dr aleq-tumor leher

8/21/2019 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



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Kista Branchial Kista Ductus Thyroglosus


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INFEKSI / INFLAMASI

* LIMFADENITIS ASPESIFIK

* LIMFADENITIS SPESIFIK

* ABSES



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NEOPLASMA

* TUMOR TIROID

* TUMOR KELENJAR LUDAH

* TUMOR JARINGAN LUNAK

* TUMOR KULIT* TUMOR SISTEM LIMFORETIKULER



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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



10/32TumorLeher - 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



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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)



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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



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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



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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



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DIAGNOSIS "ANDING

TIROIDITIS SUB AKUTA

TIROIDITIS REIDEL

TIROIDITIS HASHIMOTO

ADENOMA PARATIROID

KARSINOMA PARATIROID

TUMOR METASTASIS



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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)



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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



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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



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TUMOR KELENJAR LUDAH



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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



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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

dr aleq-tumor leher

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