tumor leher - kidis

7/18/2019 Tumor Leher - Kidis

http://slidepdf.com/reader/full/tumor-leher-kidis 1/61

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TUMOR LEHER

REFERAT Onkologi

Oleh :

Muhamad Sidik Hasanudin131421110005

Pembimbing Uama:

d!" #gung $inasi Pe!mana% M"&es"% S'"THT(&L

)#*+#, +LMU &ESEH#T#, THT(&L

-#&ULT#S &E$O&TER#, U,+.ERS+T#S P#$/#$/#R#,

RUM#H S#&+T $R" H#S#, S#$+&+,

)#,$U,*



2

2014

$#-T#R

DAFTAR ISI.............................................................................................................I

DAFTAR GAMBAR .............................................................................................III

BAB I PENDAHULUAN........................................................................................1

BAB II ANATOMI LEHER ....................................................................................3

2.1. ANATOMI LEHER ...........................................................................................3

2.2. Anatomi Fa!ia S"#$ikal...................................................................................%

2.3 P"#a#a&an 'a"#a( l"("# ......................................................................................)

2.% P"m*+l+( Da#a( L"("# ....................................................................................1,

2.- D#aina" Lim&atik Da"#a( L"("# ......................................................................1-

BAB III TUMOR LEHER .....................................................................................1)

3.1 D"&inii.............................................................................................................1)

3.2 Ei'"miologi....................................................................................................2,

3.3 /lai&ikai........................................................................................................21

3.% Diagnoi..........................................................................................................22

3.%.1 Bioi Ai#ai 0a#+m Hal+ FNAB 'an Bioi T"#*+ka..........................2

3.%.2 En'okoi 'an *ioi Dian'+.....................................................................2

3.%.3 Bioi Ekii.................................................................................................24

3.%.% Sentinel Lymph Node Biopsy SLND...........................................................24

3.%.- P"m"#ikaan "n!it#aan.................................................................................2)

3.- Maa l"("# 5ang ti'ak 'ik"ta(+i aal t+mo# #im"# .......................................3,



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3.6 Maa l"("# 5ang 'ik"ta(+i aal t+mo# #im"# ................................................31

3. T+mo# L"("# P#im"# .........................................................................................32

3..1 T+mo# 0inak L"("# ........................................................................................3%

3..2 T+mo# Gana L"("# .......................................................................................3

3.4 Mana7"m"n T+mo# l"("# ..................................................................................-,

BAB I8 /ESIMPULAN.......................................................................................-%

DAFTAR PUSTA/A.............................................................................................--

DAFTAR GAMBAR

9Gam*a# 2.1 Bata L"("# .....................................................................................-

Gam*a# 2.2 S"gitiga L"("#......................................................................................-

Gam*a# 2.3 /oma#t"m"n L"("# otongan a:ial4...................................................

Gam*a# 2.% /oma#t"m"n L"("# otongan agital4................................................4

Gam*a# 2.- Potongan m"lintang l"("#; m"m"#li(atkan #+ang a'a l"("# (+*+ngan anta#a

#+ang (a#5ngomakila#i '"ngan #+ang<#+ang 5ang lainn5a.)...............................)

Gam*a# 2.6 P"#a#a&an l"("# )................................................................................11

Gam*a# 2. P"m*+l+( 'a#a( a#t"#i 'i l"("#.).........................................................13

Gam*a# 2.4 P"m*+l+( 'a#a( $"na 'i l"("#.)..........................................................1%

Gam*a# 2.) Toog#a&i anatomi k"l"n7a# g"ta( *"ning l"("# 4.................................1

Gam*a# 2.1, Anatomi k"l"n7a# g"ta( *"ning l"("# ..............................................14

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Gam*a# 3.1 Etiologi maa l"("# non<ti#oi'%.........................................................2,

Gam*a# 3.2 Etiologi maa l"("# non<ti#oi'1,........................................................22



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Gam*a# 3.3 E$al+ai 'an mana7"m"n maa l"("# a'a ai"n '"=aa2..............2%

Gam*a# 3.% Algo#itma "$al+ai 'an mana7"m"n maa l"("# 11.............................2-

Gam*a# 3.- D#aina" lim&atik 'a#i t+mo# #im"# +nt+k "ntin"l k"l"n7a# g"ta( *"ning 1% 2)

Gam*a# 3.6 /"lomok m"tatai k"l"n7a# g"ta( *"ning '"ngan l"i #im"# 5ang 'ik"ta(+i. 14

................................................................................................................................33

Gam*a# 3. MR angiog#a&i a'a t+mo# a#aganglioma1,......................................36

Gam*a# 3.4 MRI !(=annoma $agal 'an a#a& $ag+1)........................................3

Gam*a# 3.) >T !an NHL in+ a#anaal2,..........................................................%2

Gam*a# 3.1, Pai"n *"#+ia 2 ta(+n '"ngan a#koma 7a#ingan l+nak a'a l"("# ki#i22 %%

Gam*a# 3.11 Pai"n +ia 1% ta(+n '"ngan #(a*'om5oa#!oma "m*#ional 'alam in+

"t(moi'23................................................................................................................-,



5

)#) +

PENDAHULUAN

D"&inii maa l"("# a'ala( "m*"a#an; "m*"ngkakan ata+ "#t+m*+(an a*no#mal

'ianta#a 'aa# t"ngko#ak (ingga kla$ik+la.1 Maa l"("# a'a ai"n '"=aa (a#+ 'iangga

gana amai t"#*+kti "*alikn5a. Maa l"("# 5ang *"#i&at m"tatati !"n'"#+ng

aimtomatik 5ang m"m*"a# "#la(an<la(an. G"7ala 5ang t"#kait "#ing *"#(+*+ngan '"ngan

maa l"("# t"#ma+k o'ino&agia; 'i&agia; 'i&onia; otalgia 'an "n+#+nan *"#at *a'an.2

Uia 'an lokai maa l"("# (a#+ 'i"#(atikan aat "$al+ai. S"!a#a +m+m maa l"("#

'aat 'i*"'akan m"n7a'i tiga kat"go#i 5ait+ in&lammai; n"olama 'an kong"nital. Pa'a

ai"n 'i*a=a( +ia 1- ta(+n 'an '"=aa m+'a; in&lamai a'ala( "tiologi 5ang aing "#ing

'iik+ti "tiologi k"ngnital 'an n"olama. Uia 'iata %, ta(+n; "tiologi n"olama m"n7a'i

5ang aling "#ing 'iik+ti in&lamai 'an kong"nital. Lokai maa l"("# angan m"m*ant+

+nt+k m"5ingki#kan 'iagnoi *an'ing.3

T+mo# l"("# 'it"m+kan "kita# 3? 'a#i k""l+#+(an ka+ kank"# 5ang a'a 'i Am"#ika

S"#ikat 'an "kita# 6? 'a#i "m+a o+lai kank"# '+nia a'a ta(+n 2,,2; 'an "kita#

%-.,,, ka+ kank"# k"ala 'an l"("# 'i'iagnoi a'a ta(+n 2,,% P"#*an'ingan 'alam 7"ni

k"lamin =anita l"*i( *an5ak 'a#i laki<laki @ 3 1 '"ngan +m+# #ata<#ata %,<, ta(+n. 6,?

"n'"#ita k"*an5akan 'atang '"ngan (an5a at+ k"l+(an; 5ait+ *"n7olan 'i 'a"#a( l"("# .%

Pa'a ta(+n 2,,3 'i "#ki#akan *a(=a kank"# k"ala 'an l"("# akan t"#'i#i 'a#i 2?<3?

'a#i "l+#+( kank"# 'i Am"#ika S"#ikat 'an +nt+k 1?<2? 'a#i "m+a k"matian kank"#. Total

ini m"n!ak+ 1).%,, ka+ kank"# #ongga m+l+t; )-,, ka+ kank"# la#ing 'an 4.3,, ka+

kank"# &a#ing. /"*an5akan ai"n '"ngan kank"# k"ala 'an l"("# #"gional no'al kank"#

l"("# m"miliki "n5akit m"tatai a'a aat 'iagnoi %3? 'an m"tatai 'alam 1,?.%

/ank"# k"ala 'an l"("# m"n!ak+ *"#*agai k"lomok t+mo# *iaa 5ang "#ingkali



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ag#"i& 'alam "#ilak+ *iologi m"#"ka. S"lain it+ ai"n '"ngan kank"# k"ala 'an l"("#

"#ing *"#k"m*ang m"n7a'i t+mo# #im"# k"'+a. T+mo# ini t"#7a'i a'a tingkat ta(+nan

"*"a# 3?<? 'an -,?<-? 'a#i kank"# *a#+ ""#ti t"#7a'i 'i al+#an a"#o'ig"ti$" ata

ata+ a#+<a#+.%

Maa l"("# 'aat m"n7a'i it+ai 5ang m"m*ing+ngkan 'an m"nantang; t"#+tama a'a

"la5anan #im"#. Diagnoi *an'ing angat l+a; *a(kan +nt+k 'okt"# 5ang *"#"ngalaman.

P"ma(aman 5ang k+at t"ntang anatomi; "tiologi 'an #""ntai klini maa l"("#; 'aat

'"ngan !"at m"n"gakan 'iagnoi; m"ng+#angi t" la*o#ato#i+m 5ang ti'ak "#l+; 'an

m"ningkatkan k"+aan ai"n '"ngan m"ng+#angi k"tak+tan 'an k"!"maan ai"n.-

P"n'"#ita k"ganaan m"miliki k+alita (i'+ 5ang *+#+k t"#+tama k"tika 'i(a'akan

'"ngan ta'i+m ak(i#. D"t"ki 'ini 'an "ngo*atan kank"# k"ala 'an l"("# 'aat

m"ningkatkan k+alita (i'+ 'an #ognoi 5ang l"*i( *aik. M"tatai ama# 'aat t"#7a'i

"kta# 1,<3,? a'a kank"# k"ala 'an l"("#. M"tatai ama# (a#+ 'i'"t"ki "'ini

m+ngkin +nt+k #ognoi 5ang l"*i( *aik.6

)#) ++

ANATOMI LEHER

2.1. Anatomi L"("#

S"!a#a +m+m anatomi l"("# 'i*agi 'alam '+a *agian 5ait+ "#tama; "*agian *"a#

'i*"nt+k ol"( *agian $"#t"*#a "#$ikali 'an otot<ototn5a 5ang 'i"*+t O"om+k+la#.

/"'+a; "*agian k"!il t"#l"tak 'i'"an o"om+k+la#; t"#'aat alat<alat 'alam l"("#;



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"m*+l+( 'a#a(; 5a#a& 'an lim&". Bagian<*agian ini *"#(+*+ngan ol"( *"#*agai laian 'a#i

&aia "#$ikal.

Bata l"("# a'ala( m"#+akan *i'ang 5ang 'ita#ik m"lal+i t"i in&"#io# man'i*+la; a":

'a#i #o"+ matoi'"+ 'an ton7olan l+a# okiital. S"'angkan *ata *a=a( l"("# a'ala(

*i'ang 5ang 'ita#ik m"lal+i in!i+#a +#at"#nal; kla$ik+la "#ta #o"+ ino+ $"#t"*#a

"#$ikali 8II.

Unt+k m"m+'a(kan "ma(aman m"ng"nai anatomi l"("#; maka l"("# 'i*agi ata '+a

"gitiga l"("# 5ait+ 2

1. S"gitiga ant"#io# S"gitiga ini m"miliki *ata +"#io# man'i*+la; 'i *agian ant"#io#

'i*atai midline 'an 'i *agian ot"#io# t"#'aat m+k+l+ St"#nokl"i'omatoi'"+;

'i'alam "gitiga ant"#io# t"#'aat

• S"gitiga +*makila# 'igat#ik+ Batan5a 'i *agian +"#io# man'i*+la;

*agian ant"#io# ol"( m. Digat#ik+ $"nt"# ant"#io# "'angkan *agian ot"#io#

'i*atai ol"( m Digat#ik+ $"nt"# ot"#io#.

• S"gitiga !a#oti Di*atai 'i *agian +"#io# ol"( m. Digat#ik+ $"nt"# ot"#io#;

*agian ant"#io# ol"( m. Omo(5oi' *agian +"#io#; 'i *agian ot"#io# ol"( m.

St"#no!l"i'omatoi'"+

• S"gitiga m+k+la#i Batan5a 'i *agian +"#io# ol"( m. Omo(5oi' *agian

+"#io#; *agian ant"#io# ol"( midline 'an *agian ot"#io# ol"( m.

St"#no!l"i'omatoi'"+

• S"gitiga +*m"ntal +#a(5oi' Di *agian +"#io# 'i*atai ol"( im&ii

man'i*+la; 'i *agian in&"#io# ol"( o. H5oi' 'an 'i lat"#alol"( m. Digat#i!+



8

$"nt"# ant"#io#.

2. S"gitiga ot"#io# Batan5a 'i *agian ant"#io# ol"( m+!+l+ St"#no<

!l"i'omatoi'"+; 'i *agian ot"#io# ol"( m. T#a"i+ 'an 'i *agian in&"#io#

t"#'aat kla$i!+la.

Di'alamn5a t"#'aat

• S"gitiga o!!iital D"ngan *atan5a 'i ant"#io# ol"(m. St"#no!l"i'o<matoi'"+;

'i ot"#io# ol"( m. T#a"i+ 'an 'i in&"#io# ol"( m. Omo(5oi'.

• S"gitiga +*!la$ia Di*atai +"#io# ol"( m. Omo(5oi';'i In&"#io# ol"(

kla$i!+la; 'an 'i ant"#io# ol"( m. St"#no!l"i'omatoi'"+.

2"2" #nami -asia Se!ikal

Faia "#$ikali t"#'i#i 'a#i laian 7a#ingan ikat &i*#oa 5ang m"m*+ngk+ o#gan;

otot; a#a& 'an "m*+l+( 'a#a( "#ta m"m*agi l"("# m"n7a'i *"*"#aa #+ang ot"nial. Faia

"#$ikali t"#*agi m"n7a'i '+a *agian 5ait+ &aia "#$ikali +"#&iiali 'an &aia "#$ikali

#o&+n'a. 2;3



9

*amba! 2"1 )aas Lehe!

*amba! 2"2 Segiiga Lehe!"

http://var/www/apps/conversion/tmp/scratch_4/HYPERLINK%23_ENREF_7





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2"2"1" -asia su'e!isialis se!ikalis

B"#7alan 'a#i *agian +"#io# #o"+ igomatik+ amai k" t(o#a: 'an a:illa

"'ang *ata in&"#io# a'ala( !la$i!+la. Fa!ia ini *"#+a "l+*+ng 5ang t"#'i#i 'a#i 7a#ingan

l"mak +*k+tan"+ 'an m"m*+ngk+ M. Plat5ma "#ta otot "k#"i =a7a(. Fa!ia ini

*an5ak m"ngan'+ng l"mak +*k+tan; "m*+l+( 'a#a(; 'an a#a& +"#&iial "#ta 'iia(kan

'"ngan &a!ia "#$ikali #o&+n'a ol"( M. Plat5ma 5ang tii 'an m"l+a k"a a#a( ant"#io#

l"("#. R+ang anta#a &aia "#$ikali +"#&iiali 'an &aia "#$ikali #o&+n'a *"#ii k"l"n7a#

lim&" +"#&iial; a#a& 'an "m*+l+( 'a#a( t"#ma+k $"na 7+g+la#i "kt"#na 2;3

2"2"2" -asia Se!ikalis P!unda

Fa!ia S"#$ikali P#o&+n'a t"#*agi ata

1. Lai +"#&iial

2. Lai m"'ia

3. Lai 'alam 5ang t"#'i#i 'a#i lai ala# 'an lai #"$"#t"*#a.

La'is su'e!isial asia se!ikalis '!unda :

Di"*+t 7+ga laian investing, enveloping . M"#+akan 7a#ingan &i*#oa a'a l"("#

5ang m"li+ti '+a k"l"n7a# 5ait+ k"l"n7a# a#oti 'an k"l"n7a# +*man'i*+la#; '+a otot 5ait+

m. T#a"i+ 'an m. St"#no!l"i'omatoi'"+ "#ta '+a #+ang 5ait+ #+ang +#at"#nal 'an

"gitiga ot"#io#.

Bata<*atan5a

• S+"#io# !o#+ man'i*+la 'an 5goma

• In&"#io# !la$i!+la; a!#omion 'an ina !a+la



11

• Ant"#io# o (5oi'

• Pot"#io# #o"+ matoi'; lin"a n+!(a" +"#io# 'an $"#t"*#a !"#$i!ali

*amba! 2"3 &m'a!emen Lehe! 'ngan aial6

La'is media asia se!ikalis '!unda :

Di"*+t 7+ga &a!ia visceral ka#"na m"li+ti la#ing; t#ak"a; "o(ag+ 'an k"l"n7a#

ti#oi'. Laian ini 7+ga m"li+ti strap muscle 'an m"m*"nt+k *agian &a!ia a'a #+ang

$ak+la#. Di*agian ata &a!ia ini m"l"kat a'a o (5oi' 'an *ai k"ala "#ta m"li+ti m.

B+!!inato# "(ingga 'i"*+t &a!ia *+!!o(a#5ng"al.





12

*amba! 2"4 &m'a!emen Lehe! 'ngan sagial6

La'is dalam asia se!ikalis '!unda :

T"#'i#i ata

• Ala# layer T"#l"tak ot"#io# 'a#i laian t"nga( &a!ia "#$ikali #o&+n'a 'an ant"#io#

prevertebral layer . M"m*"nt+k 'in'ing ot"#io# #+ang #"t#o&a#ing 'an 'in'ing ant"#io#

danger space. Ala# layer m"m*"nt+k 7+ga #+ang $ak+la# 'imana k"tiga laian &a!ia

"#$ikal m"li+ti #+ang $ak+la# 5ang *"#ot"ni +nt+k "n5"*a#an in&"ki 'an 'i"*+t

Lincoln high way of the neck .

• Prevertebral layer : M"m*"nt+k 'in'ing ant"#io# #+ang #"$"#t"*#a 'an 'in'ing ot"#io#

danger space "#ta m"li+ti deep muscle "gitiga ot"#io#. Laian ini *"#7alan 'a#i *ai

k"ala amai k" !o!5g"+.





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*amba! 2"5 Pngan melinang lehe!% mem'e!lihakan !uang 'ada lehe! hubungan

ana!a !uang 'ha!7ngmaksila!is dengan !uang(!uang 7ang lainn7a"8

2"3 Pe!sa!aan dae!ah lehe!

T"#'aat % a#a& +"#&iial 5ang *"#(+*+ngan '"ngan t"i ot"#io# m.t"#no!l"i'omatoi'.

Sa#a&<a#a& t"#"*+t m"m"#a#a&i k+lit 'i 'a"#a( 5ang *"#angk+tan. Sa#a& +"#&iial 5ang

'imak+' a'ala(

1. N. Okiitali mino# >2

2. N. A+#i!+la#i magn+ >2 'an >3

3. N.>+tan"+ ant"#io# !+tan"+ !olli; >2 'an >3.

%. N.S+#akla$ik+la#i >3 'an >%.

/""mat a#a& ini *"#aal 'a#i Nn S"#$ikali II; III 'an I8 'an t"#lin'+ng 'i *a=a( otot.

Dalam "#7alanan "kt#a k#anialn5a; % n"#$i k#anial t"#l"tak 'i 'a"#a( M. Digat#i!+.

Sa#a&<a#a& !#anial 5ang 'imak+'





14

1. N. agus; k"l+a# m"lal+i Fo#. 0+g+la#i; m"na#a&i al+#an "#na&aan 'an al+#an

"n!"#naan .

2. N. !lossopharyngeus; k"l+a# *"#ama N. 8ag+ ; t"#l"tak 'ianta#a ka#oti int"#na 'an

7+g+la#i int"#na. M"#+akan a#a& moto#ik +nt+k M. St5lo(a#5ng"+.

3. N. "sesorius; *"#aal 'a#i !#anial 'an >- ata+ >6. M"#+akan moto#ik +nt+k M. S>M 'an

M. T#a"i+; "'angkan !a*ang !"#$i!aln5a m"#+akan "no#ik.

%. N. #ypoglosus; k"l+a# m"lal+i !#anial (5oglo+; m"#+akan moto#ik +nt+k li'a(.

2"4 Pembuluh $a!ah Lehe!

1. ". $arotis komunis.

P"m*+l+( 'a#a( 5ang "*"la( kanan *"#aal 'a#i A. Inominata "'angkan 5ang ki#i *"#aal

'a#i A#k+ Ao#ta; *"#7alan 'i *"lakang M. m.t"#no!l"i'omatoi'. Pa'a l"$"l %hyroid Notch

m"l"*a#; 'i"*+t Bulbus $arotis; k"m+'ian *"#!a*ang '+a m"n7a'i A. /a#oti "kt"#na 'an

A./a#oti int"#na .

S"t"la( "#!a*angann5a; a#t"#i ini *"#7alan k" 'alan kanali ka#otik+ oi t"mo#ali.

M"m"#'a#a(i otak 'an mata. Di 'a"#a( l"("# ti'ak m"m*"#ikan "#!a*angan. Di *a=a( M.

Digat#i!+ t"#t+t+ ol"( m.t"#no!l"i'omatoi'



15

*amba! 2"9 Pe!sa!aan lehe! 8

1; St5lo(5oi' m+!l"C 2; (5ogloal n"#$" !#anial n"#$" IIC 3; 'igat#i! m+!l"C %; a#oti'

glan'C -; t"#no!l"i'omatoi' m+!l"C 6; g#"at"# a+#i!+la# n"#$"C ; l""# o!!iital n"#$"C 4;

$"nt#al #am+ >2C ); $"nt#al #am+ >3C 1,; a!!"o#5 n"#$" !#anial n"#$" IC 11; $"nt#al

#am+ >-C 12; ant"#io# !al"n" m+!l"C 13; (#"ni! n"#$"C 1%; *#a!(ial l":+C 1-;

+*!la$ian a#t"#5 an' $"inC 16; t(5#o!"#$i!al t#+nkC 1; $ag+ n"#$"C 14; in&"#io# #oot ana

!"#$i!aliC 1); +"#io# #oot ana !"#$i!aliC 2,; +"#io# t(5#oi' a#t"#5

2. ".$arotis eksterna.

B"#7alan m"n+7+ !oll+m man'i*+la. M"m*"#ikan 4 "#!a*angan 5ang *"#'aa#kan

l"takn5a t"#(a'a M. Digat#i!+; a'ala( **

• 'iata M. Digat#i!+ m"m*"#i 3 "#!a*angan

1. A. T"mo#ali +"#&iiali.





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2. A. Ma:illa#i int"#na.

3. A. A+#i!+la#i ot"#io#.

• 'i*a=a( M. Digat#i!+ m"m*"#i - "#!a*angan

1. A. T(5#oi'"a +"#io#.

2. A. Ling+aali.

3. A. P(a#5ng"ali a!"n'"n.

%. A. Fa!iali.

-. Ram+ Okiitali.

3. . &ugularis eksterna.

Dim+lai 'a#i *a=a( t"linga 'an *"#aal 'a#i ga*+ngan 8. A+#ik+la#i ot"#io# 'an 8.

Fa!iali ot"#io#; t"#l"tak 'ianta#a lat5ma 'an &a!ia +"#&iiali !olli. Di 'a"#a( *a=a(

l"("# *"#ga*+ng '"ngan 8. 0+g+la#i ant"#io# 'an 8. S+*kla$ia t#an$"#a.

%. . &ugularis interna.

M"#+akan k"lan7+tan 'a#i in+ t#an$"#+; 'i "*"la( atan5a t"#l"tak 'i*a=a( Gl'. Pa#oti

'an "*agian *"a# 'a#i $"na ini t"#l"tak 'i*a=a( m.t"#no!l"i'omatoi'. Di *agian *a=a(

t"#l"tak M. In&#a(5oi'.

M"n"#imam"nam+ng 'a#a( 'a#i

Sin+ "t#o+ in&"#io#.

8.(a#5ng"ali.

8. &a!iali.

8. Ling+ali.



17

8. T(5#oi'"a +"#io# 'an m"'ia.

*amba! 2" Pembuluh da!ah a!e!i di lehe!"8

', (ommon carotid artery) *, superior laryngeal artery) +, superior thyroid artery) ,internal carotid artery) -, eternal carotid artery) /, lingual artery) 0, occipital artery) 1,

ascending pharyngeal artery) 2, inferior alveolar artery) '3, maillary artery) '', ascending

palatine artery) '*, facial artery) '+, mental artery) ', submental artery) '-, angular

artery) '/, infraorbital artery) '0, buccal artery) '1, sphenopalatine artery) '2, middle

meningeal artery) *3, superficial temporal artery.






18

*amba! 2"6 Pembuluh da!ah ena di lehe!"8

', Subclavian vein) *, internal 4ugular vein) +, anterior eternal 4ugular vein) , superior

laryngeal vein) -, superior thyroid vein) /, common facial vein) 0, posterior eternal 4ugular

vein) 1, retromandibular vein, anterior division) 2, retromandibular vein, posterior division)'3, inferior alveolar vein) '', posterior auricular vein) '*, superficial temporal vein) '+,

deep temporal vein) ', pterygoid pleus) '-, deep facial vein) '/, infraorbital vein) '0,

angular vein) '1, mental vein) '2, facial vein) *3, eternal palatine vein.

&elena! Th7!id

M"#+akan k"l"n7a# "n'ok#in 5ang ti'ak m"m+n5ai al+#an k"l+a#; angat $ak+l"#;

m"l"kat k" la#5ng ol"( lig. +"no#i+m "(ingga t+#+t *"#g"#ak =akt+ m"n"lan. T"#'i#i 'a#i






19

'+a lo*+ 5ang 'i(+*+ngkan '"ngan it(m+; ka'ang<ka'ang a'a it(m+ t"#'aat lo*+

5#ami'ali. Maing<maing lo*+ t"#l"tak "tinggi ka#tilago t(5#oi' amai !in!in t#a!("a

k"<6. Uk+#an no#mal l"*i( k+#ang 2 : 2;- : ,;- in. Di"#'a#a(i ol"( A. T(5#oi'"a +"#io#

'an in&"#io#; ka'ang<ka'ang t"#'aat A. T(5#oi'"a ima 'i 'a"#a( in&"#io# k"l"n7a#.

T"#'aat N. R"!+##"n 5ang t"#l"tak 'i "*"la( 'o#o m"'ial lo*+; a#a& ini "#l+ m"n'aat

"#(atian k(++ a'a aat o"#ai k"l. t(5#oi'.

&elena! Pa!ah7!id

M"#+akan maa *"#=a#na !oklat k"k+ningan 5ang 7+mla(n5a *"#$a#iai anta#a 2<% aang;

t"#l"tak 'i ot"#io# lo*+ lat"#ali t(5#oi' '"ngan 3 k"m+ngkinan oii; 5ait+

• 'i *a=a( A. T(5#oi'"a in&"#io#; ant"#io# 'a#i &a!ia #"t#a!("a.

• 'i ata a#t"#i 'an 'i 'alam &a!ia #"t#a!("a.

• 'i 'alam k"l"n7a# t(5#oi'.

2"5 $!ainase Limaik $ae!ah Lehe!

/"l"n7a# g"ta( *"ning l"("# t"#*agi 'alam '+a k"lomok; 5ait+ #angkaian

i#k+l"#(o#iontal 'an #angkaian $"#tikal. /"l"n7a# t"#"*+t t"#'aat im"t#i a'a k"'+a ii

l"("#.

Rangkaian sirkuler

Rangkaian i#k+l"# t"#'i#i 'a#i

1. Lim&ono'i okiitali; m"n"#ima lim&" 'a#i k"ala *agian *"lakang.

2. Lim&ono'i #"t#oa+#i!+l"#; m"n"#ima lim&" 'a#i 'a"#a( t"mo#al; t"linga *agaian *"lakang



20

'an MAE. T"#l"tak 'i #o!. matoi'"+.

3. Lim&ono'i #"a+#i!+l"#; m"n"#ima lim&" 'a#i k+lit k"ala *agian '"an 'an a+#i!+l"#.

%. Lim&ono'i a#oti; m"n"#ima lim&" 'a#i nao&a#ing; >AE; !a$+m t5m(ani 'an al"*#a.

-. Lim&ono'i &a!iali; m"n"#ima lim&" 'a#i &a#ing; m+ka 'an m+koa *i*i#.

6. Lim&ono'i +*man'i*+la#i; m"n"#ima ali#an lim&" 'a#i +7+ng m"'ial mata; "*agian

(i'+ng; *i*i# ata 'an lat"#al *a=a(; g+i 'an *agian lat"#al li'a(.

. Lim&ono'i +*m"ntali; m"n"#ima lim&" 'a#i *i*i# *a=a(; +7+ng li'a( 'an 'aa# m+l+t.

4. Lim&ono'i !"#$i!al +"#&iiali; m"n"#ima lim&" 'a#i a#oti; a+#i!+la. T"#l"tak "an7ang

8. 0+g+la#i "kt"#na 'an 'iata m.t"#no!l"i'omatoi'

). Lim&ono'i !"#$i!al ant"#io#; m"n"#ima ali#an 'a#i 'a"#a( la#5ng; t(5#oi' 'an t#a!("a.

Lo#" m"m*agi '#aina" lim&atik 'a"#a( l"("# 'alam *"*"#aa k"lomok; **

1. Int"#nal 0+g+la# >(ain +"#io# nao&a#ing; 'aa# li'a(; tonil; ka#oti 'an la#ing

2. I0> m"'iami''l" I0> tonil; li'a(; la#ing; o#o (5o&a#ing; in+ a#anaal; "o&ag+;

l"("#; t(5#oi'

3. In&"#io# I0> t(5#oi'; la#ing; "o&ag+; l"("#

%. Pot"#io# !"#$i!al t#iangl" nao&a#ing; t(5#oi'.

-. S+#akla$ik+la# a#+<a#+; mamma"; GIT; g"nito+#ina#5.

6. S+*man'i*+la# int#ao#al; k"l.+*ma:ila#.

. S+*m"ntal *i*i#; 'aa# m+l+t ant"#io#; *+!!al.

4. >#i!ot(5#oi' la#ing; t(5#oi'.

). P#"a+#i!+l"# a#oti; >AE; k+lit m+ka "*"la( lat"#al; t"mo#al 'an k+lit k"ala.



21

Rangkaian vertikal

Rangkaian $"#tikal m"n"#ima ali#an lim&" 'a#i #angkaian i#k+l"# k"!+ali 'a#i +*m"ntal 'an

&a!ial "*"l+mn5a m"n+7+ k" lim&ono'i +*man'i*+la# 'a(+l+.

Sal+#an "&"#"n 'a#i ii ki#i m"n+7+ k" D+!t+ T(o#a!i!+ "'angkan ii "*"la( kanan

*"#m+a#a 'i"#t"m+an anta#a 8. 0+g+la#i int"#na '"ngan 8. S+*!la$ia.

*amba! 2"8 T'g!ai anami kelena! geah bening lehe!6





22

*amba! 2"10 #nami kelena! geah bening lehe!

' 5 4ugular chain, * 5 spinal chain, + 5 supraclavicular chain, 5 occipital lymph nodes, -

5 mastoid lymph nodes, / 5 parotid lymph nodes, 0 5 submandibular lymph nodes, 1 5

submental lymph nodes, 2 5 retropharyngeal lymph nodes, '3 5 recurrent lymph nodes, '' 5 pretracheal lymph nodes, '* 5 prethyroidean lymph nodes

)#) +++

TUMOR LEHER

3"1 $einisi


'ianta#a 'aa# t"ngko#ak (ingga kla$ik+la.1 S"tia maa l"("# a'a ai"n '"=aa (a#+

'iangga gana amai t"#*+kti "*alikn5a. Maa l"("# 5ang *"#i&at m"tatati !"n'"#+ng

aimtomatik 5ang m"m*"a# "#la(an<la(an. G"7ala 5ang t"#kait "#ing *"#(+*+ngan '"ngan





23

maa l"("# t"#ma+k o'ino&agia; 'i&agia; 'i&onia; otalgia 'an "n+#+nan *"#at *a'an.2Uia 'an lokai maa l"("# (a#+ 'i"#(atikan aat "$al+ai. S"!a#a +m+m maa l"("#

'aat 'i*"'akan m"n7a'i tiga kat"go#i 5ait+ in&lammai; n"olama 'an kong"nital. Pa'a

ai"n 'i*a=a( +ia 1- ta(+n 'an '"=aa m+'a; in&lamai a'ala( "tiologi 5ang aing "#ing

'iik+ti "tiologi k"ngnital 'an n"olama. Uia 'iata %, ta(+n; "tiologi n"olama m"n7a'i

5ang aling "#ing 'iik+ti in&lamai 'an kong"nital. Lokai maa l"("# angan m"m*ant+

+nt+k m"5ingki#kan 'iagnoi *an'ing.3

S"tia *"n7olan 5ang t"#'aat 'i l"("# (a#+ 'iiki#kan akan k"m+ngkinan +at+

k"ganaan ata+ m"tatai 'a#i t+mo# #im"# 'i t"mat lain.

*amba! 3"1 Eilgi massa lehe! nn(i!id4





24

3"2 E'idemilgi

T+mo# l"("# 'it"m+kan "kita# 3? 'a#i k""l+#+(an ka+ kank"# 5ang a'a 'i Am"#ika

S"#ikat 'an "kita# 6? 'a#i "m+a o+lai kank"# '+nia a'a ta(+n 2,,2; 'an "kita#

%-.,,, ka+ kank"# k"ala 'an l"("# 'i'iagnoi a'a ta(+n 2,,% P"#*an'ingan 'alam 7"ni

k"lamin =anita l"*i( *an5ak 'a#i laki<laki @ 3 1 '"ngan +m+# #ata<#ata %,<, ta(+n. 6,?

"n'"#ita k"*an5akan 'atang '"ngan (an5a at+ k"l+(an; 5ait+ *"n7olan 'i 'a"#a( l"("# .%

Pa'a ta(+n 2,,3 'i "#ki#akan *a(=a kank"# k"ala 'an l"("# akan t"#'i#i 'a#i 2?<3?

'a#i "l+#+( kank"# 'i Am"#ika S"#ikat 'an +nt+k 1?<2? 'a#i "m+a k"matian kank"#. Total

ini m"n!ak+ 1).%,, ka+ kank"# #ongga m+l+t; )-,, ka+ kank"# la#ing 'an 43,, ka+

kank"# &a#ing. /"*an5akan ai"n '"ngan kank"# k"ala 'an l"("# #"gional no'al kank"#

l"("# m"miliki "n5akit m"tatai a'a aat 'iagnoi %3? 'an m"tatai 'alam 1,?.%

/ank"# k"ala 'an l"("# m"n!ak+ *"#*agai k"lomok t+mo# *iaa 5ang "#ingkali

ag#"i& 'alam "#ilak+ *iologi m"#"ka. S"lain it+ ai"n '"ngan kank"# k"ala 'an l"("#

"#ing *"#k"m*ang m"n7a'i t+mo# #im"# k"'+a. T+mo# ini t"#7a'i a'a tingkat ta(+nan

"*"a# 3?<? 'an -,?<-? 'a#i kank"# *a#+ ""#ti t"#7a'i 'i al+#an a"#o'ig"ti$" ata

ata+ a#+<a#+.%

3"3 &lasiikasi

/"tika m"m"#ika ai"n '"ngan maa l"("#; "#tim*angan "#tama 'okt"# (a#+

m"m*"'akan k"lomok ai"n +ia anak 1- ta(+n; '"=aa m+'a 16<%, ta(+n; ata+

'"=aa %, ta(+n +m+#. Dalam maing<maing k"lomok; k"7a'ian "n5akit *a=aan;

in&lamai; 'an n"olatik (a#+ 'i"#(atikan ka#"na "*agian *"a# maa l"("# ma+k k"

'alam ala( at+ 'a#i tiga kat"go#i. Pai"n anak +m+mn5a m"n+n7+kkan maa l"("#



25

in&lamai l"*i( "#ing 'a#ia'a k"lainan *a=aan 'an n"olama. Ini'"n ini mi#i '"ngan

5ang 'it"m+kan a'a o#ang '"=aa m+'a. S"*alikn5a; "#tim*angan "#tama a'a o#ang

'"=aa 5ang l"*i( t+a (a#+ "lal+ n"olaia; k"m+'ian maa in&lamai 'an k"laianan

*a=aan.1,

P"#tim*angan *"#ik+tn5a (a#+ lokai maa l"("#. Hal ini angat "nting 'alam

'i&"#"niai k"lainan *a=aan ka#"na m"#"ka *iaan5a t"#7a'i 'i lokai 5ang k(a. P"n5"*a#an

ka#inoma k"ala 'an l"("# ka#inoma mi#i '"ngan "n5akit in&lamai; +m+mn5a m"ngik+ti

"n5"*a#an lim&atik. P"namilan 'an lokai maa l"("# m"tatatik 'aat m"n7a'i k+n!i

+nt+k m"ngi'"nti&ikai t+mo# #im"# ata+ +m*"# in&"ki.1,



26

*amba! 3"2 Eilgi massa lehe! nn(i!id10

3"4 $iagnsis

Langka( 'iagnotik 5ang aling "nting a'ala( "m"#ikaan &iik k"ala 'an l"("#.

8i+aliai 'an alai a'ala( komon"n 5ang aling "nting 'a#i "m"#ikaan &iik. Hal ini

m"m*ant+ m"n"nt+kan lokai maa "+ai '"ngan 'a"#a( '#aina" lim&atik; +k+#an l"i 'an

(+*+ngann5a '"ngan t#+kt+# "kita#n5a t"#&ikai ata+ ti'ak t"#&ikai; konit"ni maa;

'an *"#'"n5+tan ata+ bruit .1,



27

Dokt"# ti'ak *ol"( t"#&ok+ a'a maa l"("# 'an m"nga*aikan +nt+k m"lak+kan

"$al+ai m"n5"l+#+( "m"#ikaan k"ala 'an l"("#. Sal+#an a"#o'ig"ti& ata (a#+ 'i"#ika

"!a#a m"n5"l+#+(; *aik '"ngan ka!a !"#min ata++n "n'okoi.1,

Maa l"("# *"#'"n5+t; *#+it ata+ thrill ; +lt#aonog#a&i 'aat 'ilak+kan +nt+k

m"m*"'akan maala( $ak+la# '"g"n"#ati& mialn5a an"+#ima 'a#i kon'ii n"olatik

mialn5a; glom+ 'an t+mo# ka#oti. Ult#aonog#a&i 7+ga 'aat m"m*ant+ +nt+k

m"m*"'akan maa 5ang oli' 'an kitik; ata+ kita *#ankiali *a=aan 'an kita ti#oglo+

'a#i k"l"n7a# g"ta( *"ning 5ang oli'; t+mo# n"+#og"nik; 'an "ktoik .1,

Pa'a ai"n 5ang m"miliki maa l"("# 5ang m"m*ing+ngkan nam+n 'i'+ga m"miliki

#o" in&lamai; t"#ai anti*iotik 'an o*"#$ai; ti'ak l"*i( 'a#i 2 mingg+; 'aat 'it"#ima

"*agai +7i klini. 0ika maa t"#"*+t t"#+<m"n"#+ ata+ m"ningkat 'alam +k+#an "t"la(

"m*"#ian anti*iotik; "m"#ikaan tam*a(an lain 'i"#l+kan. Bioi '"ngan "m"#ikaan

atologi a'ala( t" 'iagnotik '"&initi&. Bioi t"#*+ka (a#+ 'ilak+kan; nam+n (an5a "t"la(

'okt"# t"la( m"lak+kan "m"#ikaan k"ala 'an l"("# l"ngka '"ngan m"ngg+nakan m"to'"

lang+ng 'an ti'ak lang+ng 'an t"la( m"lak+kan a=al *ioi ai#ai 7a#+m (al+ FNAB;

5ang m"#+akan tan'a# "#a=atan +nt+k *ioi a=al.1,



28

*amba! 3"3 Ealuasi dan manaemen massa lehe! 'ada 'asien de;asa2

Hal ini t"#+tama 'i"#l+kan +nt+k o#ang '"=aa. Bioi +m+mn5a (a#+ 'ilak+kan *ila

maa l"("# 5ang "makin m"m"#*"a#; maa l"("# aim"t#i t+nggal; maa l"("# k"#a

tana tan'a<tan'a in&"ki akti& 'an kon'ii akti& m"n+la# 5ang ti'ak m"#"on t"#(a'a

anti*iotik kon$"nional 'an 'i mana "n"nt+an *akt"#iologi #+tin ti'ak *"#(ail; "(ingga

am"l 7a#ingan 5ang 'i*+t+(kan +nt+k t+'i *akt"#iologi lan7+t.1,



29

*amba! 3"4 #lg!ima ealuasi dan manaemen massa lehe!11

P"m"#ikaan 'iagnotik 'an t" +nt+k maa a'a k"ala 'an l"("# 1,

1. P"m"#ikaan &iik Di+langC 5ang aling "nting

2. 6adionucleotide scanning a'a l"i koma#t"m"n l"("# ant"#io#C m"m*ant+ 'alam l"i

ti#oi' 'an m"lokaliai l"i *"#a'a 'alam k"l"n7a# l+'a(. PET !an 'aat m"m*ant+

m"ngi'"nti&ikai m"tatai 7a+(.



30

3. Ult#aonog#a&i Unt+k m"m*"'akan oli' 'a#i maa kitikC angat *"#g+na 'alam kita

kong"nita; 'aat 7+ga *"#g+na +nt+k l"i $ak+la#

%. A#t"#iog#a&i Unt+k l"i $ak+la# 'an t+mo# 5ang m"nm"l a'a a#t"#i ka#oti

-. Sialog#a&i Unt+k m"n'iagnoa iala'"noati ata+ +nt+k m"n!a#i maa 'alam ata+ 'i

l+a# k"l"n7a# l+'a(.

6. >T!an 'an MRI m"m*"'akan kita 'a#i l"i a'at; m"ng"ta(+i lokai maa 'alam

ata+ 'i l+a# k"l"n7a#; m"n7"lakan (+*+ngan anatomi

. <#a5 0a#ang m"m*ant+ 'alam m"m*"'akan maa l"("#

4. Anti*iotik +7i klini +nt+k k"!+#igaan in&lamai; "m"#ikaan lan7+tan 7ika maa mai(

a'a.

). /+lt+# 'an "niti$ita 7a#ingan in&lamai a'a *ioi t"#*+ka

1,. T" k+lit Dig+nakan *ila l"i in&lamai k#oni ata+ g#an+lomatoa

11. 0a#+m *ioi tan'a# "ma 'alam 'iagnoi maa l"("#C m"ngg+nakan 7a#+m k"!il

(al+C m"n'aatkan 7a#ingan lim&oi'

12. En'okoi 'an *ioi Unt+k m"ngi'"nti&ikai t+mo# #im"# "*agai +m*"# m"tataiC

'ig+nakan 'alam "m+a ai"n 5ang 'i'+ga m"n'"#ita n"olaia

13. Bioi t"#*+ka G+nakan (an5a "t"la( "m+a "m"#ikaan 'ilak+kan 'an 7ika 'iagnoi

ti'ak 7"la; "im"n +nt+k "m"#ikaan atologi.

0ika anamn"i; "m"#ikaan &iik; 'an t" 'iagnotik #+tin ti'ak m"nga#a( k" 'iagnoi

'"&initi&; "tia maa l"("# ti'ak 'ik"ta(+i; t"#+tama +nilat"#al; maa l"("# tana g"7ala

5ang "+ai '"ngan lokai k"lomok k"l"n7a# g"ta( *"ning; (a#+ 'i"#tim*angkan l"i

n"olatik m"tatai amai t"#*+kti "*alikn5a.1,

3"4"1 )i'si #s'i!asi /a!um Halus <-,#)= dan )i'si Te!buka

FNAB 'ilak+kan "*"l+m "n'okoi tai "t"la( "m"#ikaan k"ala 'an l"("# 5ang

m"n5"l+#+(. S"o#ang a(li atologi 'i"#l+kan +nt+k (ail FNAB 5ang ak+#at. FNAB t"la(

m"n7a'i tan'a# 'alam m"m*+at k"+t+an 'iagnotik 'an mana7"m"n a'a maa l"("# .1,



31

FNAB 7+ga 'ig+nakan a'a ai"n '"ngan k"ganaan +nt+k kon&i#mai m"tatai 5ang

'i"#l+kan +nt+k ta'i+m t+mo# 'an "#"n!anaan t"#ai; a'a ai"n '"ngan t+mo# #im"#

l"("# +nt+k m"m+lai t"#ai non<*"'a(; 'an a'a ai"n '"ngan maa l"("# ti'ak 'ik"ta(+i.

FNAB *iaan5a 'aat m"m*"'akan l"i kitik 'an in&lamai; l"i t+mo# 7inak 'an k"ganaan;

lim&oma 'an ka#inoma.2; 1, /(++ +nt+k l"i lim&oma (a#+ *ilak+kan *ioi "kii +nt+k

"m"#ikaan atologi 5ang 'ig+nakan +nt+k 'iagnoi 'an #"n!ana k"mot"#ai.12 Unt+k l"i

"#it"n 'an !+#iga gana; FNAB 'aat 'iin'ikaikan. FNAB 7+ga "m"#ikaan 'iagnotik

ili(an a'a "*agian *"a# 5ang 'i!+#igai k"ganaan l"("#. Di tangan 5ang *"#"ngalaman;

"niti$ita 'an "i&iita FNAB l"*i( *"a# 'a#i ),?.-

3"4"2 Endsk'i dan bi'si $i'andu

P"n!a#ian +nt+k l"i #im"# (a#+ 'ilak+kan "m"#ikaan m"n5"l+#+( *aik lang+ng 'an

ti'ak lang+ng; 5ait+ "m"#ikaan #ongga m+l+t; nao&a#ing; (io&a#ing; la#ing; ti#oi';

k"l"n7a# l+'a(; 'an k+lit k"ala 'an =a7a(. P"m"#ikaan to#ak 'an a*'om"n 7+ga 'aa

'ilak+kan; t"tai *iaan5a 7a#ang m"m*ant+ 'alam m"m*"'akan maa l"("#. FNAB a'ala(

tan'a# "$al+ai "t"la( "m"#ikaan &iik l"ngka. 0ika i&at maa ata+ +m*"# 'a#i

m"tatai 5ang 'ii'"nti&ikai ol"( FNAB t"ta +lit 'it"nt+kan; al+#an a"#o'ig"ti$" (a#+

'i"#ika "!a#a "n'okoi; t"#+tama 'i 'a"#a( +m*"# '#aina" lim&atik. 0ika 'it"m+kan l"i

t+mo# a'a al+#an a"#o'ig"ti&; l"i t+mo# t"#"*+t (a#+ 'i*ioi; *ila ti'ak a'a l"i t+mo#;

*ioi 'ian'+ guided biopsy (a#+ 'ilak+kan 'a#i 'a"#a( 5ang aling logi +nt+k t+mo#

#im"# *"#'aa#kan '#aina" lim&atik. Da"#a( ini *iaan5a a'a nao&a#ing "kita# &oa

Ro"nmll"#; tonil 'alam (al ini tonil"ktomi m"nggantikan *ioi inii; 'aa# li'a(; 'an

in+ i#i&o#mi. T+mo# #im"# "#ingkali +*m+koa ata+ tim*+l 7a+( 'i 'alam k#ita 'a#i



32

tonil alatin" ata+ liatan 7a#ingan lim&oi' ling+al. Hal ini 5ang m"n7a'i alaan m"gaa

(a#+ 'ilak+kan *ioi a'a al+#an a"#o'ig"ti& .1,

3"4"3 )i'si Eksisi

/"tika "m"#ikaan FNAB oiti& +nt+k ka#inoma; "m"#ikaan klini 'an "n'okoi

ti'ak m"ng+ngkakan lokai t+mo# #im"#; *ioi "kii a'ala( langka( *"#ik+tn5a 'alam

m"ngkon&i#maikan ata+ m"n'iagnoi maa l"("#.1,

/"tika *ioi "kii 'ilak+kan; (a#+ "g"#a 'ilak+kan "m"#ikaan atologi 'i *a=a(

mik#oko. 0ika 'iagnoi ka#inoma "l k+amoa; m"lanoma; ata+ a'"noka#inoma k"!+ali

maa a'ala( +#akla$ik+la; 'i"ki l"("# #a'ikal (a#+ 'ilak+kan.1, /(++ +nt+k l"i

lim&oma (a#+ *ilak+kan *ioi "kii +nt+k "m"#ikaan atologi 5ang 'ig+nakan +nt+k

'iagnoi 'an #"n!ana k"mot"#ai.12

3"4"4 Sentinel Lymph Node Biopsy <SL,$=

Sentinel Lymph Node Biopsy SLND a'ala( #o"'+# 'i mana k"l"n7a# g"ta( *"ning

"ntin"l 'ii'"nti&ikai; 'iam*il; 'an 'i"#ika +nt+k m"n"nt+kan aaka( t"#'aat "l<"l

kank"#.13

Pa'a SLNB 'ilak+kan lim&okintig#a&i #a o"#ai; "m"taan lim&atik int#ao"#ati&

m"ngg+nakan gamma probe o#ta*"l ata+ "=a#na *i#+ blue dye 'an 'ilak+kan

"m"#ikaan atologi 'a#i k"l"n7a# .1%



33

*amba! 3"5 $!ainase limaik da!i um! '!ime! unuk seninel kelena! geah bening14

Hail SLNB n"gati& m"n+n7+kkan *a(=a kank"# m"n5"*a# k" k"l"n7a# g"ta( *"ning

t"#'"kat ata+ o#gan lainn5a. Hail SLNB oiti& m"n+n7+kkan *a(=a "l kank"# t"#'aat 'i

k"l"n7a# g"ta( *"ning t"#'"kat "ntnin"l; 'an m+ngkin a'a 'alam k"l"n7a# g"ta( *"ning 'i

"kita#n5a k"l"n7a# g"ta( *"ning #"gional 'an; m+ngkin o#gan<o#gan lain. In&o#mai ini

'aat m"m*ant+ 'okt"# m"n"nt+kan ta'i+m kank"# 'an m"n"nt+kan mana7"m"n 5ang

t"at.13; 1-

Hail "n"litian m"ta analii m"+n7+kan *a(=a SLNB m"m+n5a "niti&it 'an

"i&ita l"*i( *aik 'a#ia'a >T !an 'an MRI *a(kan PET !an 'alam m"n"t+kan

k"t#li*atan m"taatai k"l"n7"# g"ta( *"ning. Nam+n; (a#+ 'ik"ta(+i l"i #im"#n5a. 13; 1-

3"4"5 Peme!iksaan 'eni!aan

PET S!an m"miliki ak+#ai "n"nt+an ta'i+m kank"# "kita# 6)<4?; nilai #"'iki

oiti& -6<43?; nilai #"'iki n"gati& -<46?; "niti$ita 63<1,,? 'an "i&iita ),<)%?.



34

T+mo# =ila5a( +#aglotti! 'an !in!in tonil al'"5"# a'ala( 5ang aling +lit +nt+k 'aat

'i'iagnoi '"ngan FDG<PET. Hal ini ka#"na $ol+m" t+mo# #"n'a( k"!il; l"i +"#&iial;

t"#'aat 7a#ingan lim&oi' no#mal; 'an ak+m+lai FDG 'i"k#"ikan ol"( k"l"n7a# l+'a( k"

'alam $al"k+la 'an in+ i#i&o#mi. S"m+a k"l"n7a# g"ta( *"ning l"("# m"tatai t"#'"t"ki

ol"( >T 'ikon&i#mai ol"( PET !an.16

>T !an '"ngan kont#a +nt+k maa l"("# 'aat m"lokaliai 'an ka#akt"#iai l"i

l"("#. /a#"na >T !an 'aat 'ilak+kan !"at; 'itol"#ani '"ngan *aik; 'an !+k+ t"#"'ia;

'aat 'ig+nakan +nt+k "$al+ai a=al; "#"n!anaan #a o"#ai; "na#g"tan *ioi; 'an

"$al+ai a!a<o"#ai. Nam+n; (itoatologi t"ta tan'a# "ma.1

E$al+ai (a#+ t"#'i#i 'a#i "m"#ikaan m"n5"l+#+( 'iik+ti '"ngan !an MRI; 7ika

m"m+ngkinkan. MRI m"m+ngkinkan +nt+k "#*"'aan 7a#ingan l+nak 5ang l"*i( *aik

'a#ia'a >T !an. Ol"( ka#"na it+; MRI l"*i( *aik 'aat m"nilai lokai t+mo# k"!il "#ta

l"*i( 7"la m"n+n7+kkan m"tatai l"("#.2

PET !an m"n+n7+kkan "ningkatan akti$ita glikolitik "l t+mo#; m"ngi'"nti&ikai

lokai t+mo# 5ang ot"nial. PET !an 'aat m"ngi'"nti&ikai t+mo# k"!il; *iaan5a 'i

angkal li'a( 'an 'i tonil. PET !an 'an kom*inai PET >T !an t"la( 'ig+nakan +nt+k

m"nin'aklan7+ti ai"n "t"la( "ngo*atan +nt+k m"ng"$al+ai #"k+#"ni.

2

3"5 Massa lehe! 7ang idak dikeahui asal um! '!ime!

Maa l"("# a'a ai"n '"=aa (a#+ 'i!+#igai t+mo# 'an k"ganaan. Pa'a ta(+n 1)-2;

Ma#tin 'an Romi"+; a'a 1.3,, t+mo# #im"# 'a#i k"ala 'an l"("# *"#mani&"tai maa

l"("# a'a 12;%? ka+. M"#"ka m"n5atakan; J"m*"a#an aim"t#i 'a#i at+ ata+ l"*i(



35

k"l"n7a# g"ta( *"ning l"("# a'a o#ang '"=aa (ami# "lal+ kank"# 'an *iaan5a 'i"*a*kan

ol"( m"tatai 'a#i l"i #im"# 'i m+l+t ata+ &a#ing.J P#ini ini 'aat *"#lak+ aat ini.1,

M"n+#+t L"" 'an H"lm+ m"n'+k+ng t"o#i *a(=a maa l"("# aim"t#i a'a o#ang

'"=aa (a#+ 'iangga gana amai t"#*+kti "*alikn5a. M"#"ka m"n"liti "im"n *ioi

'a#i maa l"("# a'a 163 ai"n; 'a#i ai"n K%, ta(+n; 2);%? m"miliki ka#inoma 'an

21;%? m"miliki lim&oma. P"n"litian t"#"*+t (ami# ama '"ngan Sla+g(t"#; Ma7a#aki; 'an

So+t(=i!k 'an Ma5o 'an L""; 5ang m"lao#kan *a(=a "kita# -,? m"#+akan k"ganaan

a'a maa 'i l"("#. Ini'"n "n5akit gana 'alam maa l"("# naik m"n7a'i 4,? k"tika

no'+l ti#oi' 7inak 'i"kkl+ikan.1,

P#ini k"'+a m"ng"nai l"i #im"# 5ang ti'ak 'ik"ta(+i a'ala( *a(=a "ngam*ilan

k"l"n7a# g"ta( *"ning 5ang m"m*"a# +nt+k t+7+an 'iagnotik a'ala( m"#+gikan +nt+k ai"n

'"ngan m"tatai ka#"na m"tatai 7a+( 'an #"k+#"ni #"gional l"*i( "#ing t"#7a'i a'a

ai"n 5ang t"la( m"n7alani *ioi "kii 'i*an'ingkan a'a m"#"ka '"ngan ta'i+m 5ang

ama 5ang *"l+m 'ilak+kan *ioi "kii. T"m+an ini m"n+n7+kkan *a(=a t"#7a'i gangg+an

'#aina" lim&atik 'an mani+lai maa m"tatai. Pa'a t" lim&angiog#a&i l"("# m"n+n7+kan

a'an5a gangg+an ola '#aina" lim&atik 5ang no#mal a'a t"#ai "m*"'a(an. Goo'"# 'an

Palm"# t"la( ama m"n"gakan (al ini 5ait+ t"#7a'i "ningkatan ini'"ni #"k+#"ni 'an

komlikai l+ka a'a ai"n 5ang 'ilak+kan *ioi.1,

Ua5a +nt+k m"n'iagnoa 'an mana7"m"n maa 'i l"("# (a#+ 'im+lai '"ngan

"m"#ikaan 5ang !"#mat 'a#i #ongga m+l+t; nao&a#ing; (io&a#ing; la#ing; ti#oi'; k"l"n7a#

l+'a(; 'an k+lit k"ala 'an l"("#. -,<6? ai"n 5ang m"miliki maa l"("#; lokai t+mo#

#im"# 'ii'"nti&ikai '"ngan "m"#ikaan k"ala 'an l"("# 5ang m"n5+l+#+(.1,



36

3"9 Massa lehe! 7ang dikeahui asal um! '!ime!

Ini'"ni m"tatai k"l"n7a# g"ta( *"ning l"("# anta#a lain t+mo# #ongga m+l+t 3,<6-?;

t+mo# o#o&a#ing 2)<43?; t+mo# nao&a#ing 6,<),?; t+mo# (io&a#ing -2<2?; t+mo#

+#agloti 3-<-%?; t+mo# gloti <)?; t+mo# inonaal 1,<2,?; k"l"n7a# l+'a( 2-<-,?;

k"l"n7a# ti#oi' 14<4%?.4

*amba! 3"9 &elm'k measasis kelena! geah bening dengan lesi '!ime! 7ang

dikeahui"16

L"*i( 'a#i ),? 'a#i m"tatai l"("# t"#'i#i ka#inoma "l k+amoa "'angkan

a'"noka#inoma; ka#inoma undifferentiated ; 'an k"ganaan lainn5a mialn5a; ka#inoma

ti#oi'; m"lanoma k+#ang +m+m 'i '+nia Ba#at. /a#inoma undifferentiated l"*i( "#ing



37

t"#7a'i 'i n"ga#a<n"ga#a '"ngan #"$al"ni tinggi ka#inoma nao&a#ing.12

3" Tum! Lehe! P!ime!

N"olama #im"# l"("# t"#ma+k 5ang t+mo# 5ang m+n!+l 'a#i t#+kt+# lim&o$ak+l"#

l"("# 'an 7a#ingan l+nak l"("#. N"olama ini 'aat *"#+a 7inak ata+ gana. M"ki+n 7a#ang

"n5"*a* maa l"("#; kita (a#+ "lal+ m"m"#tim*angkan t+mo# ini 'alam 'iagnoi

*an'+ng 'a#i maa l"("#.1,

Diagnoi n"olama l"("# m"m"#l+kan anamn"i l"ngka 'an "m"#ikaan &iik 5ang

!"#mat. Ha#+ 'itan5akan #i=a5at t+mo# l"("# "*"l+mn5a; #i=a5at k"l+a#ga; tan'a<tan'a

it"mik 'an t"#ai #a'iai "*"l+mn5a 'a"#a( k"ala 'an l"("#. P"m"#ikaan k"ala 'an

l"("# 5ang kom#"("ni& (a#+ m"n!ak+ t"linga 'an t+lang t"mo#al; #ongga inonaal;

nao&a#ing; o#o&a#ing; (io&a#ing; 'an la#ing "#ta "m"#ikaan a#a& k#anial. 0ika maa l"("#

ti'ak *"#'"n5+t; FNAB (a#+ 'ilak+kan.1,

P"m"#ikaan #a'iologi >T<!an 'an magn"ti! #"onan!" imaging MRI 'ilak+kan +nt+k

"$al+ai t+mo# 7a#ingan l+nak 'a#i 'a"#a( k"ala 'an l"("# '"ngan k"+nt+ngan t"#t"nt+ 'a#i

"tia 7"ni t+mo#; lokai; 'an k"'"katan '"ngan t#+kt+# $ital. M"ki+n t"m+an #a'iog#a&i

'aat m"m*"#ikan "t+n7+k +nt+k 'iagnoi; 'iagnoi 5ang ak+#at ti'ak 'aat 'ikon&i#mai

tana "$al+ai (itologi. >T !an angat *"#g+na 'alam m"ng"$al+ai kali&ikai 'alam

t+mo#. S"lain it+. MRI m"m"*"#ikan k"+nt+ngan 'a#ia'a >T !an 'alam m"ng"$al+ai

7a#ingan l+nak t+mo# 'i 'a"#a( k"ala 'an l"("#. MRI 'i#"kom"n'aikan a'a t+mo# 7a#ingan

l+nak 5ang *"#'"katan '"ngan t#+kt+# $ital 'i "kita# l"("#. Poit#on "miion tomog#a(5

PET !an +nt+k m"ng"$al+ai t+mo# #im"# 'an "n5akit m"tatai t"#t"nt+.1,



38

3""1 Tum! /inak Lehe!

N"olama 7inak l"("# "#ing ala( 'iagnoi "*agai in&"ki mialn5a; lim&a'"niti

ata+ *a=aan mialn5a; kita *#akiali a'a "m"#ikaan a=al. D"ngan '"mikian; 'iagnoi

"m+a maa l"("# m"m"#l+kan anamn"i; "m"#ikaan &iik; "m"#ikaan #a'iologi; 'an

FNAB. N"olama #im"# 7inak l"("# t"#ma+k t+mo# "m*+l+( 'a#a(; ""#ti

a#agangliomaC n"olama a#a& "#i&"#; ""#ti !(=annoma ata+ N"+#o&i*#omaC 'an

lioma.

N"olama $ak+la#.1,

H"mangioma m"m+n5ai akti$ita mitoi 5ang m"ningkat 'an k"a'aan '"mikian

'iangga "*agai n"olama "7ati. Mal&o#mai $ak+l"# ti'ak ""#ti ("mangioma;

m"m+n5ai k"!"atan "nggantian "l "n'ot("lial 5ang no#mal. L"i 5ang tinggi aki*at

k"lainan m"n5olok 5ang *"#(+*+ngan '"ngan it"m a#t"#ial 'an $"no+a 'an 'aat

m"n5"*a*kan maala( 5ang *"#*a(a5a 'a#i a'an5a "#'a#a(an mai&; gagal 7ant+ng 'an

kong"ti& !+#a( tinggi; 'an an"mia ("molitik.1,

Di 'a"#a( l"("#; ("mangioma *iaan5a *"#7"ni ka$"#noa 5ang m"#+akan *"n7olan

l+nak 5ang m"ng"mi *ila 'it"kan 'an m"ngg"l"m*+ng aat 'il"akan lagi. T+mo# ini

'itangani '"ngan "kti#ai; *ila *"a# "#l+ "#iaan *"#+a a#t"#ig#a&i ata+ &l"*og#a&i.1,

T+mo# glom+ ka#oti 5ang m"#+akan t+mo# !+k+ 7a#ang 'it"m+kan; t"#+tama 'i

"tinggi ii l"("#. Um+mn5a t+mo# ini ti'ak m"n+n7+kan g"7ala 'an a'a alai t"#'aat

'"n5+t na'i a.ka#oti. T+mo# ini 'aat 'i g"#akan 'i *i'ang (o#iontal t"tai ti'ak 'i *i'ang

$"#ti!al ka#"na (+*+ngan "#at a'a *i&+#kaio a.ka#oti kom+ni; "nanganann5a 5ait+



39

"kti#ai maa t+mo# .1,

.

*amba! 3" MR angig!ai 'ada um! 'a!aganglima10

Schwannoma

Schwannoma; t+mo# 5ang *"#aal 'a#i "l S!(=ann a#a& "#i&"#. T+mo# ini *iaan5a olit"#.

S"!a#a klini; !(=annoma l"("# m+ngkin *"#i&at maa l"("# 5ang n5"#i. Pa'a

"m"#ikaan #a'iologi; !(=annoma *iaan5a *"#*ata t"ga a'a >T<!an kont#a.

P"m"#ikaan "lan7+tn5a '"ngan "m"#ikaan (itoatologi. T#an&o#mai maligna 'a#i

!(=annoma 7a#ang t"#7a'i. Mana7"m"n ili(an !(=annoma l"("# *iaan5a m"li*atkan

#""ki *"'a(.1,



40

*amba! 3"6 MR+ sh;annma agal dan sa!a agus18

,eu!ib!ma

N"+#o&i*#oma a'ala( t+mo# 7inak "l+*+ng a#a&; maa l"("# olit"# ata+ *"*"#aa no'+l

t+mo#. N"+o&i*#oma *"#kaitan '"ngan "n5akit a+toomal 'ominan $on R"!kling(a+"n.

B"#*"'a '"ngan !(=annoma; n"+#o&i*#oma 5ang +n"n!a+lat"' 'an (itologi

m"n+n7+kkan *+n'"l 7alinan "l in'l". S""#ti !(=annoma; n"+#o&i*#oma olit"#

m"ngalami m"ngalami t#an&o#mai maligna 'an aling *aik 'io*ati '"ngan #""ki *"'a(.

B"'a( +nt+k n"+#o&i*#omatoi *iaan5a 'i"#+nt+kkan *agi m"#"ka l"i 5ang n5"#i; m"#"ka

5ang 'aat m"n5"*a*kan t"kanan 'a"#a( "kita# 'a#i +k+#ann5a 5ang *"a#; ata+ l"i 5ang

gana.1,

Li'ma

Lioma a'ala( t+mo# 7inak 5ang *"#aal 'a#i 7a#ingan a'ioa. Lioma a'ala( t+mo#

7a#ingan l+nak 5ang aling "#ing 'a#i l"("# 'an *iaan5a t"#'aat "*agai maa l"("# 5ang



41

ti'ak n5"#i. Mana7"m"n lioma a'ala( '"ngan #""ki *"'a( l"ngka +nt+k alaan "t"tika.

3""2 Tum! *anas Lehe!

P"m*a(aan *"#ik+t akan t"#ma+k t+mo# gana #im"# 5ang *"aal 'a#i t#+kt+# 'i l"("#.

N"olama *"#ik+t ini ti'ak t"#ma+k "m+a tai t"#ma+k 5ang aling "#ing (a#+

'i"#tim*angkan 'alam 'iagnoi *an'ing maa gana 'i 'a"#a( l"("#.1,

Tum! Ti!id

N"olama ti#oi'; *aik 7inak ma++n gana; a'ala( "n5"*a* +tama maa l"("#

koma#t"m"n ant"#io# 'i "m+a k"lomok +ia 'an *"#ama '"ngan m"tatai k"l"n7a# g"ta(

*"ning. M"tatai k"l"n7a# g"ta( *"ning a'ala( g"7ala a=al a'a "kita# 1-? ka+

ka#inoma aila#.1,

No'+l ti#oi' 5ang 7inak aling "#ing t"#7a'i a'a +m+# 3, <-, ta(+n. Aa*ila no'+l

'i7+mai a'a +m+# 2, ta(+n; 2,<,? a'ala( gana; '"mikian 7+ga kala+ +m+# K -, ta(+n.

A'an5a g"7ala lokal +a#a a#a+ 'an 'i&agi *iaan5a 'aat m"#+akan "t+n7+k a'an5a i&at

in$ai& +at+ k"ganaan ti#oi'. S+at+ no'+l ti#oi' 5ang +'a( *"#ta(+n<ta(+n *"a#n5a t"ta

*iaan5a 7inak; akan t"tai aa*ila *"#+*a( m"n7a'i m"m*"a# 'alam =akt+ 5ang ingkat

*+lanmingg+ maka "#l+ 'i=aa'ai *"#+*a( m"n7a'i gana. Lak+kan "m"#ikaan

it"mati +#+t 'a#i ata k" *a=a(; im"t#i *an'in gkan kan an 'an ki #i ; im+l tan

k an an 'an ki #i *"#amaan ; "kama 'an 7angan l+a m"li(at k"ala *agian *"lakang.

S"!a#a #+tin (a#+ 'i"$al+i 7+ga k"a'aan k"l"n7a# g"ta( *"ning l"("#n5a; a'aka(

"m*"a#an; lak+kan "$al+ai t"#"*+t "!a#a it"mati +la.

Pa'a "n5akit ini 'aat 'i"#tai "m*"a#an ti#oi' '"ngan &+ngi no#mal "+t i#oi';



42

*"#k+#ang (ioti#oi' ata+ m"ningkat (i"#ti#oi'. Bila 'i"#tai '"ngan &+ngi *"#k+#ang

ata+ m"ningkat *iaan5a gam*a#an klinin5a 7"la; "(ingga 'iagnoi agak m+'a(

'it"gakkan.

P"m"#ikaan (o#mon ti#oi' 'an TSH aling "#ing m"ngg+nakan radioimmuno7

assay 869" 'an !a#a en;yme7linked immunoassay ELISA 'alam "#+m ata+ lama

'a#a(. P"m"#ikaan T% total TT% 'ik"#7akan a'a "m+a "n'"#ita '"ngan "n5akit ti#oi'. T3

total TT3 angat m"m*ant+ +nt+k (i"#ti#oi' 'an TSH angat 'i"#l+kan +nt+k m"ng"ta(+i

(ioti#oi'.

D"ngan &oto #ontg"n 'aat m"m"#7"la a'an5a '"$iai t#ak"a; ata+ "m*"a#an t#+ma

#"t#ot"#nal 5ang a'a +m+mn5a "!a#a klini +'a( *ia kita '+ga; &oto #ontg"n l"("#

oii ant"#o ot"#io# 'an oii lat"#al 'i"#l+kan +nt+k "$al+ai kon'ii 7alan na&a.

A'an5a kali&ikai (al+ a'a t#+ma m"n+n7+kkan ka#inoma ail"# "'ang kali&ikai 5ang

kaa# *ia t"#'aat a'a "n'"mik goit"# 5ang lan7+t ata+ 7+ga *ia a'a ka#inoma m"'+l"#

P#ini i'ik ti#oi' a'ala( 'a"#a( '"ngan &+ngi 5ang l"*i( akti& akan m"nangka

#a'ioakti$ita 5ang l"*i( tinggi. Ra'ioioto 5ang +m+m 'ig+nakan 'alam *i'ang ti#oi'ologi

a'ala( I131; I123; I12-; T!))m "#t"!(n"tat". Ra'iai gamma 'ig+nakan +nt+k 'iagnotik;

"'angkan #a'iai *"ta (an5a "nting +nt+k t"#ai.

USG; !an ti#oi'; 'an t" &+ngi ti#oi' (a#+ 'ilak+kan +nt+k ai"n 5ang m"miliki

maa l"("# koma#t"m"n ant"#io# 5ang *"#g"#ak aat m"n"lan. Maa ti#oi' 'it"m+kan kitik

'"ngan USG (a#+ 'iai#ai. L"i a'at (a#+ 'ilak+kan t" n+kli# T3;&T%; TSH. S"kita#

2,<2-? 'a#i no'+l 'ingin olit"# akan t"#*+kti kitik; 'an "kita# 2,<2-? a'ala( kank"#.

FNAB a=al maa ti#oi' 'aa 'ilak+kan tana t" n+kli# 'an USG; 'an (al ini t"la( m"n7a'i

tan'a# 'iagnoi ka#"na m"ng(ailkan 'iagnoi 5ang l"*i( !"at; "konomi; 'an '"&initi&



43

+nt+k i&at maa ti#oi'.1,

Limma

Lim&oma malignan 5ang *"#i&at it"mik 'an 'aat m+n!+l "*agai lim&oma 'i l"("#.

/"l"n7a# *iaan5a m"m*"a#; k"n5al; +m+mn5a *"#*"n7ol<*"n7ol; 'an ti'ak n5"#i. Bia a'a

g"7ala +m+m ""#ti #aa l"la( 'an '"mam. Diagnoi 'it"gakkan m"lal+i "m"#ikaan

atologi 7a#ingan m"lal+i *ioi 'an "m"#ikan (itoliatologik. Lim&oma Non<Ho'gkin

NHL a'ala( k"lomok "n5akit lim&oma gana 5ang ("t"#og"n 5ang 7+ga m+ngkin m+n!+l

"#tama "*agai lim&oma l"("# .1,

P"n"nt+an ta'i+m 5ang t"at angat "nting "*"l+m m"m+lai t"#ai. Pai"n (a#+

m"lal+i "m"#ikaan l"ngka 5ang m"li+ti anamn"i; "m"#ikaan &iik; t"#ma+k

la#ingokoi in'i#"k. P"m"#ikaan "n+n7ang ""#ti (omputed tomography >T ata+

<agnetic 6esonance 9maging MRI 'aat m"nilai "!a#a l"*i( l"ngka "#l+aan 'a#i +at+

t+mo# 'i 'a"#a( k"ala 'an l"("#.

Lim&oma *iaan5a 'ik#it; k"n5al; 'an ti'ak n5"#i t"kan.

S"im"n 'a#i maa 'aat a=aln5a 'i*ioi ol"( FNAB. Bila (ail FNAB mai( *"l+m

7"la; langka( 'iagnotik *"#ik+tn5a (a#+ 'ilakk+kan *ioi t"#*+ka +nt+k "m"#ikaan

(itoatologi l"ngka. 0ika "m"#ikaan &iik ata+ la#ing&a#ingokoi t"#'aat k"lainan !in!in

al'"5"#; *ioi a'a 'a"#a( t"#"*+t 'i"#l+kan +nt+k 'iagnoi 'an "n"nt+an ta'i+m

lim&oma.1,

P"m"#ikaan FNAB 'aat m"n'"t"ki +at+ "n5akit 5ang #"k+#"n ata+ "#+*a(an

(itologi; nam+n ti'ak 'aat m"m*"'akan; aaka( lim&oma t"#"*+t *"#i&at &olik+l"# ata+

'i&+; 5ang m"#+akan &akto# "nting 'alam m"n"nt+kan '"#a7at 'an #ognoi +at+



44

lim&oma. Unt+k it+la( *ioi t"#*+ka l"*i( 'iili( +nt+k m"n"nt+kan 'iagnoi a=al.

P"m"#ikaan im+no(itokimia 'aat m"m*ant+ m"m*"'akan lim&oma '"ngan k"ganaan

analatik ata+ +n'i&&"#"ntiat"' anti*o'i antik"#atin +nt+k ka#inoma; anti*o'i #ot"in anti<

S<1,, +nt+k m"lanoma 'an anti*o'i anl"+koit +nt+k lim&oma. P"m"#ikaan

im+no(itokimia 7+ga 'aat m"m*ant+ m"m*"'akan in&ilt#at lim&oi' 7inak 'a#i +at+

lim&oma '"ngan *ant+an mik#oko !a(a5a. -

S"*agian *"a# NHL m"ng"k#"ikan "nan'a "l T ata+ "l B. Sat+ "t an"l

"m"#ikaan antig"n "l T 'aat m"m*"'akan lim&oma "l T '"ngan +at+ (i"#laia.

Lim&oma "l B m"ng"k#"ikan at+ k"la t+nggal 'a#i #antai #ingan kaa ata+ lam'a;

"'angkan (i"#laia m"n+n7+kkan +at+ !am+#an 'a#i k"'+a k"la t"#"*+t.

P"m"#ikaan im+no(itokima ata+ "m"#ikaan mol"k+l"# lainn5a akan l"*i( *aik

aa*ila 'ilak+kan a'a 7a#ingan 5ang mai( "ga#; maka "*aikn5a klinii m"m*"#ikan

in&o#mai t"ntang a'an5a k"!+#igaan 'iagnoi a'ala( +at+ lim&oma k"a'a a(li atologi.

S+at+ 7"ni +*ti" (itologi +at+ NHL m"m"nga#+(i "n"nt+an ta'i+m; t"#ai 'an

(a#aan (i'+ ai"n.

*amba! 3"8 >T san ,HL sinus 'a!anasal20

P"m"#ikaan Positron =mission %omography PET *"#g+na +nt+k m"ng"$al+ai ia

maa t+mo# a'a ak(i# t"#ai +nt+k m"n"nt+kan tat+ k"kam*+(an "n5akit.



45

Tum! kelena! ludah

T+mo# k"l"n7a# l+'a( (a#+ 'i"#tim*angkan "tia kali maa a'at m"m"#*"a#

t"#l"tak 'i '"an 'an 'i *a=a( t"linga; 'i +'+t man'i*+la; ata+ 'alam "gitiga

+*man'i*+la. T+mo# 7inak k"l"n7a# l+'a( *iaan5a tana g"7ala. G"7ala n5"#i; "#t+m*+(an

5ang !"at; a#alii a#a& k#anial >N 8II; ata+ &ikai k+lit 'i!+#igai k"ganaan.

P"m"#ikaan #a'iog#a&i 'iagnotik mialn5a; ialog#a(5; !an n+kli#; >T !an 'aat

'ilak+kan +nt+k 'iagnoi t+mo# k"l"n7a# l+'a(. Diagnoi ati a'ala( '"ngan *ioi

t"#*+ka 'alam *"nt+k "ngangkatan k"l"n7a# +*man'i*+la# ata+ a#oti'"!tom5 +"#&iial.2;

1,

&anke! Pa!aganglimas

S"tia maa a'a l"("# (a#+ 'i#a*a 'an a+k+ltai +nt+k m"matikan *a(=a maa

ti'ak m"l"kat ata+ tim*+l 'a#i t#+kt+# $ak+la#. Ma5o#ita a#aganglioma ti'ak m"m"#l+kan

7a#ingan +nt+k 'iagnoi 5ang ak+#at; ""#ti 5ang 'i7"lakan 'i *agian "*"l+mn5a. Pot"ni

k"ganaan a#aganglioma *"#ko#"lai '"ngan lokai aal; 2? amai 1)? 'ilao#kan

m"n7a'i gana; t+mo# glom+ 7+g+la#" m"#+akan #""nta" aling #"n'a( 'an t+mo# $agal

#""nta" t"#tinggi. S"kita# 6? 'a#i t+mo# ka#oti m"n+n7+kkan k"7anaan; m"ki+n

"m"#ikaan (itologi 'iangga ti'ak !+k+ +nt+k m"n"nt+kan k"ganaan. Hal ini

*"#'aa#kan a'a "#ilak+ t+mo# ""#ti m"tatai k"l"n7a# g"ta( *"ning ata+ m"tatai

7a+(.

,e'lasma Ruang Pa!a'ha!7ngeal

B"#*agai ti" k"ganaan #im"# #+ang a#a(a#5ng"al t"la( 'ilao#kan; mialn5a t+mo#

gana k"l"n7a# li+# ka#inoma a'"noi' kitik; !a#!inoma ":<l"omo#&ik a'"noma; ka#inoma



46

"l a!ini!; t+mo# n"+#og"nik gana; lim&oma; lioa#koma; &i*#oa#koma; m"ningioma

gana; 'an lain<lain.

Sa!kma"

L"("# 'an a#oti m"#+akan lokai t"#*an5ak t"#7a'in5a a#!oma a'a k"ala 'an l"("#;

m"ki+n k+#ang 'a#i 1? 'a#i "m+a k"ganaan k"ala 'an l"("#. Di Am"#ika S"#ikat;

k+#ang 'a#i -,,, ka+ 5ang 'ilao#kan "tia ta(+nn5a; 4,? a'a '"=aa. Da#i 7+mla(

t"#"*+t; (an5a 1-? amai 2,? a'a k"ala 'an l"("#; '"ngan lokai 'i 7a#ingan l+nak l"("#

'an 'a"#a( in+ a#anaal 5ang aling "#ing. M"ki+n "tiologi *"l+m 'ik"ta(+i;

n"olama ini *"#aal 'a#i "l m""n!(5mal; !onto(n5a "l "n'ot"l; otot; t+lang #a=an; 'an

7a#ingan ikat. L"*i( 'a#i 4,? #i a#koma *"#aal 'a#i 7a#ingan l+nak; "'angkan "kita# 2,?

m+n!+l 'alam t+lang.21; 22

Aa*ila "m+a lokai 'i"#tim*angkan; ti" aling "#ing a'ala( (itio!5toma &i*#o+

malignan HFM. Di k"ala 'an l"("#; a#koma 5ang aling "#ing a'a anak<anak a'ala(

#(a*'om5oa#!oma RMSC a'a o#ang '"=aa; ot"oa#!oma; angioa#!oma; HFM; 'an

&i*#oa#!oma t"#7a'i aling "#ing. RMS a'ala( a#koma 5ang aling "#ing a'a anak<anak

'an 7+ga m"#+akan a#koma aling *an5ak a'a 'a"#a( k"ala 'an l"("#. S"!a#a

k""l+#+(an; HFM 'iangga 7"ni 5ang aling "#ing 'a#i a#!oma.

21; 22



47

*amba! 3"10 Pasien be!usia 2 ahun dengan sa!kma a!ingan lunak 'ada lehe! ki!i22

Sa#koma 'iklai&ikaikan 'an 'i*"#i "namaan "+ai '"ngan 7a#ingan aaln5a; *+kan

'a#i lokai aal. Ban5ak J7a#ingan l+nakJ a#koma ""#ti HMF 'aat 'i'iagnoi a'a

t+lang; t"tai 'iagnoi t"#gant+ng a'a "'iaan (itologi. Sit"m ta'i+m "ka#ang t"#ia(

aaka( *"#aal 'a#i t+lang ata+ 7a#ingan l+nak aal a#koma t"#"*+t.

P"ngo*atan a#koma 'i 'a"#a( k"ala 'an l"("# m"li*atkan "n'"katan m+lti'iilin;

"$al+ai; "(ingga 'aat otimal 'an #"(a*ilitai. P"#a=atan (a#+ "lal+ m"n5"#takan

kon+ltai '"ngan a(li *"'a( k"ala 'an l"("#; onkologi m"'i; 'an onkologi #a'iai 'alam

k"#7aama 5ang "#at '"ngan k"ala 'an l"("# atologi 'an n"+#o#a'iologit. S"iali lain

"#ing t"#li*at 'alam "#a=atan ai"n ini t"#ma+k a(li onkologi gigi; #ot(o'ontit

makilo&aial; 'an "iali #"(a*ilitai. Hitologi; "$al+ai; 'an "ngo*atan "tia 7"ni

(itologi a#koma 'an it+ aal akan *"#$a#iai; 'an '"ngan '"mikian; akan 'i*a(a "+ai

'"ngan "l aal.21; 22



48

Sa!kma #lela!

Sa#koma al$"ola# 7a#ingan l+nak a'ala( t+mo# langka 5ang m"li*atkan k"ala 'an l"("#

a'a 2-? ka+; m"ki+n k+#ang 'a#i 1? 'a#i "m+a a#koma. S"l aal ti'ak 'ik"ta(+i;

m"ki+n 'i&"#"niai "l otot 'an a#a& t"la( 'ii'"nti&ikai. Lokai t"#"#ing 5ang t"#k"na 'i

k"ala 'an l"("# a'ala( li'a( 'an o#*it; '"ngan o#*it 5ang m"miliki #ognoi 5ang t"#*aik.

Sa#koma al$"ola# 7a#ingan l+nak 7a#ang m"li*atkan l"("# 'an 'ilao#kan *"#m"tatai k"

l"("# 'a#i k"ala 'an l"("# k+#ang 'a#i 1,? 'a#i ka+; "(ingga 'i"ki l"("# k+#ang

*"#alaan. M"tatai 7a+( t"#7a'i 'an m+ngkin ti'ak a'a "lama *"#ta(+n<ta(+n ata+ '"ka'"

"t"la( t+mo# a=al 'io*ati. T"#ai "m*"'a(an t"ta an'alan "ngo*atan; m"ki+n "#ing

kam*+(. Dilao#kan k"*"#(ailan '"ngan "ngo*atan m+ltimo'alita t"#ma+k k"mot"#ai;

Angka +#$i$al 6-? a'a - ta(+n tai t+#+n m"n7a'i -,? a'a 1, ta(+n.21; 22

#ngisa!ma"

Angioa#!oma a'ala( a#koma langka 5ang lain 5ang t"#7a'i k+#ang 'a#i 1? 'a#i "m+a

a#koma; "t"nga(n5a m"li*atkan k"ala 'an l"("#. P"n5akit ini m+ngkin m"li*atkan

"m*+l+( 'a#a( 'an lim&atik; 'i&"#"niai 'a#i l5m(angioa#!oma. Etiologi mai( *"l+m

7"la m"ki+n t#a+ma; #a'iai; 'an l5m("'"ma t"la( 'ikaitkan '"ngan *"*"#aa ka+.

P"ngo*atan +tama a'ala( "m*"'a(an; m"ki+n 'i*+t+(kan ma#gin l"*a# ka#"na i&at

m+lti"nt"# t+mo# ini 'an tingkat k"kam*+(an m"n'"kati -,?. T"#ai #a'iai a!a o"#ai

7+ga 'i#"kom"n'aikan; a'a +la '"ngan m"ngg+nakan k"mot"#ai 'alam n"olama

t"#"*+t. M"tatai "#ingn5a t"#7a'i a'a a#+<a#+ 'an (ati; "'angkan m"tatai #"gional

"#ing 'i k+lit k"ala.21; 22

Hemangiendhelima e'ielid"



49

T+mo# ini angat langka 'an k"t"#li*atann k"ala 'an 'a"#a( l"("# (an5a "kita# 1,?

amai 1-? 'a#i ka+. L"i ini 'it"m+kan *"#aal 'a#i 7"ni "it("lio' ata+ (itio!5toi' "l

"n'ot"l. P"ngo*atann5a '"ngan "kii *"'a( '"ngan t"#ai #a'iai. /"kam*+(an 'an ot"ni

m"tatai *"#ko#"lai '"ngan ag#"i$ita *iologi '"ngan l"i "it("lioi' m"miliki #ognoi

5ang l"*i( *aik; "'angkan l"i a#komatoa m"miliki ot"ni m"tatatik 5ang l"*i( tinggi

'an #ognoi 5ang l"*i( *+#+k.21

>hnd!sa!ma"

M"ki+n !(on'#oa#!oma *iaan5a 'it"m+kan 'i 'a"#a( #a(ang ata 'an #a(ang *a=a(

'a#i k"ala 'an l"("#; nam+n 7+ga *ia 'i'aatkan 'i l"("# ata+ 7a#ingan l+nak. S"!a#a

(itologi; "m*"nt+kan t+lang #a=an a'a '"ngan *"#*agai tingkat 'i&"#"niai 'an k"la.

T+mo# ini *iaan5a 'iklai&ikaikan "*agai t+lang ata+ ":t#ao"o+ 'an +*ti"n5a

kon$"nional; m5:oi'; 'an m""n!(5mal '"ngan m""n!(5mal m"n7a'i 7a+( l"*i( "#ing

a'a anak<anak 'an '"=aa m+'a. P"ngo*atan *"#+a #""ki *"'a( l+a; 'an 'aat

'i"#tim*angkan #a'iai a!a o"#ai; t"#+tama a'a t+mo# '"ngan g#a'ing tinggi. Angka

+#$i$al !(on'#oa#!oma 'i k"ala 'an l"("# 4;2? 'alam - ta(+n 'an ,;6? 'alam

1,ta(+n '"ngan -);-? m"n7alani o"#ai a7a; "m"nta#a 21;,? m"miliki t"#ai #a'iai

a'7+$ant.

Osesa!kma"

Ot"oa#!oma k"ala 'an l"("# t"#+tama a'a man'i*+la 'an makila; '"ngan man'i*+la

m"miliki ini'"n "'ikit l"*i( tinggi. T+mo# 7a#ang m"li*atkan 7a#ingan l+nak l"("#;

m"ki+n m"tatai 'a"#a( t"#iolai t"la( 'ilao#kan 'i aming *"*"#aa lao#an 5ang

m"li*atkan (5oi' 'an la#ing. P"ngo*atan l"i ini t"#+tama #""ki *"'a( '"ngan ata+ tana



50

t"#ai #a'iai 'an k"mot"#ai. Ini'"n m"tatai k" "#$ikal 'ilao#kan k+#ang 'a#i 1,?;

"(ingga 'i"ki l"("# k+#ang *"#man&aat.

-ib!sa!ma"

L"("# a'ala( lokai k"'+a 5ang aling "#ing a'a &i*#oa#!oma k"ala 'an l"("#; "t"la(

'a"#a( in+ a#anaal. M"ki+n 'aat t"#7a'i a'a "m+a +ia; l"*i( "#ing t"#7a'i a'a

o#ang '"=aa anta#a %, 'an , ta(+n. N"olama ini *"#aal 'a#i &i*#o*lat 'an *iaan5a

tim*+l "!a#a ontan t"tai 'ik"ta(+i m+n!+l 'i 'a"#a( *"ka l+ka *aka# 'an t"#ai #a'iai. 21

Leim7sa!ma"

L"iom5oa#!oma a'ala( n"olama 5ang "#ing a'a '"=aa lan7+t; m"ki+n 'aat

t"#7a'i a'a "m+a +ia. M"#+akan 6? 'a#i "m+a a#koma; 'an 3? m"li*atkan 'a"#a(

k"ala 'an l"("#. N"olama ini *"#k"m*ang 'a#i otot olo 'an "!a#a (itologi tamak

&aik+la *"#ola t"gak l+#+ '"ngan inti cigarshaped ; itolama "oino&ilik; 'an $ak+ola

a#an+!l"a#. T"#ai '"ngan #""ki l+a '"ngan ma#gin n"gati&. Di"ki l"("# 'aat

'iin'ikaikan ka#"na ot"ni m"tatai #"gional 'an 7a+(. P#ognoi *"#$a#iai '"ngan lokai

aal 'an (itologi *"#$a#iai; "(ingga "timai ak+#at +#$i$al "tia lokai +lit.21

Li'sa!kma"

M"ki+n 'iangga "*agai a#!oma 7a#ingan l+nak 5ang aling "#ing 'a#i o#ang

'"=aa; 5ait+ 12? amai 14? 'a#i ka+; k"t"#li*atan 'a"#a( k"ala 'an l"("# 7a#ang;

t"#7a'i a'a "kita# 3? amai 6?. Lioa#koma 'iangga t"#7a'i l"*i( "#ing a'a lokai

7a#ingan l+nak l"*i( 'alam 'a#i lioma ata+ lioma atiikalC m"tatai "#$ikal 7a#ang

t"#7a'i; 'an m"tatai 7a+( t"la( 'ilao#kan a'a a#+<a#+ 'an (ati.

-ib!us hisi7ma Maligna"



51

S"*agian m"ngangga FHM a#koma 7a#ingan l+nak 5ang aling "#ing a'a o#ang

'"=aa. Nam+n 7a#ang m"li*atkan 'a"#a( k"ala 'an l"("#; m"ki+n 'aat t"#7a'i 'i

7a#ingan l+nak in+ a#anaal; l"("#; 'aa# t"ngko#ak; 'an k"l"n7a# a#oti. Da#i 44

(itio!5toma &i*#o+ 7inak 'an gana 'a#i k"ala 'an l"("#; l"("# m"#+aka lokai k"'+a

5ang aling "#ing "t"la( inonaal. Fakto# "tiologi t"#ma+k t"#ai #a'iai "*"l+m 'an

"ngg+naan ilika "*agai *a(an in7"ki.

Hemangi'e!i7ma ganas"

H"mangio"#i!5toma m+n!+l 'a#i "l<"l imm"#man; 5ang t"#7a'i "kita# kail"# 'an

$"n+la okaill"#. Ma5o#ita ("mangio"#i!5toma k"ala 'an l"("# 'it"m+kan a'a in+

a#anaal; m"ki+n (ami# "tia 7a#ingan *ia t"#li*at; t"#ma+k l"("#.

Tum! selubung sa!a 'e!ie! maligna

Itila( t+mo# "l+*+ng a#a& "#i&"# maligna TSSPM m"nga!+ a'a 7"ni n"+#oa#!oma

5ang m"=akili (ami# 1,? 'a#i "m+a a#koma; *"i&at ag#"i& '"ngan #ognoi 5ang

*+#+k. T"#ai #""ki l+a '"ngan ma#gin 5ang 7"la 'an #a'iai a!a o"#ai ; ma#gin 'an

+k+#an t+mo# *"#(+*+ngan '"ngan angka +#$i$al. P#ognoi *+#+k m"ki+n "ngo*atan

ag#"i&; l"*i( 'a#i %,? t"#'aat #"k+#"ni; m"ki+n k"7a'ian m"tatai lim&atik 7a#ang

'i'aatkan.

Rhabdmisa!kma <RMS=

RMS a'ala( k"ganaan 5ang *"#aal 'a#i "l<"l m""n!(5mal t"#kait '"ngan 'i&"#"niai

otot #angka. Ini m"#+akan a#!oma 7a#ingan l+nak 5ang aling "#ing a'a anak<anak 'an

2,? 'a#i "m+a a#koma. L"*i( 'a#i %-? 'a#i #(a*'om5o<a#!oma m+n!+l 'i 'a"#a( k"ala

'an l"("#; '"ngan ini'"n t"#tinggi a'a '"ka'" "#tama 'an +n!akn5a t"#7a'i a'a '"ka'"



52

k"'+a 'an k"tiga. Lokai 5ang aling "#ing 'i k"ala 'an l"("# 'a#i -, ka+ t"#ma+k

=a7a(; o#*it; #ongga (i'+ng; l"("#; in+ a#anaal; 'an it+ a#am"ning"al. M"tatai

t"#7a'i a'a 33? ka+; lokai t"#"#ing a'ala( +m+m t+lang; !ai#an "#"*#oinal; !ai#an

"#iton"al; 'an a#+<a#+. Lao#an lain m"ng+ngkakan 7a#ingan l+nak l"("# t"#li*at 'alam

(ami# 1%? 'a#i k"ala 'an l"("# RMS '"=aa. T+mo# ini 'ikat"go#ikan ol"( 9ntergroup

6habdomyosarcoma Study IRS k" 'alam +*ti" *"#ik+t "m*#ional; $a#ian "m*#ional<

*ot#5oi'; $a#ian "l "m*#ional<in'l"; al$"ola#<klaik; 'an $a#ian 5ang oli'; 'i*"'a<*"'akan

'an analatik. Ini 7+ga "#ing 'iklai&ikaikan "*agai "m*#ional; al$"ola#; l"omo#&ik; 'an

7"ni !am+#an. Em*#ional 5ang m"#+akan RMS 5ang aling "#ing a'a anak<anak 'an

o#ang '"=aa. T"#ai +tama *"#+a k"mot"#ai in'+ki 'iik+ti '"ngan t"#ai #a'iai;

m"ki+n k"'+an5a 'aat 'ig+nakan. P"m*"'a(an *iaan5a *"#t+7+an +nt+k debulking ata+

a'a t+mo# 5ang 'aat 'i#""ki ""n+(n5a tana !a!at &+ngional ata+ kom"tik. Di"ki

l"("# 'i"#tim*angkan a'a k"t"#li*atan l"("# ata+ 7"la t"#'aat "m*"a#an a'"noat(5.

Tingkat +#$i$al +nt+k maing<maing lokai 5ait+ )2?; 6)?; 'an 41?.21<23



53

*amba! 3"11 Pasien usia 14 ahun dengan !habdm7sa!ma emb!inal dalam sinus

ehmid23

Sa!kma sinial"

Sa#koma ino$ial m"#+akan 6? amai 1,? 'a#i "m+a a#koma 7a#ingan l+nak 'an

3? amai 1,? 'a#i "m+a a#koma k"ala 'an l"("#. T+mo# ini *iaan5a m+n!+l a'a +ia

2, amai %, ta(+n; a'a 'a"#a( (5o(a#5ng"al 'an #"t#o(a#5ng"al. Di"ki l"("# ti'ak



54

"#l+ ka#"na ti'ak a'an5a m"tatai "#$ikal. Angka +#$i$al %? amai -4? amai

'"ngan %,? k"7a'ian k"kam*+(an'aat

Melanma"

M"lanoma a'ala( k"ganaan "l "ng(ail igm"n m"lanoit t"#l"tak t"#+tama 'i k+lit;

t"tai 7+ga 'it"m+kan 'i mata; t"linga; al+#an "n!"#naan; l"tom"ning"n; 'an m"m*#an

m+koa.

M"ki+n m"lanoma 'aat tim*+l ata+ *"#m"tatai k" l"("# tana lokai #im"#

'ik"ta(+i; "$al+ai m"n5"l+#+( (a#+ 'ilak+kan +nt+k m"ngi'"nti&ikai lokai #im"#.

S"*+a( tin7a+an 'a#i 3,, ka+ m"lanoma ol"( Balm 'an lain<lain m"ng+ngkakan "kita#

-;? t"#'aat a'a no'+ lim&atik "#$ikal tana 'ik"ta(+i lokai #im"#n5a. T"#ai '"ngan

o"#ai 'an +#$i$al -<ta(+n %4?; '"ngan #ata<#ata 36 *+lan a'a ai"n '"ngan ta(a II

m"lanoma k+lit. Tin'akan 'i"ki l"("# ti'ak 'aat m"ningkatkan k"lang+ngan (i'+

'i*an'ingkan ai"n '"ngan 'i"ki l"("# t+n'a +nt+k m"tatai #"gional l"*i( 'a#i 3 *+lan

"t"la( t"#ai #im"#. Ini'"n m"tatai 7a+( !+k+ tinggi a'a ai"n m"ngalami m"tatai

#"gional.21; 2%

3"6 Manaemen Tum! lehe!

Tum! lehe! 7ang idak dikeahui asal um! '!ime!

0ika (ail "m"#ikaan +nt+k l"("# 'an "m"#ikaan al+#an a"#o'ig"ti& "!a#a

m"n5"l+#+( t"la( 'ilak+kan nam+n lokai l"i #im"# mai( *"l+m 7"la; t"#ai *ioi "kii

(a#+ 'ilak+kan *a(kan 'i"ki l"("#. /"tika 'it"m+kan a'"no!a#!inoma; "*agian *"a#



55

ai"n 46? m"miliki m"tatai 'ital lain. S"kita# -? kank"# l"("# 'i'iagnoi 'a#i

"l+#+( a"n '"ngan maa l"("# 5ang ti'ak 'ik"ta(+i; "(ingga m"m"#l+kan *ioi "kii

+nt+k 'iagnoi.1,

Ra'iai #o&ilaki mai( kont#o$"#ial. L"i ini ti'ak akan m"n'aat man&aat 'a#i

i#a'iai t"#"*+t. Ra'iai #o&ilaki 'aat m"n5"*a*kan ka#inoma m+koa. T"#ai ini 7+ga

'aat m"n5"*a*kan "&"k aming *"#k"an7angan +tama *"#+a :"#otomia; 'i&agia; 'an

ka#i" gigi. Tingkat k""m*+(an t"la( 'ilao#kan l"*i( tinggi '"ngan o"#ai a'a l"("#

'a#ia'a t"#ai #a'iai a7a.1,

Pai"n t+mo# l"("# 5ang l"i #im"#n5a ti'ak 'ik"ta(+i (a#+ 'ilak+kan "m"#ikaan

5ang *"#+lang. L"i #im"# 5ang aling "#ing a'ala( nao&a#ing ka#"na m"#+akan *agian

5ang aling +lit +nt+k m"m"#ika. P"m"#ikaan la*o#ato#i+m P>R 'ig+nakan +nt+k

m"n'"t"ki EB8 a'a ka#inoma no'al m"tatai 'aat 'ig+nakan +nt+k m"m*ant+

m"ngi'"nti&ikai ka#inoma nao&a#ing.

Massa lehe! 7ang dikeahui asal um! '!ime!

( Managemen 'ada um! '!ime! 7ang sea!a klinis 'sii e!da'a measasis ke

kelna! geah bening lehe!

Maa l"("# a'a ai"n '"ngan t+mo# #im"#5ang 'ik"ta(+i 'a#i k"ala 'an l"("#

(a#+ 'it"#ai "+ai '"ngan #ini<#ini maing<maing t+mo#. S"!a#a +m+m; k"tika

t"#7a'i m"tatai k"l"n7a# g"ta( *"ning; lim&a'"n"ktomi (a#+ 'ilak+kan *"#amaan

'"ngan "ngangkatan t+mo# #im"#. Bila t+mo# #im"# ti'ak t"#l"tak 'i k"ala ata+ l"("#;

*ioi "kii maa l"("# 'ilak+kan +nt+k kon&i#mai 'iagnoi 'an ta'i+m; mana7"m"n

"lan7+tn5a t"#gant+ng 'a#i t+mo# #im"#.1,



56

Pai"n m"tatai N1 (a#+ 'ilak+kan 'i"ki l"("# 5ang "+ai ata+ #a'iot"#ai

'"ngan ata+ tana k"mot"#ai. 0ika m"tatai ta'i+m N1 t"#"*+t #"on komlit

t"#(a'at #a'iot"#ai a7a; o*"#$ai l"*i( 'ian7+#kan 'a#ia'a t"#ai *"'a(. S"t"la(

'ilak+kan 'i"ki l"("# +nt+k m"tatai l"("# N1; #a'iot"#ai a'7+$ant a!a o"#ai (a#+

'i"#tim*angkan; t"#+tama 5ang m"m+n5a ngka #"k+#"ni 5ang tinggi.2-; 26

Pai"n m"tatai l"("# N2 ata+ N3 (a#+ 'ilak+kan 'i"ki l"("# 'iik+ti ol"(

#a'iot"#ai "kt"#nal; ata+ #a'iot"#ai "kt"#nal 'iik+ti 'i"ki l"("#.2-

0ika maa m"tatai 'i l"("# t"#&ikai 'an unresectable,#a'iot"#ai 'an k"mot"#ai

m"n7a'i t"#ai ili(an. 2-

( Managemen 'ada um! '!ime! 7ang sea!a klinis negai e!da'a measasis ke

kelna! geah bening lehe!

B"*"#aa "#i #"t#o"kti& *"a# t"la( m"lao#kan k"7a'ian m"tatai k"l"n7a# g"ta(

*"ning l"("# 'it"m+kan a'a "m"#ikaan atologi 'a#i "im"n l"("# "t"la( 'i"ki

l"("# #a'ikal a'a ai"n '"ngan "!a#a klini ti'ak m"miliki m"tatai k" l"("# N,.

Nama lainn5a a'ala( m"tatai ama# o!!+lt m"tatai.2-; 26

T+mo# o#o&a#ing 'an (io&a#ing m"miliki m"tatai ama# K-,? ka+; t+mo#

#ongga K2,? ka+; t+mo# +#agloti 4<3,? ka+; t+mo# gloti ,<1-? ka+.

2-; 26

Riiko m"tatai ama# 'aat 'ig+nakan "*agai 'aa# +nt+k 'ilak+kan t"#ai

#o&ilaki l"("#. Pai"n ta'i+m N, l"("# "!a#a klini 5ang m"miliki #iiko l"*i( 'a#i

2,? 'a#i m"tatai ama# 'i l"("#; (a#+ 'ilak+kan t"#ai #o&ilaki l"("#; *aik '"ngan

'i"ki l"("# ata+ '"ngan #a'iot"#ai "kt"#nal. Nam+n; *"l+m t"#'aat "n"litian



57

Ran'omi"' >lini!al T#ial R>T 5ang m"n'"&iniikan am*ang #iiko 'imana t"#ai

#o&ilaki l"("# 'i"#l+kan.2-; 26

)#) .

/ESIMPULAN


'ianta#a 'aa# t"ngko#ak (ingga kla$ik+la.1 Maa l"("# a'a ai"n '"=aa (a#+ 'iangga

gana amai t"#*+kti "*alikn5a

/"lainan k"ala 'an l"("# 'aat t"#7a'i g"7ala maa l"("#. Ekii *"'a( 'ilak+kan

k"!+ali +nt+k *"*"#aa maa in&lamai; +nt+k 'iagnotik. /"tika tan'a<tan'a "#a'angan

5ang t"#kait '"ngan maa; mana7"m"n anti*iotik '"ngan o*"#$ai amai 2 mingg+ 'aat

'ilak+kan.

Pa'a anak<anak 'an +ia %, ta(+n *ioi "kii 'ilak+kan "t"la( "m"#ikaan l"ngka

k"ala 'an l"("# 'an "m"#ikaan lain ti'ak m"ng(ailkan in&o#mai l"*i( lan7+t. Pa'a ai"n

'"=aa K%, ta(+n; (a#+ 'ilak+kan "m"#ikaan &iik k"ala 'an l"("# 5ang l"ngka 'an

*"#+lang. S"t"la( "m"#ikaan &iik; FNAB m"#+akan tan'a# "m"#ikaan *ila ti'ak



58

'it"m+kan t+mo# #im"#n5a.

T+mo# #im"# 'a#i l"("# 7a#ang t"#7a'i; t"tai (a#+ 'i"#tim*angkan 'alam 'iagnoi

*an'ing 'a#i "tia maa l"("# +nt+k m"m+ngkinkan "$al+ai 'an mana7"m"n 5ang otimal.

Diagnoi +tama "#ing m"m*+t+(kan #""ki *"'a(; 5ang m+ngkin m"m"#l+kan #""ki l+a

'"ngan ma#gin 5ang 7"la 'an 'i"ki l"("#.

DAFTAR PUSTA/A

1. Ro"man B; >la#k O. N"!k Ma. Dalam So+*a ; Fink MP; /ai"# LR; S+#g"on

A>o; P"a#!" H; "n5+nting. A>S +#g"#5 #in!il" #a!ti!".E'ii k" 6. >(i!ago

"*MD P#o&"ional P+*.C 2,,.

2. Lal=ani A. >URRENT Diagnoi T#"atm"nt Otola#5ngolog5<<H"a' an' N"!k

S+#g"#5; T(i#' E'ition.E'ii. M!g#a=<(illC 2,11.

3. St"=a#t MG; S"l"ni!k SH. Di&&"#"ntial Diagnoi in Otola#5ngolog5 H"a' an' N"!k

S+#g"#5.E'ii. T(i"m"C 2,11.

%. Do("#t5 G. >URRENT Diagnoi an' T#"atm"nt S+#g"#5 T(i#t""nt( E'ition.E'ii k"

13. Mi!(igan M!G#a=<Hill E'+!ationC 2,,).

-. Fo=l"# 0>; Ma#o$i!( R; 0o(non 0T. E$al+ating a n"!k ma na##o=ing t(" 'i&&"#"ntial

'iagnoi. 0aaa. 2,12C2-33,<-.

6. Po"!+ B; En" P; B"#t"t"an+ S8; En" R; >i#toi+ >; Po"!+ >R. M"t(o' o&

in$"tigating m"tatati! l5m( no'" in ("a' an' n"!k !an!"#. Ma"'i!a. 2,13C4%34%<

.

. L+!ioni M; S"#a&ini I; S(a( 0P; M"'ina 0; St"in"# ; Anton"lli A. P#a!ti!al G+i'" to



59

N"!k Di"!tion.E'ii. S#ing"#C 2,,.

4. P#o*t R; G#"$"# G. Bai! Oto#(inola#5ngolog5 A St"<*5<St" L"a#ning G+i'".E'ii

k" 2. N"= 9o#k T(i"m"C 2,,6.

). 0o(non 0T; Ro"n >A; Bail"5 B0. Bail"5 H"a' an' N"!k S+#g"#5<<

otola#5ngolog5.E'ii k" -. olt"# /l+="# H"alt(Liin!ott illiam ilkinC 2,1%.

1,. M!G+i#t F. Di&&"#"ntial Diagnoi o& N"!k Ma". Dalam Flint P; >+mming >;

"n5+nting. >+mming Otola#5ngolog5 H"a' N"!k S+#g"#5.E'ii k" -. P(ila'"l(ia

Mo*5El"$i"#C 2,1,.

11. ang S<G. Di&&"#"ntial Diagnoi an' T#"atm"nt o& N"!k Ma". 0 /o#"an M"' Ao!.

2,,C-,613<2-.

12. Balm A0M; $an 8"lt(+5"n MLF; Ho"*"# F0P; 8og"l 8; $an '"n B#"k"l MM.

Diagnoi an' T#"atm"nt o& a N"!k No'" S="lling S+i!io+ &o# a Malignan!5 An

Algo#it(mi! A#oa!(. Int"#national 0o+#nal o& S+#gi!al On!olog5. 2,1,C23-41<%,.

13. S"lman T0; Mann >; amo#a 0; Al"5a#' TL; /(an /. Diagnoti! a!!+#a!5 o& t"t &o#

l5m( no'" tat+ in #ima#5 !"#$i!al !an!"# a 5t"mati! #"$i"= an' m"ta<anal5i.

>ma7. 2,,4C144--<62.

1%. Nakam+#a 9; Ot+ka F. S"ntin"l L5m( No'" Bio5 &o# M"lanoma an' S+#gi!al

A#oa!( to L5m( No'" M"tatai.E'ii.C 2,13.

1-. T(omon >F; St. 0o(n MA; La=on G; G#ogan T; Ela(o&& D; M"n'"lo(n AH.

Diagnoti! $al+" o& "ntin"l l5m( no'" *io5 in ("a' an' n"!k !an!"# a m"ta<

anal5i. E+#o"an a#!(i$" o& oto<#(ino<la#5ngolog5 o&&i!ial 7o+#nal o& t(" E+#o"an

F"'"#ation o& Oto<R(ino<La#5ngologi!al So!i"ti" EUFOS a&&iliat"' =it( t(" G"#man



60

So!i"t5 &o# Oto<R(ino<La#5ngolog5 < H"a' an' N"!k S+#g"#5. 2,13C2,211-<22.

16. >ala*#"" L; 0"#"!"k<Foa BA; 0a"m 0; Ro!!a A; B#+!(ini R; O#"!!(ia R; "t al.

Diagnoi an' manag"m"nt o& n"!k m"tata" &#om an +nkno=n #ima#5. A!ta

Oto#(inola#5ngologi!a Itali!a. 2,,-C2-12<12.

1. >(a#an I; /aoo# A; /+ma# N; 0aga=at N; Sing(al M/; /+ma# HS. E$al+ation o& N"!k

Ma =it( >om+t"' Tomog#a(5 An O*"#$ational St+'5. Int"#national 0o+#nal o&

S!i"nti&i! St+'5. 2,1%C2114<22.

14. G#o7"an P; Monni"# P. >"#$i!al no'+l" 'iagnoi an' manag"m"nt. R"$ M"' S+i"

Roman'". 2,,-C12%6361<6.

1). /im SH; /im NH; /im /R; L"" 0H; >(oi H<S. S!(=annoma in H"a' an' N"!k

P#"o"#ati$" Imaging St+'5 an' Int#a!a+la# En+!l"ation &o# F+n!tional N"#$"

P#""#$ation. 9on"i M"'i!al 0o+#nal. 2,1,C-16)34<%2.

2,. Oli$"i#a HF; >a#$al(o AS; A#gollo N>; N"$" >A; MO. D. R(ino!l"#oma an' Naal

non<Ho'gkin L5m(oma. . Int A#!( Oto#(inola#5ngol. 2,,)C131)6<4.

21. Da5 T; 0o" 0. P#ima#5 N"olam o& T(" N"!k Dalam Flint P; >+mming >;

"n5+nting. >+mming Otola#5ngolog5 H"a' N"!k S+#g"#5.E'ii k" -. P(ila'"l(ia

Mo*5El"$i"#C 2,1,.

22. Al7a*a* AS; Naon R; /ai R; Pat(ak /A. H"a' an' N"!k So&t Ti+" Sa#!oma. In'ian

0o+#nal o& S+#gi!al On!olog5. 2,11C2%246<),.

23. (+ 0; (ang 0; Tang G; H+ S; (o+ G; Li+ 9; "t al. >om+t"' tomog#a(5 an' magn"ti!

#"onan!" imaging o*"#$ation o& #(a*'om5oa#!oma in t(" ("a' an' n"!k. On!olog5

L"tt"#. 2,1%C411--<6,.



61

2%. S(a(anka R; Smit(a BR. H"a' an' N"!k M"lanoma. ISRN S+#g"#5. 2,12C2123<-.

2-. T"5moo#ta( A; "#n"# 0A. >+##"nt a'$an!" in 'iagnoi an' +#gi!al t#"atm"nt o&

l5m( no'" m"tatai in ("a' an' n"!k !an!"#. GMS >+##"nt Toi! in

Oto#(inola#5ngolog5; H"a' an' N"!k S+#g"#5. 2,12C11Do!,%.

26. SIGN. Diagnoi an' manag"m"nt o& ("a' an' n"!k !an!"# < A national !lini!al

g+i'"lin". E'in*+#g S!otti( Int"#!oll"giat" G+i'"lin" N"t=o#kC 2,,6.

tumor leher - kidis

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