kuliah TUMOR HATI baru.ppt

7/23/2019 kuliah TUMOR HATI baru.ppt

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11

TUMOR HATITUMOR HATI ALI IMRON YUSUF,SpPD,KGEH,FINASIMALI IMRON YUSUF,SpPD,KGEH,FINASIM

DIVISI GASTRO-HEPATOLOGIDIVISI GASTRO-HEPATOLOGI

BAG-I.PENYAKIT DALAM F.K. UNILA/RSUDBAG-I.PENYAKIT DALAM F.K. UNILA/RSUDDr.ABD MOELOEK BANDAR LAMPUNGDr.ABD MOELOEK BANDAR LAMPUNG



KLASIFIKASI TUMOR HATIKLASIFIKASI TUMOR HATI

JINAKJINAK GANASGANAS

Tumor EpitelialTumor Epitelial

AdenomaAdenoma

hepatoselulerhepatoseluler

KarsinomaKarsinoma

hepatoseluler (HCC)hepatoseluler (HCC)Adenoma intrahepatikAdenoma intrahepatik KarsinomaKarsinoma

fibrolamelarfibrolamelar

Sistadenoma bilierSistadenoma bilier

intrahepatikintrahepatikHepatoblastomaHepatoblastoma

apilomatosis bilierapilomatosis bilier Kolan!iokarsinomaKolan!iokarsinoma

(CC)(CC)

SistadenokarsinomaSistadenokarsinoma



KLASIFIKASI TUMOR HATIKLASIFIKASI TUMOR HATIJINAK JINAK GANASGANAS

Tumor MesenkimalTumor Mesenkimal

HemangiomaHemangioma AngisarkomaAngisarkoma

FibromaFibroma FibrosarkomaFibrosarkoma

LeiomiomaLeiomioma LeiomiosarkomaLeiomiosarkomaLipomaLipoma LiposarkomaLiposarkoma

AngiomiolipomaAngiomiolipoma RabdomiosarkomaRabdomiosarkoma

LimfangiomaLimfangioma HemangioendoteliomaHemangioendoteliomaepitelioidepitelioid

MesoteliomaMesotelioma

Tumor lainlainTumor lainlain

Hiperplasia nodularHiperplasia nodularfokal !FNH"fokal !FNH"

Tumor #ati metastasisTumor #ati metastasis

Kista #atiKista #ati



Tumor Ha! "!#a$ Tumor Ha! "!#a$

S%&a!# $!'a (a!, )a#* %r'%r!#* a+a&a(S%&a!# $!'a (a!, )a#* %r'%r!#* a+a&a(hemangiomahemangioma (%ma#*!oma $a%r#o'a.(%ma#*!oma $a%r#o'a.

Pa+a '%mua !#*$a umur, &%!( '%r!#*Pa+a '%mua !#*$a umur, &%!( '%r!#*0a#!a, &%'! 'o&!%r aau mu&!p%&, +a#0a#!a, &%'! 'o&!%r aau mu&!p%&, +a#!a'a#)a a'!moma!$. U$ura# %ra#)a$!a'a#)a a'!moma!$. U$ura# %ra#)a$a+a&a( 1 2 3m +a# '%r!#* +! '%*m%#a+a&a( 1 2 3m +a# '%r!#* +! '%*m%#

po'%r!or &ou' $a#a# '%*m%# 4 aau 5.po'%r!or &ou' $a#a# '%*m%# 4 aau 5.R%'%$'! (a#)a +!a#6ur$a# !&aR%'%$'! (a#)a +!a#6ur$a# !&am%#*a$!a$a# $%&u(a# )* %rma$#a.m%#*a$!a$a# $%&u(a# )* %rma$#a.



Kar'!#oma H%pao'%&u&%r H77Kar'!#oma H%pao'%&u&%r H77

8 Tumor *a#a' pr!m%r (a! )a#* %r'%r!#* Tumor *a#a' pr!m%r (a! )a#* %r'%r!#*

+!%mu$a#.+!%mu$a#.

8 M%&!pu! 9,4: +ar! '%&uru( $a'u' $a#$%rM%&!pu! 9,4: +ar! '%&uru( $a'u' $a#$%rma#u'!a '%ra m%#%mpa! p%r!#*$a $% 9ma#u'!a '%ra m%#%mpa! p%r!#*$a $% 9

pa+a &a$!-&a$! +a# $% ; pa+a p%r%mpua#pa+a &a$!-&a$! +a# $% ; pa+a p%r%mpua#

'%a*a! $a#$%r %r'%r!#* +! +u#!a +a#'%a*a! $a#$%r %r'%r!#* +! +u#!a +a#

urua# $% 2 +ar! $a#$%r '!'%m 'a&ura#urua# $% 2 +ar! $a#$%r '!'%m 'a&ura#3%r#a '%%&a( $a#$%r $o&or%$a& +a# $a#$%r3%r#a '%%&a( $a#$%r $o&or%$a& +a# $a#$%r

&amu#*.&amu#*.



Kar'!#oma H%pao'%&u&%r H77Kar'!#oma H%pao'%&u&%r H77

8 T!#*$a $%$%rapa# %r!#**! %r3aa +! A'!a T!#*$a $%$%rapa# %r!#**! %r3aa +! A'!a

T!mur +a# T%#**ara '%ra +! A<r!$a T%#*a(, T!mur +a# T%#**ara '%ra +! A<r!$a T%#*a(,

'%+a#*$a# )a#* %r%#+a( +! Eropa Uara,'%+a#*$a# )a#* %r%#+a( +! Eropa Uara,

Am%r!$a T%#*a(, Au'ra&!a, +a# S%&a#+!a Baru.Am%r!$a T%#*a(, Au'ra&!a, +a# S%&a#+!a Baru.

8 S%$!ar =>: $a'u' H77 +! +u#!a %ra+a +!S%$!ar =>: $a'u' H77 +! +u#!a %ra+a +!

#%*ara %r$%ma#* '%p%r! A'!a T!mur, A'!a#%*ara %r$%ma#* '%p%r! A'!a T!mur, A'!a

T%#**ara, +a# A<r!$a T%#*a( )a#* +!$%a(u! T%#**ara, +a# A<r!$a T%#*a( )a#* +!$%a(u!

'%a*a! 0!&a)a( +%#*a# pr%a&%#'! !#**!'%a*a! 0!&a)a( +%#*a# pr%a&%#'! !#**!

(%pa!!' !ru'.(%pa!!' !ru'.



Kar'!#oma H%pao'%&u&%rKar'!#oma H%pao'%&u&%r

H77H778 H77 6ara#* +!%mu$a# pa+a u'!a mu+a.H77 6ara#* +!%mu$a# pa+a u'!a mu+a.

8 Umum#)a +! 0!&a)a( +%#*a#Umum#)a +! 0!&a)a( +%#*a#

$%$%rapa# H77 !#**! , $a'u' H77 &a$!-$%$%rapa# H77 !#**! , $a'u' H77 &a$!-&a$! &%!( a#)a$ +ar!pa+a p%r%mpua#&a$! &%!( a#)a$ +ar!pa+a p%r%mpua#

'%ra umur pa'!%# ?>-@> ( &%!( mu+a'%ra umur pa'!%# ?>-@> ( &%!( mu+a

+ar!pa+a pa'!%# +! 0!&a)a( +%#*a#+ar!pa+a pa'!%# +! 0!&a)a( +%#*a#

$%$%rapa# H77 r%#+a(.$%$%rapa# H77 r%#+a(.



Fa$or R%'!$o H77Fa$or R%'!$o H77

8 HBVHBV

Kar'!#o*%#!'!a' HBV %r(a+ap (a!Kar'!#o*%#!'!a' HBV %r(a+ap (a!

mu#*$!# m%&a&u! pro'%' !#ama'!mu#*$!# m%&a&u! pro'%' !#ama'!$ro#!$, p%#!#*$aa# pro&!<%ra'!$ro#!$, p%#!#*$aa# pro&!<%ra'!

(%pao'!, !#%*ra'! HBV DNA $%(%pao'!, !#%*ra'! HBV DNA $%

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+%#*a# *%# p%#6amu.+%#*a# *%# p%#6amu.




8 H7VH7V

D! 0!&a)a( +%#*a# !#*$a !#<%$'! HBVD! 0!&a)a( +%#*a# !#*$a !#<%$'! HBV

r%#+a(, H7V m%rupa$a# <a$or r%'!$or%#+a(, H7V m%rupa$a# <a$or r%'!$op%#!#* +ar! H77.p%#!#* +ar! H77.

H%pao$ar'!#o*%#%'!' a$!a !#<%$'!H%pao$ar'!#o*%#%'!' a$!a !#<%$'!

H7V +!+u*a m%&a&u! a$!a'H7V +!+u*a m%&a&u! a$!a'#%$ro!#ama'! $ro#!$ aau '!ro'!' (a!.#%$ro!#ama'! $ro#!$ aau '!ro'!' (a!.




8 S!ro'!' Ha!S!ro'!' Ha!

M%rupa$a# <a$or r%'!$o uama H77 +! +u#!aM%rupa$a# <a$or r%'!$o uama H77 +! +u#!a

+a# m%&aar%&a$a#*! &%!( +ar! =>: $a'u'+a# m%&aar%&a$a#*! &%!( +ar! =>: $a'u'H77. S%!ap a(u# 2-9:, pa'!%# SH a$a#H77. S%!ap a(u# 2-9:, pa'!%# SH a$a#

m%#+%r!a H77 +a# H77 m%rupa$a#m%#+%r!a H77 +a# H77 m%rupa$a#

p%#)%a $%ma!a# uama pa+a SH. Pr%+!$orp%#)%a $%ma!a# uama pa+a SH. Pr%+!$or

uama H77 pa+a SH a+a&a( 6%#!' $%&am!# &a$!-uama H77 pa+a SH a+a&a( 6%#!' $%&am!# &a$!-

&a$!, $a+ar AFP '%rum, %ra#)a p%#)a$!&a$!, $a+ar AFP '%rum, %ra#)a p%#)a$!

+a# !#**!#)a a$!a' pro&!<%ra'! '%& (a!.+a# !#**!#)a a$!a' pro&!<%ra'! '%& (a!.




8 Aao$'!#Aao$'!#

Dar! p%r3oaa# !#aa#* +!$%a(u!Dar! p%r3oaa# !#aa#* +!$%a(u!

a(0a Aao$'!# B? %r'!<aa(0a Aao$'!# B? %r'!<a$ar'!#o*%#!$. Sa&a( 'au m%$a#!'m%$ar'!#o*%#!$. Sa&a( 'au m%$a#!'m%(%pao$ar'!#o*%#%'!'#)a !a&a((%pao$ar'!#o*%#%'!'#)a !a&a($%mampua# AFB? m%#*!#+u$'! mua'!$%mampua# AFB? m%#*!#+u$'! mua'!

pa+a $o+o# @C; +ar! *%# 'upr%'orpa+a $o+o# @C; +ar! *%# 'upr%'orumor p92.umor p92.

D!pro+u$'! 6amur A'p%r*!&&u'.D!pro+u$'! 6amur A'p%r*!&&u'.




8 O%'!a'O%'!a'

O%'!a' m%rupa$a# <a$or uama NAFLDO%'!a' m%rupa$a# <a$or uama NAFLD$(u'u'#)a NASH )a#* +apa %r$%ma#* m%#6a+!$(u'u'#)a NASH )a#* +apa %r$%ma#* m%#6a+!

'!ro'!' (a! +a# +apa %r&a#6u m%#6a+! H77.'!ro'!' (a! +a# +apa %r&a#6u m%#6a+! H77.8 DMDM

M%rupa$a# <a$or r%'!$o p%#)a$! (a! $ro#!$M%rupa$a# <a$or r%'!$o p%#)a$! (a! $ro#!$maupu# H77 m%&a&u! %r6a+!#)a p%r&%ma$a# (a!maupu# H77 m%&a&u! %r6a+!#)a p%r&%ma$a# (a!+a# NASH. "u*a +!(uu#*$a# +%#*a# p%#!#*$aa#+a# NASH. "u*a +!(uu#*$a# +%#*a# p%#!#*$aa#$a+ar !#'u&!# +a# !#'u&!#-&!$% *ro0( <a3or' IGF'$a+ar !#'u&!# +a# !#'u&!#-&!$% *ro0( <a3or' IGF')a#* m%rupa$a# <a$or promo!< po%#'!a& u#u$)a#* m%rupa$a# <a$or promo!< po%#'!a& u#u$$a#$%r.$a#$%r.




8 A&$o(o&A&$o(o&

8 Fa$or r%'!$o &a!# p%#)a$! (a! auo!mu#Fa$or r%'!$o &a!# p%#)a$! (a! auo!mu#

(%pa!!' auo!mu#, PB7'!ro'!' !&!%r(%pa!!' auo!mu#, PB7'!ro'!' !&!%rpr!m%r, p%#)a$! (a! m%ao&!$pr!m%r, p%#)a$! (a! m%ao&!$

(%mo$romao'!' *%#%!$, +%'!%#'!(%mo$romao'!' *%#%!$, +%'!%#'!

a#!r!p'!#a#!r!p'!# -?, p%#)a$! !&'o#,+&&,-?, p%#)a$! !&'o#,+&&,

$o#ra'%p'! ora&, '%#)a0a $!m!a T(orora',$o#ra'%p'! ora&, '%#)a0a $!m!a T(orora',!#!& $&or!+a,#!ro'am!#, !#'%$!'!+a!#!& $&or!+a,#!ro'am!#, !#'%$!'!+a

or*a#o$&or!#, a'am a#!$, +a# %ma$au.or*a#o$&or!#, a'am a#!$, +a# %ma$au.



Kara$%r!'!$ K&!#!' H77Kara$%r!'!$ K&!#!' H77

8 D! I#+o#%'!a $(u'u'#)a "a$ara H77D! I#+o#%'!a $(u'u'#)a "a$ara H77

+!%mu$a# %r'%r!#* pa+a m%+!a#+!%mu$a# %r'%r!#* pa+a m%+!a#

umur a#ara 9> +a# 4> a(u# +%#*a#umur a#ara 9> +a# 4> a(u# +%#*a#pr%+om!#a'! pa+a &a$!-&a$!.pr%+om!#a'! pa+a &a$!-&a$!.

8 G%6a&a )a#* pa&!#* '%r!#* +!$%&u($a#G%6a&a )a#* pa&!#* '%r!#* +!$%&u($a#

a+a&a( #)%r! aau p%ra'aa# !+a$a+a&a( #)%r! aau p%ra'aa# !+a$#)ama# +! $ua+ra# $a#a# aa'#)ama# +! $ua+ra# $a#a# aa'

a+om%#.a+om%#.



Kara$%r!'!$ K&!#!' H77Kara$%r!'!$ K&!#!' H77

8 Pa'!%# '!ro'!' (a! )a#* ma$!# m%muru$Pa'!%# '!ro'!' (a! )a#* ma$!# m%muru$

$o#+!'!#)a, +!'%ra! $%&u(a# #)%r! $ua+ra#$o#+!'!#)a, +!'%ra! $%&u(a# #)%r! $ua+ra#

$a#a# aa', aau %raa p%m%#*$a$a#$a#a# aa', aau %raa p%m%#*$a$a#&o$a& +! (%par pau +!3ur!*a! m%#+%r!a&o$a& +! (%par pau +!3ur!*a! m%#+%r!a

H77.H77.

8 Pa'!%# p%#)a$! (a! $ro#!$ +%#*a# HB'A*Pa'!%# p%#)a$! (a! $ro#!$ +%#*a# HB'A*

aau a#!-H7V po'!!< )a#* m%#*a&am!aau a#!-H7V po'!!< )a#* m%#*a&am!p%ruru$a# $o#+!'! '%3ara m%#+a+a$.p%ruru$a# $o#+!'! '%3ara m%#+a+a$.



Kara$%r!'!$ K&!#!' H77Kara$%r!'!$ K&!#!' H77

8 T%mua# '!' %r'%r!#* a+a&a( T%mua# '!' %r'%r!#* a+a&a(

(%paom%*a&!, +%#*a# aau a#pa(%paom%*a&!, +%#*a# aau a#pa

ru! (%pa!$, 'p&%#om%*a&!, a'!%',ru! (%pa!$, 'p&%#om%*a&!, a'!%',!$%ru', +%mam +a# aro oo!$%ru', +%mam +a# aro oo



P%m%r!$'aa# P%#)ar!#*P%m%r!$'aa# P%#)ar!#*

8 P%#a#+a umorP%#a#+a umor

Ka+ar AFP m%#!#*$a pa+a 4>-5>: +ar!Ka+ar AFP m%#!#*$a pa+a 4>-5>: +ar!

pa'!%# H77 +a# $a+ar &%!( +ar! C>> #*/mLpa'!%# H77 +a# $a+ar &%!( +ar! C>> #*/mLa+a&a( +!a*#o'!' aau 'a#*a 'u*%'!<a+a&a( +!a*#o'!' aau 'a#*a 'u*%'!<

u#u$ H77. N!&a! #orma& +apa +!%mu$a#u#u$ H77. N!&a! #orma& +apa +!%mu$a#

6u*a pa+a H77 'a+!um &a#6u. Ha'!& po'!!< 6u*a pa+a H77 'a+!um &a#6u. Ha'!& po'!!<

pa&'u +apa 6u*a +!%mu$a# pa+a (%pa!!'pa&'u +apa 6u*a +!%mu$a# pa+a (%pa!!'a$u aau $ro#!$ +a# pa+a $%(am!&a#.a$u aau $ro#!$ +a# pa+a $%(am!&a#.



p%#a#+a umorp%#a#+a umor

P%#a#+a umor &a!##)a u#u$ H77 )a!u +%'-P%#a#+a umor &a!##)a u#u$ H77 )a!u +%'-

*amma 3aro) pro(rom!# D7P aau*amma 3aro) pro(rom!# D7P aau

PIVKA-@ )a#* $a+ar#)a m%#!#*$a (!#**aPIVKA-@ )a#* $a+ar#)a m%#!#*$a (!#**a

;?: pa'!%# H77, #amu# 6u*a +apa;?: pa'!%# H77, #amu# 6u*a +apa

m%#!#*$a pa+a +%'!%#'! !am!# K,m%#!#*$a pa+a +%'!%#'! !am!# K,

(%pa!!' $ro#!$ a$!< aau m%a'a'!'(%pa!!' $ro#!$ a$!< aau m%a'a'!'

$ar'!#oma.$ar'!#oma.

P%#a#+a umor )* &a!# '%p%r! AFP-L2 'uauP%#a#+a umor )* &a!# '%p%r! AFP-L2 'uau

'u'ra$'! AFP,'u'ra$'! AFP, -L <u3o'!+a'% '%rum, +&&.-L <u3o'!+a'% '%rum, +&&.



P%m%r!$'aa# P%#)ar!#*P%m%r!$'aa# P%#)ar!#*

8 USGUSG

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u&a#. U#u$ umor $%3!& pa+a pa'!%#u&a#. U#u$ umor $%3!& pa+a pa'!%#+%#*a# r%'!$o !#**!, USG &%!(+%#*a# r%'!$o !#**!, USG &%!(

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D!a*#o'!'D!a*#o'!'

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Kr!%r!a '!o-(!'o&o*!'Kr!%r!a '!o-(!'o&o*!'

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(a!(a!

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Kr!%r!a $om!#a'! 'au 3ara !ma*!#* +%#*a# $a+arKr!%r!a $om!#a'! 'au 3ara !ma*!#* +%#*a# $a+ar

AFP '%rumAFP '%rum

- &%'! <o$a& J @ 3m +%#*a# (!p%ra'$u&ar!'a'!- &%'! <o$a& J @ 3m +%#*a# (!p%ra'$u&ar!'a'!ar%r!a&ar%r!a&





T%rap! T%rap!

8 R%'%$'! (%pa!$R%'%$'! (%pa!$

P!&!(a# uama u#u$ pa'!%# #o# '!ro'!'P!&!(a# uama u#u$ pa'!%# #o# '!ro'!'

+%#*a# <u#*'! (a! #orma&.+%#*a# <u#*'! (a! #orma&.Ko#ra!#+!$a'! !#+a$a# m%a'a'!'Ko#ra!#+!$a'! !#+a$a# m%a'a'!'

%$'ra(%pa!$, H77 +!<u' aau mu&!<o$a&,%$'ra(%pa!$, H77 +!<u' aau mu&!<o$a&,

'!ro'!' 'a+!um &a#6u, +a# p%#)a$!'!ro'!' 'a+!um &a#6u, +a# p%#)a$!

p%#)%ra )a#* +apa m%mp%#*aru(!p%#)%ra )a#* +apa m%mp%#*aru(!$%a(a#a# pa'!%# m%#6a&a#! op%ra'!.$%a(a#a# pa'!%# m%#6a&a#! op%ra'!.



T%rap! T%rap!

8 Tra#'p&a#a'! (a! Tra#'p&a#a'! (a!

8 A&a'! umor p%r$ua#A&a'! umor p%r$ua#

8 T%rap! Pa&!a!< T%rap! Pa&!a!< TAE/TA7E ra#'ar%r!a& %mo&!a!o#/3(%mo TAE/TA7E ra#'ar%r!a& %mo&!a!o#/3(%mo

%mo&!a!o# pa+a H77 'a+!um%mo&!a!o# pa+a H77 'a+!um

m%#%#*a(-&a#6u m%#u#6u$$a# p%#uru#a#m%#%#*a(-&a#6u m%#u#6u$$a# p%#uru#a#

p%rumu(a# umor '%ra +apap%rumu(a# umor '%ra +apam%#!#*$a$a# (arapa# (!+up pa'!%# H77m%#!#*$a$a# (arapa# (!+up pa'!%# H77

)a#* !+a$ r%'%$a%&.)a#* !+a$ r%'%$a%&.



kuliah TUMOR HATI baru.ppt

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