok, inti hiperkhromatik dan pleomorfik, hiperkhromatik dan pleomorfik, dikelilingi dikelilingi halohalomorfologi sel Paget = sel morfologi sel Paget = sel karsinoma duktal invasif/ non karsinoma duktal invasif/ non invasif invasif
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KARSINOMA DUKTAL INVASIF, NOSKARSINOMA DUKTAL INVASIF, NOS
A. Gambaran potongan makroskopis
B. Gambaran mikroskopis
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KARSINOMA DUKTAL INSITUKARSINOMA DUKTAL INSITU
KomedokarsinomaKomedokarsinoma
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KARSINOMA DUKTAL INSITUKARSINOMA DUKTAL INSITU
Karsinoma papilar in situKarsinoma papilar in situ
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KARSINOMA LOBULAR INSITUKARSINOMA LOBULAR INSITU
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KARSINOMA LOBULAR INVASIFKARSINOMA LOBULAR INVASIF
Masa batas tidak tegas. Masa batas tidak tegas. konsistensi kenyal konsistensi kenyal HistologisHistologis– sel tumor kecil, relatif uniformsel tumor kecil, relatif uniform– deretan sel tunggal - deretan sel tunggal - Indian file Indian file - -
mengelilingi asini atau duktus mengelilingi asini atau duktus normal, konsentrik di sekitar lobuli normal, konsentrik di sekitar lobuli kelenjar yang menjadi karsinoma kelenjar yang menjadi karsinoma lobular in situlobular in situ
– stroma jaringan ikat padat. stroma jaringan ikat padat. Kejadian: 5% Kejadian: 5% sifat bilateralitas (20%)sifat bilateralitas (20%)Jenis:Jenis:– histiositoid: sel dengan sitoplasma histiositoid: sel dengan sitoplasma
banyak, granular, berbuihbanyak, granular, berbuih– signet ring cell: signet ring cell: sel seperti cincin sel seperti cincin
stempelstempel
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KARSINOMA MEDULARKARSINOMA MEDULAR
1% 1%
di bawah 50 tahundi bawah 50 tahun
masa besar (>10 cm), masa besar (>10 cm), kenyal lunakkenyal lunak
HistologisHistologis– stroma sedikitstroma sedikit– sel tumor poligonal – sel tumor poligonal –
spindle - tersusun spindle - tersusun lembaran atau pulau besarlembaran atau pulau besar
– stroma, di tepi tumor stroma, di tepi tumor dijumpai sebukan limfosit dijumpai sebukan limfosit sedang sampai berat sedang sampai berat respon imunitas terhadap respon imunitas terhadap tumor tumor prognosis jauh prognosis jauh lebih baiklebih baik
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KARSINOMA KOLOID (MUKOIDES)KARSINOMA KOLOID (MUKOIDES)
1% 1% di bawah 50 tahundi bawah 50 tahunmasa besar (>10 cm), masa besar (>10 cm), kenyal lunakkenyal lunakHistologisHistologis– stroma sedikitstroma sedikit– sel tumor poligonal – sel tumor poligonal –
spindle - tersusun spindle - tersusun lembaran atau pulau besarlembaran atau pulau besar
– stroma, di tepi tumor stroma, di tepi tumor dijumpai sebukan limfosit dijumpai sebukan limfosit sedang sampai berat sedang sampai berat respon imunitas terhadap respon imunitas terhadap tumor tumor prognosis jauh prognosis jauh lebih baiklebih baik
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KARSINOMA TUBULARKARSINOMA TUBULAR
Disebut pula karsinoma Disebut pula karsinoma berdiferensiasi baikberdiferensiasi baikUsia rata-rata 50 tahunUsia rata-rata 50 tahunmasa berbatas tidak tegas - masa berbatas tidak tegas - konsistensi keras - diameter konsistensi keras - diameter 10 mm10 mmHistologis:Histologis:– menyerupai lesi jinak – menyerupai lesi jinak –
kelenjar berdiferensiasi baik kelenjar berdiferensiasi baik (terutama adenosis (terutama adenosis mikroglandular)mikroglandular)
– tidak dijumpai nekrosis dan tidak dijumpai nekrosis dan mitosismitosis
– pleomorfisme sangat ringan.pleomorfisme sangat ringan.
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METODA DIAGNOSTIKMETODA DIAGNOSTIK
TEKNIK - BAJAHTEKNIK - BAJAH
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METODA DIAGNOSTIKMETODA DIAGNOSTIK
SITOLOGI - BAJAHSITOLOGI - BAJAH
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Horizontal mammographyHorizontal mammography
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METODA DIAGNOSTIKMETODA DIAGNOSTIK
MAMMOGRAFIMAMMOGRAFI
Fibroadenoma mammae Karsinoma mammae
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INFRARED IMAGING SYSTEMINFRARED IMAGING SYSTEMThermographic Finding: Typical Thermographic Finding: Typical breast cancerbreast cancer case which shows hyperthermia case which shows hyperthermia
on the tumor area and hyper vascularization around tumor.on the tumor area and hyper vascularization around tumor.
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StadiumStadiumStadium IStadium I
T1a: T T1a: T 0.5 cm 0.5 cm
T1b: 0.5 cm < T T1b: 0.5 cm < T 1 cm 1 cm
T1c: 1 cm < T T1c: 1 cm < T 2 cm 2 cm
T1 N0 M0T1 N0 M0
T T 2 cm 2 cm
T1T1
N0 = Tidak ada metastasis limfonodi regionalM0 = Tidak ada metastasis jauh
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Stadium IIAStadium IIA
T2 N0 M0T2 N0 M0
N1 = metastasis to movable ipsilateral axillary lymph node(s)M0 = no distant metastasis
2 cm < T 2 cm < T << 5 cm 5 cm
Tidak Tidak ditemukan ditemukan tumortumor
T0T0
T0 T0 T1T1
N1 M0N1 M0}
T2T2
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Stadium IIBStadium IIB
T3 N0 M0T3 N0 M0
N1 = metastasis to movable ipsilateral axillary lymph node(s) (p) N1a, N1bM0 = no distant metastasis
T > 5 cmT > 5 cm
T2 N1 M0T2 N1 M0
T3T3
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Stadium IIIAStadium IIIAT0T0T1T1T2T2T3T3
Metastasis to ipsilateral axillary lymph node(s) N1 = movableN2 = fixed to one another or to other structuresM0 = no distant metastasis
T3 N1 M0T3 N1 M0N2 M0N2 M0
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Stadium IIIBStadium IIIB
Any T N3 M0Any T N3 M0
N3 = metastasis to ipsilateral internal mammary lymph node(s)M0 = no distant metastasis
Tumor of any sizewith direct extensionto chest wall or skin
T4d = inflammatorycarcinoma
T4 any N M0T4 any N M0
T4T4
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Stage IVStage IV
M1 = distant metastasis (including metastases to ipsilateral supraclavicular, cervical, or contralateral internal mammary lymph nodes)
Any T any N M1Any T any N M1
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With thanks to Professor W.Jonat
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With thanks to Professor W.Jonat
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