Download - Tumor Orbita Dr Ardizal Rahman
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TUMOR dr. Ardizal Rahman, SpM
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Tumor Palpebra dan Adneksa
• Tumor jinakMoluscum
contagiosumNevusVerukaXantelasmaHemangioma
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Gambar Hemangioma
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Tumor Ganas Palpebra
1. Epitelial
1. Karsinoma sel basal
2. Karsinoma sel skuamosa
2. Adneksa : Karsinoma sel sebacea
3. Sel Pigmen : melanoma
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Karsinoma Sel Basal• Asal : Lapisan basal epitel kulit• Frekwensi : >>• Predileksi :
Palpebra inferior Kantus internus Palpebra superior Kantus eksternus
• Bersifat lokal destuktif• Jarang bermetastasis• Angka kematian : 2 – 3 %• Diagnosis pasti biopsi• Bersifat radiosensitif
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Klasifikasi Berdasarkan klinis dan Patologi
• Tipe nodular
• Tipe multisentrik
• Tipe morphea
• Tipe ulserativa
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Pengobatan / Tindakan
• Non bedah : Radioterapi Kemoterapi Interferon
• Bedah Eksisi dengan potong beku Bedah mikrografi cara MOHS Bedah dengan laser CO2 Eksisi tanpa potong beku
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• Terbatas pada adneksa Eksisi 3 – 5 mm batas makroskopis
• Menginvasi orbita Eksentrasi Radioterapi
• Invasi intrakranial Konsultasi bedah syaraf
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Gambar Basalioma
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Karsinoma Sel Skuamosa• Frekwensi < 5%• Asal : kelopak mata < konjungtiva• Pralesi berupa papiloma, berbenjol-benjol,
ulserasi• Invasi intra okuler, orbita• Metastasis KGB regional• Metastasis jauh• Angka kematian cukup tinggi
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Pengobatan / Tindakan1. Operasi
1. Eksisi2. Enukleasi3. Eksenterasi orbita4. Debulking
2. Radioterapi3. Sitostatik4. Kombinasi
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I. Kelopak mata1. Eksisi 6-7 mm batas makroskopis2. Invasi orbita
1. Tanpa pembesaran KGB Eksentrasi dan radioterapi
2. Pembesaran KGB Eksenterasi, diseksi KGB regional,radioterapi
3. Invasi intrakranial : konsultasi bedah syaraf4. Metastasis jauh : sitostatik
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II. Konjungtiva Bulbi1. 1-2 mm : eksisi dan krioterapi
2. 2-5 mm : enukleasi bulbi
3. > 5 mm : eksentrasi
Gambar Skuamos Sel Karsinoma
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Tumor Intra OkulerA. Jinak
1. Nevus
2. Angioma retina
3. Hemangioma koroid
B. Ganas
1. Melanoma Ganas
2. Retinoblastoma
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Retinoblastoma• Usia < 4 tahun• 30% bilateral• 94% mutasi somatik, 6% mutasi
gen• Berawal dari retina
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Gambaran Mikroskopis• Sel-sel kecil, bulat atau poligonal, inti
besar, sedikit sitoplasma, kadang-kadang berbentuk bunga mawar
• Pertumbuhan Endofitik Eksofitik
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Gejala Klinis - DD1. Leukokoria
1. Katarak2. Endoftalmitis3. Ablasio retina4. Coats diseases
2. Strabismus3. Hifema spontan4. Proptosis
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Pembagian Stadium1. Tumor terbatas pada bola
a. Dini : Leukokoria (-)
b. Advance intra okuler : leukokoria +
2. Proptosis
a. Tanpa pembesaran kel lymph regional
b. Disertaipembesaran kel lymph regional
3. Tumor dengan metastasis jauh
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TerapiA. Operasi
B. Penyinaran
C. Fotokoagulasi
D. Cryoterapi
E. Khemoterapi
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Diagnosis dan Penatalaksanaan Retinoblastoma
Apa itu Retinoblastoma ?Kenapa terjadi ?Gejala klinis ?
Pemeriksaan ? Klasifikasi ?
Diagnosis banding ?Penatalaksanaan ?
Prognosis ?
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Retinoblastoma : Tumor ganas primer
intraokuler
Insiden : 1:14 000 s/d 1:34 000 lahir hidup
Insiden di RS M Djamil : 125 kasus pada
tahun 1988-2005
75% Unilateral
25% Bilateral
10% ada riwayat keluarga
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Gambaran KlinisGambaran Klinis
Leukokoria 60%
Strabismus 20%
Glaukoma Sekunder
Inflamasi orbita
Gejala invasi ke orbita
Metastasis ke kelenjer limfe & otak
Peningkatan T I K
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KLASIFIKASI KLASIFIKASI
GROUP A B
1 Tumor Soliter, 4 DD / belakang ekuator
Tumor multiple, 4 DD / belakang ekuator
2 Tumor Soliter, 4 – 10 DD / belakang Ekuator
Tumor Multiple, 4 – 10 DD / Belakang Ekuator
3 Lesi anterior sampai ekuator Tumor Soliter 10 DD Posterior sampai ekuator
4 Tumor Multiple > 10 DD Lesi anterior ke ora serata
5 Tumor Masif ½ atau > Retina Vitreus Seeding
Klasifikasi Reese - Ellsworth.
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Klassifikasi Abraham Intra okuler Orbita Nervus Optikus Metastasis intrakranial Metastasis Hematogen
Klasifikasi St Yude Hospital
Tumor terbatas pada retina
Tumor terbatas pada bola mata
Tumor ekstraokuler
Metastasis jauh
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Klasifikasi di RS Dr M.Djamil Padang
Tumor terbatas pada bola mataTanpa leukokoriaDengan leukokoria
ProptosisMetastasis jauh
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Diagnosis Banding
Primer hiperplasia vitreous persisten
Coat’s disease
Toksokariasis
Uveitis intermedia
Displasia retina
Retinositoma
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PENYEBARAN Intra okuler
Nervus Optikus
Invasi Koroid
Kelenjer limfe regional
Rongga orbita Proptosis
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PenatalaksanaanFotokoagulasi
Krioterapi
Radioterapi
Kemoterapi
EnukleasiPenatalaksanaan berdasarkan
ukuran tumorTumor kecilTumor mediumTumor besarTumor meluas ekstraokulerTumor bermetastasis jauh
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• Tumor Kecil– FOTOKOAGULASI– KRIOTERAPI
• Tumor Medium– Brakiterapi– Kemoterapi– Radioterapi
• Tumor Besar– Kemoterapi– Enukleasi bulbi
Tumor yang sudah meluas ke jaringan ekstraokuler
EksenterasikemoterapiRadioterapi
Tumor bermetastasis jauh
kemoterapi
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TUMOR INTRA RETINAL
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TUMOR INTRAOKULER
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TUMOR DENGAN PROPTOSIS
TUMOR DENGAN METASTASE
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TUMOR ORBITA• Proptosisa. Pemeriksaan
1. Anamnesis2. Pemeriksaan
1. Pemeriksaan mata1. Visus2. Inspeksi: posisi dan gerakan3. Hertel4. Palpasi5. Slit lamp6. Funduskopi7. TIO
2. Pemeriksaan Kelenjer Lymph regional
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Pemeriksaan Penunjang
Laboratorium
USG
CT Scan
Patologi Anatomi
Konsultasi
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TUMOR ORBITA
A. Primer1. Koristoma : kista dermoid, epidermoid, teratoma
2. Hamartoma : Hemangioma, limfangioma, fakomatosis
3. Tumor mesenkimal : fibroma, fibrosarkoma, fibrous Histiositoma
4. Tumor syaraf : neurofibroma, Schwannoma, Glioma saraf optik, meningioma
B. Sekunder1. Retinoblastoma2. Neuroblastoma3. Ewings Tumor