Squamous cell carcinoma of the lung

Bronchial epithelium

95% tumor primer paru berasal dari epitel bronkus ( karsinoma bronkogenik)

Klasifikasi karsinoma bronkogenik

1. Non small cell lung carcinoma (NSCLC) (70-75%) 1. SCC (25-30%) 2. Adenokarsinoma (30-35%) 1. Acinar 2. Papilary 3. Solid with mucus production 4. Bronchioloalveolar carcinoma 3. Karsinoma sel besar (10-15%) 2. Karsinoma sel kecil (20-25%) ( neuroendocreine tumor) 3. Pola kombinasi (5-10%)

Prinsip umum tumor paru

1. Pembagian NSCLC dan SCLC adalah untuk untuk tujuan pengobatan 2. SCLC lebih cocok kemoterapi, karena hampir semua SCLC telah bermetastasi saat terdiagnosis, sedangkan NSCLC tidak berespon terhadap kemoterapi dan sebaiknya ditangani dengan bedah 3. SCLC ditandai dengan mutasi gen TP 53 dan RB, sedangkan NSCLC lebih sering terjadi inaktivasi p16/CDKN2, pengaktian K-RAS banyak terjadi pada jenis NSLC yang adenokarsinoma

Penyebab
Genetik, rokok, gas industri, pulusi udara, TB, COPD

Clinical feature 1. Dyspnea, weight loss, chest pain,hemoptysis, produksi sputum ( gejala umum tumor paru yang pertumbuhannya di di sentral atau endobroncial 2. Male 3. Smoking 4. Mutasi p53, gene RB-1, p16(INK4a), EGFR 5. Arise in segmental or terminal bronchi

Makros Appearance
1. Most squamous cell carcinomas arise in the central portion of the lung from the major or segmental bronchi, although 10% originate in the periphery. 2. Firm, grey-white, 3- to 5-cm ulcerated lesions, which extend through the bronchial wall into the adjacent parenchyma. 3. Necrosis and hemorrhage. 4. Central cavitation is frequent. 5. On occasion, a central squamous carcinoma occurs as an endobronchial tumor.

Microscopic appearance

1.

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3. 4.

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The microscopic appearance of squamous cell carcinoma is highly variable. Well-differentiated squamous cell carcinomas display keratin pearls, which are eosinophilic aggregates of keratin surrounded by concentric (onion skin) layers of squamous cells . Individual cell keratinization also occurs, in which a cell's cytoplasm assumes a glassy, intensely eosinophilic appearance. Intercellular bridges are identified in some well-differentiated squamous cancers as slender gaps between adjacent cells, which are traversed by fine strands of cytoplasm. By contrast, some squamous tumors are so poorly differentiated that they show no foci of keratinization and are difficult to distinguish from large cell, small cell, or spindle cell carcinomas. Tumor cells may be readily found in the sputum, in which case the diagnosis is made by exfoliative cytology.

Perjalanan SCC
a. b. c. d. Paparan rokok hiperplasia sel goblet Hiperplasia sel basal Metaplasia sel skuamosa Dysplasia skuamosa (ditandai dengan hilangnya polaritas nucleus, pleomorfisme, dan gambaran mitotik e. CIS ( membaran basal masih intak) f. Ca Invasive

Bronchiolo-alveolar carcinoma

As compared to SCC 1. More peripher 2. Smaller 3. Grow more slowly 4. Less frequent associated with history of smoking 5. Tend to metastasize widely and early

1. Women 2. Non Smoker Hyperplasia adenomatosa atypical K-RAS mutation

Makros 1. occurs in the pulmonary parenchyma in the terminal bronchioloalveolar 2. peripheral portions of the lung either as a single nodule or, more often, as multiple diffuse nodules that sometimes coalesce to produce a pneumonia-like consolidation 3. parenchymal nodules have a mucinous, gray translucence when secretion is present but otherwise appear as solid, gray-white areas
Mikros 1. the tumor is characterized by a pure bronchioloalveolar growth pattern with no evidence of stromal, vascular, or pleural invasion 2. growth along preexisting structures without destruction of alveolar architecture. This growth pattern has been termed "lepidic," an allusion to the neoplastic cells resembling butterflies sitting on a fence 3. Two thirds of tumors are nonmucinous, consisting of Clara cells and type II pneumocytes, in which cuboidal cells grow along the alveolar walls); the remaining one-third are mucinous tumors featuring columnar goblet cells filled with mucus

Metastatic breast cancer on the lung

Metastatic hepatocellular carcinoma of the lung

Capillary hemangioma

HEMANGIOMA
Klasifikasi : 1. Hemangioma kapiler (paling sering), regress spontaneously 2. Hemangioma kavernosa (port wine stain), do not regress spontaneously 3. Granuloma piogenik (hemangioma kapiler lobularis) Hemangioma 1. Differensiasi endotel ( penanda endotel : CD31 atw faktor von willebrand) 2. Peningkatan jumlah pembuluh normal atau abnormal yg terisi oleh darah 3. Sulit dibedakan dari malformasi dan hamartoma Clinical feature Umumnya lokal, tapi juga bisa mengenai area luas (angiomatosis) Mayoritas superficial, tapi juga bisa di organ dalam (hati) Sering di kepala dan leher Jarang jadi ganas Biasanya pada bayi dan anak ( membesar kemudian regresi spontan sebelum pubertas Multiple hemnagiomatous sindrome terjadi pada von Hippel-Lindau Syndrome dan SturgeWeber Syndrome

Hemangioma kapiler
Sering di kulit, subkutis, dan selaput lendir rongga mulut dan bibir, tapi bisa juga di hati , limpa, ginjal Hemangioma kapiler tipe stroberi pada kulit neonatus (hemangioma juvenilis)

Makros Beberapa mili sampai centi Merah terang samapai biru Datar atw sedikit meninggi Epitel diatasnya utuh
Mikros Berlobus, tidak berkapsul Banyak kapiler berdiding tipis tersusun rapat, biasanya terisi darah, dan dilapisi endotel gepeng Pembuluh dipisahkan oleh sedikit stroma Di lumen mungkin ada trombosis Ruptur pembuluh menyebabkan pembentukan jaringan parut Kadang ada pengendapan pigmen hemosiderin pada lesi

Lymphangioma

Analog dengan hemangioma Differensiasi endotel Klasifikasi 1. Limfangioma biasa (kapiler) 2. Limfangioma kavernosa (higroma kistik)

Limfangioma kapiler
Clinical feature Terutama di kepala, leher, ketiak, tapi bisa juga di organ dalam Makros Sedikit meninggi atw bertangkai Diamter 1-2 cm Soft, cystic, well demarcated Mikros Rongga limfe berlapis endotel ( seperti limfatik normal) dibawah epidermis Limfatik kecil dilapisi lapisan adventisia yang tidak jelas, dan limfatik besar dilapisi serabut otot yang differensiasi buruk Rongga limfatik tersisi cairan protein, limfosit dan mungkin eritrosit Agregat limfoid pada jaringan ikat Dapat dibedakan dari saluran kapiler karena tidak ada darah didalamnya

Thrombus

Pulmonary congestion