Karsinoma Paru

Oleh:
Nurbaiti
 Pendahuluan
► 95% berasal dari epitel bronkus
(bronchogenic carcinoma)
► 5%  bronchial carcinoid, bronchial gland
tumor, mesenchymal malignancies
(fibrosarcomas, leiomyomas), lymphomas
► Hamartoma
 Bronchogenic Carcinoma/ Bronchial
Carcinoma (BC)
► >> negara industri
► Usia 55-65 th, := 2:1, 1/3 kasus
penyebab kematian
► ↑ pada perokok
► Prognosis: 5 ysr : 14-45 %
Patogenesis
 Lanjutan
►4 klasifikasi besar BC: squamous ca,
adenocarcinoma, large cell undiff.ca, small
cell ca.
► Kepentingan terapi: Small cell lung cancer
(SCLC) dan Non Small cell lung cancer
(NSCLC)
► SCLC resposif kemo/dan radioterapi
><NSCLC tidak (surgery)
Kalsifikasi WHO (2007)
 Lanjutan
► Perbedaan genetik antara SCLC dan NSCLC
► SCLC : - mutasi pada gen Rb dan Tp53.
- aktivasi p16/CDKN2A
► NSCLC: -mutasi pada K-RAS onkogen
 Etiologi BC
► Nitrosamine
► Akumulasibeberapa kelainan genetik
jar.normal jar.neoplasma
Lanjutan
 Gejala klinis
► Timbul setelah terjadi penyebaran.
► Batuk kronis, suara serak, nyeri dada,
superior vena caval synd, pericardial atau
pleural effusion, atelektasis, pneumonia.
 Lanjutan
► Timbul gejala para neoplastic synd:
- Hypercalcemia
- Synd. Chusing
- SIADH (synd.inapropriated secretion of antidiuretic
hormone)
- Neuromuscular snyd.
- Clubbing finger, hypertrofi pulmonary
osteoarthropathy
- Kelainan darah (tromboplebitis, DIC)
 Makroskopik

http://images.google.co.id/imgres?imgurl=http://www.som.tulane.edu/classware/pathology/medical_pathology/New_for_98/Lung_Review/Lung_carcinoma/BronchogenicCA-
gross.jpg&imgrefurl=http://www.som.tulane.edu/classware/pathology/medical_pathology/New_for_98/Lung_Review/Lung-
19.html&usg=__1EI6vw1yFnCq91JMNH2sMZ26BdQ=&h=300&w=396&sz=61&hl=id&start=22&um=1&tbnid=vTHiaS7jnRjtoM:&tbnh=94&tbnw=124&prev=/images%3Fq%3
Dbronchial%2Bcarcinoma%26ndsp%3D18%26hl%3Did%26sa%3DN%26start%3D18%26um%3D1
 Squamous Cell Carcinoma
► >
► >> pada bronkus, nekrosis sentral
cavitas.
► Menyumbat bronkus atelektasis dan
infeksi di bagian distal.
 Mikroskopik

http://images.google.co.id/imgres?imgurl=http://www.ncbi.nlm.nih.gov/bookshelf/picrender.fcgi%3Fbook%3Dcomponc%26part%3Dch7%26blobname%3Dch7f9.jpg&
imgrefurl=http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi%3Fbook%3Dcomponc%26part%3Dch7&usg=___q8WHOIl1NzucGunbZ9XMEfZTbQ=&h=323&w=474&sz=1
51&hl=id&start=23&um=1&tbnid=ZA4PrSKguIfwhM:&tbnh=88&tbnw=129&prev=/images%3Fq%3Dbronchial%2Bcarcinoma%26ndsp%3D18%26hl%3Did%26sa%3
DN%26start%3D18%26um%3D1
SC, FNAB
SC, FNAB,IHC p63
 Adenocarcinoma
► Peripheral lung scar (scar carcinoma)
► Etiologi : Rokok??
► Mudah metastasis
► Lesi precancer: atypical adenomatous
hyperplasia (AAH)
► Adeno-carcinoma sequence
 Mikroskopik

http://images.google.co.id/imgres?imgurl=http://www.ncbi.nlm.nih.gov/bookshelf/picrender.fcgi%3Fbook%3Dcomponc%26part%3Dch7%26blobname%3Dch7f9.jpg&i
mgrefurl=http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi%3Fbook%3Dcomponc%26part%3Dch7&usg=___q8WHOIl1NzucGunbZ9XMEfZTbQ=&h=323&w=474&sz=151
&hl=id&start=23&um=1&tbnid=ZA4PrSKguIfwhM:&tbnh=88&tbnw=129&prev=/images%3Fq%3Dbronchial%2Bcarcinoma%26ndsp%3D18%26hl%3Did%26sa%3DN%
26start%3D18%26um%3D1
 Bronchioloslveolar adenocarcinoma

http://images.google.co.id/imgres?imgurl=http://www.ncbi.nlm.nih.gov/bookshelf/picrender.fcgi%3Fbook%3Dcomponc%26part%3Dch7%26blobname%3Dch7f9.jpg&imgrefurl=http://w
ww.ncbi.nlm.nih.gov/bookshelf/br.fcgi%3Fbook%3Dcomponc%26part%3Dch7&usg=___q8WHOIl1NzucGunbZ9XMEfZTbQ=&h=323&w=474&sz=151&hl=id&start=23&um=1&tbnid=Z
A4PrSKguIfwhM:&tbnh=88&tbnw=129&prev=/images%3Fq%3Dbronchial%2Bcarcinoma%26ndsp%3D18%26hl%3Did%26sa%3DN%26start%3D18%26um%3D1
 Papillary Adenocarcinoma

http://images.google.co.id/imgres?imgurl=http://www.ncbi.nlm.nih.gov/bookshelf/picrender.fcgi%3Fbook%3Dcomponc%26part%3Dch7%26blobname%3Dch7f9.jpg&imgrefurl=http://
www.ncbi.nlm.nih.gov/bookshelf/br.fcgi%3Fbook%3Dcomponc%26part%3Dch7&usg=___q8WHOIl1NzucGunbZ9XMEfZTbQ=&h=323&w=474&sz=151&hl=id&start=23&um=1&tbnid
=ZA4PrSKguIfwhM:&tbnh=88&tbnw=129&prev=/images%3Fq%3Dbronchial%2Bcarcinoma%26ndsp%3D18%26hl%3Did%26sa%3DN%26start%3D18%26um%3D1
 Large Cell Carcinoma
► Sel besar-besar, giant cell, spindel sel,
anaplastik, mix. inti sel vesikuler, anak inti
jelas,
► Membentuk pulau-pulau , struktur seperti
kelenjar.
► Prognosis buruk.
Large Cell Carcinoma
 Mikroskpik

http://www.pathguy.com/lectures/large_cell_lung_cancer.jpg
 MIkroskopik

http://images.google.co.id/imgres?imgurl=http://dermatology.cdlib.org/113/letters/urticaria-
cancer/3.jpg&imgrefurl=http://dermatology.cdlib.org/113/letters/urticaria-cancer/de.html&usg=__wRmDJyV5Yl8YBTeN-
csy9kBmAOY=&h=240&w=320&sz=36&hl=id&start=11&um=1&tbnid=_su7uGN0JUECRM:&tbnh=89&tbnw=118&prev=/images%3Fq%3Dbronchial
%2Bcarcinoma%2Blarge%2Bcell%26hl%3Did%26sa%3DG%26um%3D1
 Mikroskpik

http://images.google.co.id/imgres?imgurl=http://www.willroberts.com/lungcancer/image10.jpg&imgrefurl=http://www.willroberts.com/lungcancer/path.html&usg=__1o
HW2VFqblFK6OWf4S7_6xUIH0I=&h=161&w=258&sz=15&hl=id&start=45&um=1&tbnid=hNXNbtQcSqjWDM:&tbnh=70&tbnw=112&prev=/images%3Fq%3Dbronchi
al%2Bcarcinoma%2Blarge%2Bcell%26ndsp%3D18%26hl%3Did%26sa%3DN%26start%3D36%26um%3D1
 Small Cell Lung Carcinoma
► Gross: abu-abu pucat.
► Mikroskopik: sel bulat, sitoplasma sedikit,
kromatin inti kasar. Nuklear moulding.
Mitosis banyak ditemukan.
► Besar sel ~ 2x limfosit.
► Nekrosis >
Small Cell Lung Carcinoma
Mikroskopik
SCLC, FNAB, thyroid transcription
factor-1 [TTF-1] immunostain
 Prognosis
► NSCLC lebih baik dibanding SCLC
 Broncial Carcinoid
► Berasal dari sel kulchitsky
► Sel mengandung neurosecretori granules
► Bagian dari multiple endocrin neoplasia
► Dewasa muda (40 th)
► 5% dari neoplasma paru
► Asimptomatik
► 5 ysr 50-95%.
 Tipe bronchial carcinoid
► Typical Carcinoid - well differentiated
carcinoma
► - Atypical Carcinoid - moderately
differentiated carcinoma
► - Small Cell Carcinoma - poorly
differentiated and
► - Large Cell Neuroendocrine
Carcinoma - poorly differentiated
 Makroskopik
► >> tumbuh kearah lumen bronkus
► Polipoid atau berupa plak (collar button
lesion).
► Batas tegas
 Makroskpik

http://images.google.co.id/imgres?imgurl=http://www.lmp.ualberta.ca/resources/pathoimages/Images-
C/000p038a.jpg&imgrefurl=http://www.surgical-
pathology.com/atypical_carcinoid.htm&usg=__yrJe23dYT_hJ-
nLPFUSXYCv55p4=&h=392&w=616&sz=117&hl=id&start=38&um=1&tbnid=95-
fJ0HSURV5fM:&tbnh=87&tbnw=136&prev=/images%3Fq%3Dbronchial%2Bcarcinoma%2Bnuclear%2Bm
oulding%26ndsp%3D18%26hl%3Did%26sa%3DN%26start%3D36%26um%3D1
 Mikroskopik
► Terdiri dari kelompokan sel bergerombol,
rosette
► Sel bulat uniform
► Kromatin kasar, mitosis <<.
► Atypical carcinoid: mitosis >>, pleomorfik,
fokal nekrosis
http://images.google.co.id/imgres?imgurl=http://www.lmp.ualberta.ca/resources/pathoimages/Images-C/000p038a.jpg&imgrefurl=http://www.surgical-
pathology.com/atypical_carcinoid.htm&usg=__yrJe23dYT_hJ-nLPFUSXYCv55p4=&h=392&w=616&sz=117&hl=id&start=38&um=1&tbnid=95-
fJ0HSURV5fM:&tbnh=87&tbnw=136&prev=/images%3Fq%3Dbronchial%2Bcarcinoma%2Bnuclear%2Bmoulding%26ndsp%3D18%26hl%3Did%26sa%3DN%26start%3D3
6%26um%3D1
 Atypical carcinoid

http://www.lmp.ualberta.ca/resources/pathoimages/Images-C/000p038a.jpg
 Large Cell Neuroendocrine
Carcinoma

http://images.google.co.id/imgres?imgurl=http://www.lmp.ualberta.ca/resources/pathoimages/Images-C/000p038a.jpg&imgrefurl=http://www.surgical-
pathology.com/atypical_carcinoid.htm&usg=__yrJe23dYT_hJ-nLPFUSXYCv55p4=&h=392&w=616&sz=117&hl=id&start=38&um=1&tbnid=95-
fJ0HSURV5fM:&tbnh=87&tbnw=136&prev=/images%3Fq%3Dbronchial%2Bcarcinoma%2Bnuclear%2Bmoulding%26ndsp%3D18%26hl%3Did%26sa%3DN%26start
%3D36%26um%3D1
 Asbestosis
► Penyakit paru dikarenakan asbestos terhirup
dalam jangka waktu lama.
► Terjadi setelah terekspos lama (10th)
► Pekerja industri paling beresiko
► Tipe : amphibole/blue asbes (lurus dan
tipis) : amphibole, chorocidolite,
anthophyllite, tremolite, actinolite ;
serpentine/white asbes (melengkung) :
chrysolite
 Lanjutan
Asbestos dapat menyebabkan:
► pleural effusion
► Diffuse pleural thickening – penebalan
pleura
► Lung cancer – perokok terekspos
asbetos lebih beresiko.
► Malignant mesothelioma
► Pleural plaques
 Patogenesis
► Seratmasuk ke alveoli  aktivasi sistim
imun inflamasi  Inflamasi kronis 
makrofag merangsang pertumbuhan
fibroblast fibrosis dinding alveolus
menebal.
 Gejala klinis
► Batuk
► Dada sesak
► Nafas pendek
 Makroskopik

http://images.google.co.id/imgres?imgurl=http://medlib.med.utah.edu/WebPath/jpeg1/LUNG083.jpg&imgrefurl=http://health-
pictures.com/Asbestosis.htm&usg=__ICmDFK5Yp4ZXssaq4giu2a2_Av8=&h=331&w=504&sz=75&hl=id&start=1&um=1&tbnid=chLLx4FrcwJKvM:&tbnh=85&tbnw=130&pr
ev=/images%3Fq%3Dasbestosis%2Blungs%26hl%3Did%26sa%3DN%26um%3D1
Asbestosis
 Asbestos Body

http://images.google.co.id/imgres?imgurl=https://courses.stu.qmul.ac.uk/smd/kb/pathology/introcoursepics/images/asbesbod.jpg&imgrefurl=https://courses
.stu.qmul.ac.uk/smd/kb/pathology/introcoursepics/pathtes1.htm&usg=__kNmmXbJvKuvJZulea5hR3Ns-
F9s=&h=604&w=800&sz=125&hl=id&start=41&um=1&tbnid=Z0GBKz_mgphaFM:&tbnh=108&tbnw=143&prev=/images%3Fq%3Dbronchial%2Bcarcinoma
%26ndsp%3D18%26hl%3Did%26sa%3DN%26start%3D36%26um%3D1
 Asbestos Body

http://images.google.co.id/imgres?imgurl=http://www.thompsonmechanical.ca/images/asbestos%2520in%2520lungs.gif&imgrefurl=http://www.thompsonmechanical.ca/asbestos.htm
&usg=__UExgaY4LQx7FoHl6bdhWBwszJOg=&h=425&w=624&sz=114&hl=id&start=72&um=1&tbnid=zdr4JimyHGsBJM:&tbnh=93&tbnw=136&prev=/images%3Fq%3Dasbestos%2
6ndsp%3D18%26hl%3Did%26sa%3DN%26start%3D54%26um%3D1
 Malignant Mesotelioma
► >> dari pleura.
► >> pada individu terpapar asbes (50%),
SV40 (?), negara industri
► Inkubasi 25-40 th.
► Patogenesis??
► Gen yang terpengaruh: p16/CDKN2A,
neurofibromatosis 2(NF2),
Lanjutan
Makroskopik
 Mikroskopik
► 3 tipe:
1. Epitelioid
2. Sarcomatoid
3. biphasic
Terima Kasih