07 tumor leher (edit 2011)
DESCRIPTION
Tumor Leher (Edit 2011)TRANSCRIPT
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TUMOR LEHER
Prof. Dr. dr. Widodo Ario Kentjono, Sp.THT-KL (K)
Dept/SMF Ilmu Kesehatan Telinga Hidung Tenggorok Bedah Kepala dan Leher
FK Universitas AirlanggaRSUD Dr. Soetomo
Surabaya
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NEOPLASMA◦Primer◦Metastasis regional
KONGENITAL INFLAMASI Lain-lain
TUMOR LEHER
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NODUL LIMFOID/KGB di KEPALA & LEHER
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Primer :◦ Jinak : Adenoma pleomorfik kel. parotis,
nodul/kista tiroid, lipoma◦Ganas : KSS/adenokarsinoma tiroid,
rabdomiosarkoma, Limfoma maligna Metastasis :
◦ Karsinoma nasofaring (KNF) : paling banyak◦Karsinoma rongga mulut◦Karsinoma laring, dll
NEOPLASMA
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Kista brankialisKista duktus tiroglosusLimfangioma/HemangiomaKista timusKista dermoid
KONGENITAL
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Terdapat 300/800 nodul getah bening di daerah kepala dan leher
Limfadenopati : (nyeri tekan, kadang hiperemi)◦Bakteri (Tonsilitis akut/kronik)◦Virus◦TBC (multipel, terjadi pengejuan, pecah)
Sialadenitis :◦Parotis◦Submaksila
Jamur
INFLAMASI
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Laringokel (membesar kalau mengejan)
Divertikulum faring (kantong)
LAIN-LAIN
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Nodul leher sering terjadi pada anak. Nodul kecil yang mobil serta tidak
bertambah besar sering terjadi pada anak muda.
Benjolan leher yang persisten atau bertambah besar pada dewasa perlu pemeriksaan lebih lanjut.
Benjolan leher pada dewasa/orang tua dianggap ganas kecuali terbukti sebaliknya.
Beberapa Pedoman
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Anamnesis yang lengkap dan seksama
Pemeriksaan fisik yang lengkap
FNAB (fine needle aspiration biopsy)
CT Scan atau MRI
LANGKAH PEMERIKSAAN
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Neoplasma Primer :◦ Kista brankial (bisa terinfeksi)◦ Limfoma maligna (Hodgkin’s/non Hodgkin’s)
Metastasis : Sesuai aliran limfe
◦ KNF tu. Leher yg letaknya di bawah ujung tulang mastoid, di belakang arkus mandibula, sebelah medial m. sternokleidomastoid
◦ Kars. rongga mulut KGB level I dan II ◦ Kars. hipofaring, laring KGB level II, III,
dan IV
TUMOR LEHER LATERAL
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Kongenital : kista duktus tiroglosus Neoplasma :
Submandibula : tumor kelenjar ludahTumor tiroid : (bergerak waktu menelan)◦ Jinak : nodul tiroid◦ Ganas : karsinoma tiroid
TUMOR LEHER MEDIAL
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A
C
B
A : kista terinfeksi
B : abses
C : metastasis Ca
+ CT scan
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KISTA BRANKIALIS
TUMOR JINAK
LIPOMA LEHER
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A
B
C
A : TUMOR TIROID
B : TUMOR TIROID
C : KISTA DUKTUS
TIROGLOSUS
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PERLUASAN TUMOR GANAS
KARSINOMA RONGGA MULUT
KARSINOMA LARING
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KARSINOMA LIDAH
KARSINOMA PAROTISKARSINOMA RONGGA MULUT
TUMOR GANAS
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TUMOR LEHER PADA KARSINOMA NASO FARING (KNF)
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TUMOR LEHER PADA KARSINOMA NASO FARING (KNF)
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BIOPSI TUMOR DI NASOFARING
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Untuk mengetahui histopatologi tumor metastasis di KGB leher
AmanMurahCepat (sehari selesai)
FNAB
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Tidak dianjurkan untuk tumor metastasis di leher, o.k :◦perdarahan hebat◦timbul luka terbuka◦penyebaran tumor (metastasis jauh)
prognosis semakin buruk
BIOPSI INSISI/EKSISI
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Tumor leher sering ditemukan Pada anak biasanya jinak Pada dewasa/orang tua harus waspada
bila penyebab tidak jelas Anamnesis yang lengkap, pemeriksaan
fisik, biopsi tumor primer, FNAB untuk tumor sekunder/metastasis, radiologi
Hindari biopsi insisi/eksisi pada tumor metastasis di KGB leher
RINGKASAN
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Terimakasih