Tumor of endocrine organ

Tumor of endocrine organ

Dr. Muhartono, M.Kes, Sp.PA
Dr. Muhartono, M.Kes, Sp.PA

Tumor of the pituitary gland
Tumor of the pituitary gland

The vas majority of neoplasms located in

The vas majority of neoplasms located in
sella turcica are benign pitutary adenoma
sella turcica are benign pitutary adenoma
derived from adenohypophysial cells
derived from adenohypophysial cells

n many cases, they can be succesfully

n many cases, they can be succesfully
removed by minimally invasive
removed by minimally invasive
transspenoidal surgery
transspenoidal surgery

!oever their biology is comple" and they

!oever their biology is comple" and they
can cause a variety of endocrin syndrome
can cause a variety of endocrin syndrome
and disorders.
and disorders.

Pitutary tumor
Pitutary tumor

Difinition#
Difinition#

Terleta$ pada sela tursica

Terleta$ pada sela tursica

mayoritas pitutary adenoma

mayoritas pitutary adenoma

Sel%sel adenohypofise
Sel%sel adenohypofise

Sedi$it# pitutary carcinoma

Sedi$it# pitutary carcinoma

&!' (lasification
&!' (lasification

Pitutary adenoma
Pitutary adenoma

Typical adenoma )*+*,-

Typical adenoma )*+*,-

Atypical adenoma )*+*,.

Atypical adenoma )*+*,.

Pitutary carcinoma )*+*,/

Pitutary carcinoma )*+*,/

0pidemiology
0pidemiology

Pitutary adenoma
Pitutary adenoma

.-%.12 dari intracranial neoplasia

.-%.12 dari intracranial neoplasia

*+2
*+2

autopsi
autopsi

3arang pada ana$%ana$

3arang pada ana$%ana$

*2 dari pitutary
*2 dari pitutary
adenoma
adenoma

(linical features
(linical features

Pitutary adenoma
Pitutary adenoma

hormone e"cess
hormone e"cess
4P56, 7!, TS!, A(T!, 8S!, 6!9
4P56, 7!, TS!, A(T!, 8S!, 6!9

Mass effect
Mass effect

intracranial mass
intracranial mass

!eadeche
!eadeche

6oss of normal anterior pitutary hormon

6oss of normal anterior pitutary hormon
production
production

:isual field disturbance

:isual field disturbance

Pemeri$saan
Pemeri$saan

imaging
imaging

!istopatology
!istopatology

Dibeda$an menjadi
Dibeda$an menjadi

Acidofili$
Acidofili$

;asofili$
;asofili$

(hromophobe
(hromophobe

Mayoritas monomorphic proliferation

Mayoritas monomorphic proliferation

Mitosis jarang
Mitosis jarang

Ki<+,M;%. =/2
Ki<+,M;%. =/2

P1/>
P1/>

Dengan penemuan imunohisto$imia,

Dengan penemuan imunohisto$imia,
hormon profile, gambaran ultrastru$tur
hormon profile, gambaran ultrastru$tur
ma$a tumor ini di$lasifi$asi$an lebih detail
ma$a tumor ini di$lasifi$asi$an lebih detail

7! adenoma?P56?TS!?
7! adenoma?P56?TS!?
A(T!?gonadotropin? null? plurihormonal?
A(T!?gonadotropin? null? plurihormonal?
pitutary carcinoma
pitutary carcinoma


7ro@th patterns
7ro@th patterns

0"pansive gro@th
0"pansive gro@th

Tumor di$elilingi jaringan i$at, biasanya tida$ Tumor di$elilingi jaringan i$at, biasanya tida$
ber$apsul ber$apsul

nvasive gro@th
nvasive gro@th

Melibat$an tulang, saraf, pembuluh darah, Melibat$an tulang, saraf, pembuluh darah,
duramater duramater

Pitutary carcinoma
Pitutary carcinoma

Metastasis craniospinal,sistemi$ Metastasis craniospinal,sistemi$

etiology
etiology

Pitutary tumourigenesis
Pitutary tumourigenesis

'ncogen
'ncogen

5as 5as

(yclin D. (yclin D.

Tumor suppressor gene

Tumor suppressor gene

Men. Men.

5; 5;

TP1/ TP1/

P.< P.<

7ADDA1 7ADDA1

Therapy
Therapy

Surgical
Surgical

Medical
Medical

radiation
radiation

Surgical
Surgical

Transsphenoidal minimal invasive

Transsphenoidal minimal invasive

ndi$asi
ndi$asi

Tumor @ith progressive mass efect, e.g visual loss Tumor @ith progressive mass efect, e.g visual loss

!yperfunction# chusing disease, achromegaly, !yperfunction# chusing disease, achromegaly,

hypertyroidisme hypertyroidisme

8ailure of prior treatment such as medical teraphy 8ailure of prior treatment such as medical teraphy

Massive acute haemorrhagic necrosis of adenoma Massive acute haemorrhagic necrosis of adenoma

Medical treatment
Medical treatment

Dopamin agonist
Dopamin agonist

P56
P56

Somatostatin
Somatostatin

7!, TS!
7!, TS!

7! antagonist
7! antagonist

5adiation teraphy
5adiation teraphy

Preop
Preop

ncomplet
ncomplet

recurrent
recurrent

Tumor of the tyroid
Tumor of the tyroid

Papillary carcinoma
Papillary carcinoma

8ollicular carcinoma
8ollicular carcinoma

Poorly diferentiated carcinoma

Poorly diferentiated carcinoma

Bndifferentiated carcinoma
Bndifferentiated carcinoma

Medulary carcinoma
Medulary carcinoma

8ollicular adenoma
8ollicular adenoma

Papilary carcinoma
Papilary carcinoma

Difinition
Difinition

A malignant epithelial tumor sho@ing

A malignant epithelial tumor sho@ing
evidence of follicular cell differentiation
evidence of follicular cell differentiation
and caracteriCed by distinctive nuclear
and caracteriCed by distinctive nuclear
features.
features.

0pidemiology
0pidemiology

Paediatric thyroid malignancy

Paediatric thyroid malignancy

*-%1- tahun
*-%1- tahun

8emale# male
8emale# male

A#.
A#.

0"ecellent D E-2 $hususnya pasien =A1

0"ecellent D E-2 $hususnya pasien =A1
tahun
tahun

incidence
incidence

Tertinggi diantara $arsinoma tyroid

Tertinggi diantara $arsinoma tyroid

etiology
etiology

5adiation e"posure
5adiation e"posure

localiCation
localiCation

Tyroid
Tyroid

0ctopic thyroid tissue

0ctopic thyroid tissue

struma ovarii
struma ovarii

(linical features
(linical features

Massa tyroid
Massa tyroid

(ervical lymphadenopaty
(ervical lymphadenopaty

Tyroid function test
Tyroid function test

Tida$ membantu diagnosis

Tida$ membantu diagnosis

TS!, T/,TA
TS!, T/,TA

8ine needle aspiration biopsy
8ine needle aspiration biopsy

Sitologi
Sitologi

Kelompo$an sel sel atipi$ yang tersusun

Kelompo$an sel sel atipi$ yang tersusun
papil%papil dengan inti
papil%papil dengan inti

po@dery
po@dery
chromatin, thic$ nuclear membran,
chromatin, thic$ nuclear membran,
pseudoinclusion, nuclear groove,
pseudoinclusion, nuclear groove,
multinucleated giant cell
multinucleated giant cell

Psamoma bodies
Psamoma bodies

maging
maging

Bltrasound
Bltrasound

5adioactive iodine scans

5adioactive iodine scans

(T scan
(T scan

M5
M5

macroscopy
macroscopy

Massa abu%abu putih

Massa abu%abu putih

;atas tida$ tegas

;atas tida$ tegas

nfiltrasi $e organ parenchym

nfiltrasi $e organ parenchym

Dystrophic calcification
Dystrophic calcification

;one formation
;one formation

(ystic change
(ystic change

Tyroglossal duct cyst dapat muncul

Tyroglossal duct cyst dapat muncul

Fodal metastasis
Fodal metastasis

8at, sceletal muscle, oesofagus, laryn" dan

8at, sceletal muscle, oesofagus, laryn" dan
trachea
trachea



Tumor spread
Tumor spread

6ymmphatic chanel
6ymmphatic chanel

regional nodal
regional nodal
metastasis
metastasis

&alaupun jarang venous invasion dapat

&alaupun jarang venous invasion dapat
terjadi
terjadi

Stage grouping
Stage grouping

= A1
= A1

DA1
DA1

= A1
= A1

Stage
Stage

Any T any F M-
Any T any F M-

Stage
Stage

Any T any F M.
Any T any F M.

D A1 tahun
D A1 tahun

Stage
Stage

T. F- M- T. F- M-

Stage
Stage

T* F- M- T* F- M-

Stage
Stage

T/F-M-?T.%/F.aM- T/F-M-?T.%/F.aM-

Stage :
Stage :

TAaF-%.aM-? T.%/F.bM- TAaF-%.aM-? T.%/F.bM-

T. =*
T. =*

T* *%A
T* *%A

T/ DA
T/ DA

TAa # menyebar melebihi $apsul?subcutan

TAa # menyebar melebihi $apsul?subcutan
tissue, laryn", trachea, esofagus recurrent
tissue, laryn", trachea, esofagus recurrent
laryngeal nerve
laryngeal nerve

T Ab? prevertebral fascia? a. carotis? v.

T Ab? prevertebral fascia? a. carotis? v.
mediastinal
mediastinal

F- belum
F- belum

F. regional node metastasis

F. regional node metastasis

F.a pretracheal, paratracheal,

F.a pretracheal, paratracheal,
prelaryngeal
prelaryngeal

F.b cervical? superior mediastinal

F.b cervical? superior mediastinal

M- belum
M- belum

M. sudah metastasis jauh

M. sudah metastasis jauh

!istopatology
!istopatology

7round glass appearance

7round glass appearance

Fuclear groove
Fuclear groove

Pseudoinclusion
Pseudoinclusion

Papillary arcitecture
Papillary arcitecture

Metaplasia sGuamosa
Metaplasia sGuamosa

Psammoma bodies
Psammoma bodies





imunnochemistry
imunnochemistry

(yto$eratin
(yto$eratin

Tyroglobulin and tyroid transcription factor%

Tyroglobulin and tyroid transcription factor%
. 4TT8%.9
. 4TT8%.9

:ariant
:ariant

8ollicular variant
8ollicular variant

Macrofollicular variant
Macrofollicular variant

'ncocytic variant
'ncocytic variant

(lear cell variant

(lear cell variant

Difuse sclerosing variant

Difuse sclerosing variant

Tall cell variant

Tall cell variant

(olumnnar cell variant

(olumnnar cell variant

Solid variant
Solid variant

7rading
7rading

&ell diffferentiated
&ell diffferentiated

Tumor necrosis, vascular invasion,

Tumor necrosis, vascular invasion,
mitosis, inti atipia
mitosis, inti atipia

prognosis yang buru$

prognosis yang buru$

!istogenesis
!istogenesis

8ollicular cell
8ollicular cell

Somatic genetic
Somatic genetic

50T,PT( rearrangement
50T,PT( rearrangement

.-G...*
.-G...*

Prognostic and predictive factor
Prognostic and predictive factor

.-ysr
.-ysr

E-2
E-2

E)2untu pasien muda

E)2untu pasien muda

Bsia
Bsia

Stadium
Stadium

:ariant
:ariant

tall cell dan columnar

tall cell dan columnar

buru$.
buru$.

8ollicullar carcinoma
8ollicullar carcinoma

Keganasan tyroid yang menunju$$an

Keganasan tyroid yang menunju$$an
deferensiasi sel%sel foli$el.
deferensiasi sel%sel foli$el.

Tanda#
Tanda#

nvasi $e $apsul
nvasi $e $apsul

nvasi $e pembuluh darah

nvasi $e pembuluh darah


munohisto$imia
munohisto$imia

5ea$tif terhadaf
5ea$tif terhadaf

Tyroglobulin
Tyroglobulin

TT8%.
TT8%.

Derajat invasi
Derajat invasi

Minimally
Minimally

@idely
@idely

Metastasis
Metastasis

Tulang teng$ora$
Tulang teng$ora$

Tulang panjang
Tulang panjang

Tulang vertebra
Tulang vertebra

Paru%paru
Paru%paru

dll
dll

Poorly differentiated
Poorly differentiated

nsular carcinoma
nsular carcinoma

Bsia lebih tua dari $elompo$ @ell

Bsia lebih tua dari $elompo$ @ell
differentiated
differentiated

7roosly invasive
7roosly invasive

nsular pattern
nsular pattern

Periteliomatoiu
Periteliomatoiu
s pattern
s pattern

munohisto$imia
munohisto$imia

5ea$tif# tyroglobulin dan TT8%.

5ea$tif# tyroglobulin dan TT8%.

Tida$
Tida$

calcitonin
calcitonin

TT8%.
TT8%.

trabecular
trabecular

Mi$ros$opis
Mi$ros$opis

nsular pattern
nsular pattern

Peritheliomatous pattern
Peritheliomatous pattern

Bndifferentiated carcinoma
Bndifferentiated carcinoma

Hanaplati$
Hanaplati$

Tua
Tua

7ejala# hoarseness, dysphagia, dyspneu

7ejala# hoarseness, dysphagia, dyspneu

7ross# highly necrotic and hemorrhagic

7ross# highly necrotic and hemorrhagic
solid tumor
solid tumor


type
type

Spindel
Spindel

7iant cell
7iant cell

Kebanya$an dari transformasi dari tipe

Kebanya$an dari transformasi dari tipe
@ell differentiated#
@ell differentiated#

Papillary ca
Papillary ca

8ollicular ca
8ollicular ca

Poorly diff ca
Poorly diff ca

!arapan hidup < bulan

!arapan hidup < bulan

stru$tur vital
stru$tur vital
pada leher
pada leher

Medullary carcinoma
Medullary carcinoma

Keganasan berasal dari sel (

Keganasan berasal dari sel (

H solid carcinoma? hialin carcinoma? (%cell

H solid carcinoma? hialin carcinoma? (%cell
carcinoma
carcinoma

Solid proliferation of round to polygonal

Solid proliferation of round to polygonal
cells of granular amphophilic cytoplasm
cells of granular amphophilic cytoplasm
and medium nucleus
and medium nucleus

Dipisah$an highly vascular stroma,

Dipisah$an highly vascular stroma,
$olagen dan amyloid
$olagen dan amyloid






munohisto$imia
munohisto$imia

calcitonin.TT8%., chromogranin >,(0A

calcitonin.TT8%., chromogranin >,(0A

(0A>
(0A>

bentu$
bentu$

Sporadic )-2
Sporadic )-2

A1 tahun
A1 tahun

8amilial *-2
8amilial *-2

/1 tahun
/1 tahun

Dihubung$an dengan M0F A,;

Dihubung$an dengan M0F A,;

50T mutation
50T mutation

Penyebaran
Penyebaran

Kgb leher dan mediastinum

Kgb leher dan mediastinum

Paru, liver, s$eletal

Paru, liver, s$eletal


Pengobatan
Pengobatan

Tyroidectomy> cervical lymphadenectomy

Tyroidectomy> cervical lymphadenectomy

6o$al ruccerent /12

6o$al ruccerent /12

1ysr
1ysr

+-%)-2
+-%)-2