TUMOR PAYUDARA

NormalLaktasiPremenopausePascamenopause

FREKUENSI LESI PAYUDARA

GAMBARAN KLINIS LESI PAYUDARA

MAKROSKOPIS PERUBAHAN FIBROKISTIK BLUE DOME CYST

GAMBARAN HISTOLOGIS PERUBAHAN FIBROKISTIK

A, Hiperplasi sedang (florid)B. Hiperplasi atipikPerubahan fibrokistik

Sclerosing adenosisPerubahan fibrokistik

MIKROSKOPIS GINEKOMASTIA

Enucleated fibroadenoma of the breast

Fibroadenoma

Fibroadenoma

Fibroadenoma

Fibroadenoma(HE) x 25

GAMBAR MAKROSKOPIS DAN MIKROSKOPIS FIBROADENOMA MAMMAE

Tumor phyllodesPapilloma duktus besarPapilloma duktus kecil

Karsinoma inflamasi

PENYAKIT PAGETumur lebih tuakarsinoma intraduktal mengenai duktus ekskretorius utama meluas dan infiltasi ke kulit putting dan areola kering, pecah, ulserasi, hiperemia, edemagambaran khas: invasi epidermis sel Pagetsel Paget: sel besar, tunggal atau berkelompok, inti hiperkhromatik dan pleomorfik, dikelilingi halomorfologi sel Paget = sel karsinoma duktal invasif/ non invasif

Skin ulceration: breast cancer

KARSINOMA DUKTAL INVASIF, NOSGambaran potongan makroskopis B. Gambaran mikroskopis

KARSINOMA DUKTAL INSITUKomedokarsinoma

KARSINOMA DUKTAL INSITUKarsinoma papilar in situ

KARSINOMA LOBULAR INSITU

KARSINOMA LOBULAR INVASIFMasa batas tidak tegas. konsistensi kenyal Histologissel tumor kecil, relatif uniformderetan sel tunggal - Indian file - mengelilingi asini atau duktus normal, konsentrik di sekitar lobuli kelenjar yang menjadi karsinoma lobular in situstroma jaringan ikat padat. Kejadian: 5% sifat bilateralitas (20%)Jenis:histiositoid: sel dengan sitoplasma banyak, granular, berbuihsignet ring cell: sel seperti cincin stempel

KARSINOMA MEDULAR1% di bawah 50 tahunmasa besar (>10 cm), kenyal lunakHistologisstroma sedikitsel tumor poligonal spindle - tersusun lembaran atau pulau besarstroma, di tepi tumor dijumpai sebukan limfosit sedang sampai berat respon imunitas terhadap tumor prognosis jauh lebih baik

KARSINOMA KOLOID (MUKOIDES)1% di bawah 50 tahunmasa besar (>10 cm), kenyal lunakHistologisstroma sedikitsel tumor poligonal spindle - tersusun lembaran atau pulau besarstroma, di tepi tumor dijumpai sebukan limfosit sedang sampai berat respon imunitas terhadap tumor prognosis jauh lebih baik

KARSINOMA TUBULARDisebut pula karsinoma berdiferensiasi baikUsia rata-rata 50 tahunmasa berbatas tidak tegas - konsistensi keras - diameter 10 mmHistologis:menyerupai lesi jinak kelenjar berdiferensiasi baik (terutama adenosis mikroglandular)tidak dijumpai nekrosis dan mitosispleomorfisme sangat ringan.

METODA DIAGNOSTIK TEKNIK - BAJAH

METODA DIAGNOSTIK SITOLOGI - BAJAH

Horizontal mammography

METODA DIAGNOSTIK MAMMOGRAFIFibroadenoma mammaeKarsinoma mammae

INFRARED IMAGING SYSTEMThermographic Finding: Typical breast cancer case which shows hyperthermia on the tumor area and hyper vascularization around tumor.

StadiumStadium IT1a: T 0.5 cm

T1b: 0.5 cm < T 1 cm

T1c: 1 cm < T 2 cmT1 N0 M0T 2 cmT1

N0 = Tidak ada metastasis limfonodi regional M0 = Tidak ada metastasis jauh

Stadium IIAT2 N0 M0N1 = metastasis to movable ipsilateral axillary lymph node(s) M0 = no distant metastasis2 cm < T < 5 cm

Tidak ditemukan tumor

T0

T0 T1N1 M0}T2

Stadium IIBT3 N0 M0N1 = metastasis to movable ipsilateral axillary lymph node(s) (p) N1a, N1b M0 = no distant metastasisT > 5 cm

T2 N1 M0T3

Stadium IIIAT0T1T2T3Metastasis to ipsilateral axillary lymph node(s) N1 = movableN2 = fixed to one another or to other structuresM0 = no distant metastasisT3 N1 M0N2 M0

Stadium IIIBAny T N3 M0N3 = metastasis to ipsilateral internal mammary lymph node(s)M0 = no distant metastasisTumor of any sizewith direct extensionto chest wall or skin

T4d = inflammatorycarcinomaT4 any N M0T4

Stage IVM1 = distant metastasis (including metastases to ipsilateral supraclavicular, cervical, or contralateral internal mammary lymph nodes)Any T any N M1

With thanks to Professor W.Jonat

With thanks to Professor W.Jonat

18. Breast CancerThis patient has breast cancer. The peau dorange or dimpling effect of the skin is apparent. 15. Breast Cancer: Horizontal Mammography35. Breast Cancer: Stage IStage I disease T1 N0 M0 is common. T1 tumors are 2 cm in dimension. T1a tumors are 0.5 cm. T1b tumors are >0.5 cm, but 1 cm in greatest dimension. T1c tumors are 1 cm, but no more than 2 cm in greatest dimension. This early breast cancer is often diagnosed on screening mammograms. 36. Breast Cancer: Stage IIAStage IIA is also common. It is T0 N1 M0, T1 N1 M0, or T2 N0 M0. T2 lesions are over 2 cm and up to 5 cm. 37. Breast Cancer: Stage IIBStage IIB lesions are either T2 N1 M0 or T3 N0 M0 tumors. T3 tumors are >5 cm. The prognosis of these cancers is intermediate. Pathologic confirmation of the diagnosis is mandatory (N1a is micrometastasis 0.2 cm; N1b is metastasis to lymph nodes >0.2 cm).

38. Breast Cancer: Stage IIIAStage IIIA tumors are T0-3 N2 M0 or T3 N1 M0. N2 lesions are fixed to one another or to other structures. The prognosis for this stage is not good. Chemotherapy is usually used for treatment. 39. Breast Cancer: Stage IIIBStage IIIB disease is either T4 any N M0 or any T N3 M0. T4 lesions are tumors of any size with extension to chest wall or skin. T4a involves only extension to the chest wall, while T4b presents as edema, skin ulceration on the breast, or satellite skin nodules to the same breast. T4c involves both T4a and T4b. 40. Breast Cancer: Stage IVStage IV, or metastatic, breast cancer is a lethal disease. The most common sites of metastases are soft tissue (skin or draining lymph nodes), bone, and viscera (eg, liver, lung).