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KEGANASAN P LEURA

Sabrina Ermayanti. KEGANASAN P LEURA. Bagian Pulmonologi dan Kedokteran Respirasi FK Unand. Structure of the Thoracic Cavity. Pleural Anatomy. Lungs are surrounded by thin tissue cal l ed the pleura , a continuous membrane that folds over itself Parietal pleura lines the chest wall

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KEGANASAN P LEURA

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  1. Sabrina Ermayanti KEGANASAN PLEURA BagianPulmonologidanKedokteranRespirasi FK Unand

  2. Structure of the Thoracic Cavity

  3. Pleural Anatomy • Lungs are surrounded by thin tissue calledthe pleura, a continuous membrane that folds over itself • Parietal pleura lines the chest wall • Visceral pleura covers the lung (sometimes called the pulmonary pleura)

  4. Schematic diagram of pleural anatomy; s.c.=systemic capillary; p.c.=pulmonary capillary

  5. SelMesothelial • selapisselmesothelial • pavement-like cells •  melapisipermukaan pleura • sel yang aktif, sensitif & responsif • terhadapberbagairangsangan • dinamik

  6. SelMesothelial Fungsi : • transportasidanpergerakancairan danpartikel • migrasileukosit responinflamasi • sintesissitokin, fcpertumbuhan & matriksekstraseluler • melepaskanfcutkmerangsang deposisidanpembersihan fibrin dan antigen

  7. Cairan Pleura Volume: Normal sedikit (+) Noppen et al.  8,4 ± 4,3 ml. Terdiridari: protein (tu. albumin,globulin, and fibrinogen) sel (tu. Selmesothelial , monocytes, and lymphocytes) Pd manusia 75% macrophages  25% lymphocytes  < 2% mesothelial cels, neutrophils and eosinophils

  8. Neoplasma Pleura • Primer • benign (jarang) • Lipoma • Fibroma • Endotheliomas • Angiomas • Cysts • malignant mesothelioma • Secondary • >> adenocarcinomaparu, GIT, ovarium

  9. MESOTELIOMA

  10. Insiden •  penggunaanasbestos stlh PD -2 [McDonald 1987] • Negara Industri :  2 per satujuta♀  10 - 30 per satujuta♂  ♂ = 10 x ♀ • Resiko >>  daerahgalangankapal • 5-7% dariorang yang terpapar asbestos • 50% tidakadariwayatterpapar asbestos

  11. Insiden • Occupational Exposureto Asbestos • AS  >> th 2004 = 2.300  paparan > th 30-60 • Eropa Barat  >> th 2018 = 9.000  > th 70 • Laten period  20 - 40 tahun • Paparan dg gedungygdiisolasi dg asbestos  sangatjarang [Hughes et al. 1986; Lilienfield 1991

  12. Gejala Umur 40 – 70 th 2/3 kasus Riwayatterpapar asbestos 20 thsebelumnya ataulebih Nyeri dada  nonpleuritik  menjalarke abdomen atas / lengan Sesaknafas >>  BB  , batukkeringdandyspnea  bbrppasien  demamtdktinggi ManifestasiKlinis

  13. Tanda Tanda –tandaefusi pleura I = cembung, pergerakantertinggal Pl = fremitus < Pk = redup – pekak A = Suaranafas -sp (-) Clubbing finger Atrial fibrillation ManifestasiKlinis

  14. PemeriksaanPenunjang • Ro thoraks • 70-95% efusi pleura • efusimasif • 50% hemitoraks • tidakjelasgambaran • tumor pleura

  15. PemeriksaanPenunjang • CT Scan toraks • pleura menebal • terutama pleura • mediastinum • irreguler • volume hemitoraks yang • kenabervariasi •  30-42% mengecil

  16. PemeriksaanPenunjang • Sitologicairan pleura • 3 Tipesel • Epithelial Type : 50 % of cases • most often confused with adenocarcinoma • Mesenchymal Type : 16 % of cases • Mixed Type : 34 % of cases

  17. PemeriksaanPenunjang • Sitologicairan pleura

  18. PemeriksaanPenunjang • MRI • Bronkoskopi • Biopsi pleura • Tertutup • Terbuka • VATS

  19. Diagnosis (2) • Cardinal Characteristics [Boutin 1998] • Age between 55 - 65 • Previous occupational exposure to asbestos • Pleural Effusion • C.T. / MRI (with nodular lesions of the parietal pleura)

  20. Staging I Confined to ipsilateral pleura II Involves chest wall, mediastinum, pericardium or contralateral pleura III Involves both thorax and abdomen or lymph nodes outside thorax IV Distant metastasis

  21. Treatment There is no single treatment which has proven effective... Surgery Radiation Chemotherapy Immunotherapy Gene Therapy

  22. Tumor metastaseke pleura • Insiden :  penyebabefusi pleura eksudat no 2 setelah parapneumoniefusi • Tumor primer • kankerparu • kankerpayudara 75% • limfoma • lain2  Ca ovarium, sarcoma, Ca lambung, Ca kolon, Ca pankreas, Ca buli2 dll

  23. ManifestasiKlinis • Gejaladantandaefusi pleura • Gejaladantanda tumor primer

  24. PemeriksaanPenunjang Ro toraks CT Scan toraks Sitologicairan pleura Biopsi pleura

  25. PemeriksaanPenunjang • Tes Immunochemical •  Adenoca  CEA; MOC-3,1; B72,3; Ber-EP4 & BG-8 • Tumor marker pd cairan pleura •  CEA; CYFRA21-1; SCC antigen;SSEA-1

  26. Penatalaksanaan • Punksicairan pleura • Kemoterapisistemik • Radioterapi • Radiasimediastinal • Pleurodesis • Indwelling Pleural catheter • Pleuro-peritoneal shunt

  27. ....Thank You....

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