retikulo-end. fk ums 2010u
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PPatologiatologi SSistemistemRRetikulo-etikulo-EEndhotelialndhotelial
Kuliah FK. UMS SurakartaKuliah FK. UMS Surakarta
oleh : dr. Oyong, SpP.oleh : dr. Oyong, SpP.
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meliputi !meliputi !- sel darah putih "leukopenia,- sel darah putih "leukopenia,
neutropenia#, leukemia,neutropenia#, leukemia,- in$lamasi sel darah putih %- in$lamasi sel darah putih %
kel.getah &ening,kel.getah &ening,- neopl. sel darah putih% 'M,- neopl. sel darah putih% 'M,- leukemia "oleh PK#,- leukemia "oleh PK#,
- mieloma multiple,- mieloma multiple,- histiositosis sel 'angerhans,- histiositosis sel 'angerhans,
splenomegali.splenomegali.
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Enlargement of Lymph NodesEnlargement of Lymph Nodes
Anatomy & TopographyAnatomy & Topography
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'nn. :'nn. :
(. tdk tera&a)sangat ke*il,(. tdk tera&a)sangat ke*il,+. tera&a: reakti$,+. tera&a: reakti$,in$eksi"spesi$ik)tdk#, neoplasmain$eksi"spesi$ik)tdk#, neoplasma
primer, neoplasma sekunder.primer, neoplasma sekunder.
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Physical Characteristics of enlarged nodesPhysical Characteristics of enlarged nodes
Nodes with metastatic CaNodes with metastatic Ca : Stony hard, nontender, ell- : Stony hard, nontender, ell-lo*alied, &ound to surrounding tissue, nonmoa&le.lo*alied, &ound to surrounding tissue, nonmoa&le.
Acute infectionAcute infection : $irm, tender, asymetri*, matted, oerlying: $irm, tender, asymetri*, matted, oerlying
skin might &e red % edematous.skin might &e red % edematous.Chronic infectionChronic infection : nontender, nonedematous.: nontender, nonedematous.
Acute leukemiaAcute leukemia : tender.: tender.
Nodes in lymphomaNodes in lymphoma : large,symetri*, ru&&ery, $irm, moa&le,: large,symetri*, ru&&ery, $irm, moa&le,
dis*rete, nontender.dis*rete, nontender.
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Location of enlarged nodesLocation of enlarged nodes
Generalized adenopathy ! " separate nodes#Generalized adenopathy ! " separate nodes#
-- Non$%odgkin LymphomaNon$%odgkin Lymphoma
- /hroni* 'ympho*yti* leukemia- /hroni* 'ympho*yti* leukemia
- immuno&lasti* lymphadenopathy- immuno&lasti* lymphadenopathy
Generalized adenopathyGeneralized adenopathy
- Un*ommon in adult ith in$e*tion, e0*ept- Un*ommon in adult ith in$e*tion, e0*ept
- mononu*leosis, 12/, hepatitis, se*ondary syphilis,- mononu*leosis, 12/, hepatitis, se*ondary syphilis,to0oplasmosis, histoplasmosis.to0oplasmosis, histoplasmosis.
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'pecific Location'pecific Location
Post auricular adenopathyPost auricular adenopathy : Ru&ella: Ru&ella
(nilateral anterior auricular adenopathy(nilateral anterior auricular adenopathy : 1ra*homa,: 1ra*homa,*on3un*tiitis, 12/, syphilis.*on3un*tiitis, 12/, syphilis.
)ilateral cer*ical adenopathy)ilateral cer*ical adenopathy : 12/, mononu*leosis,: 12/, mononu*leosis,
to0oplasmosis,to0oplasmosis, lymphomalymphoma, leukemia., leukemia.(nilateral cer*ical mass(nilateral cer*ical mass : Metastati* $rom 4P/.: Metastati* $rom 4P/.
Palpa+le supracla*icular nodesPalpa+le supracla*icular nodes : 4eoplasti* in: 4eoplasti* ina&domen)*hest.a&domen)*hest.
A,illary nodesA,illary nodes : drain part o$ &reast.: drain part o$ &reast.
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'pecific location-'pecific location-
.nguinal adenopathy.nguinal adenopathy : 'ymphogranuloma enereum,: 'ymphogranuloma enereum,*han*roid,syphilis.*han*roid,syphilis.
Enlarged mediastinal/hilar Enlarged mediastinal/hilar nodes "5-ray# may&e asymptomati*nodes "5-ray# may&e asymptomati*or tra*heo&ron*hial *ompression.or tra*heo&ron*hial *ompression.
)ilateral mediastinal adenopathy)ilateral mediastinal adenopathy : *ommon in: *ommon in N%LN%L%ilar adenopathy%ilar adenopathy : 12/ "unilateral#, *o**idioidmy*osis %: 12/ "unilateral#, *o**idioidmy*osis %sar*oidosis "&ilateral#.sar*oidosis "&ilateral#.
A+dominal nodesA+dominal nodes might enlarge in any disorderith *ausemight enlarge in any disorderith *ausegeneral adenopathy.general adenopathy.
0etroperitoneal adenopathy0etroperitoneal adenopathy : 4eoplasti*, espe*ially: 4eoplasti*, espe*iallylymphomatuslymphomatus
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'ymph 4ode'ymph 4ode
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'ymph 4ode'ymph 4ode1 A22 L34P% 5E'
" CAP'(LE
6 PE0. P%E0 '.N('
7 PA0A 28L.C(LA0
C80TE9/ T CELL
:8NE
; L34P%8.< 28L.CLE/
) CELL :8NE
= E22 L34P% 5E'
> A0TE0. & 5E.N
? 4E<(LLA
@ 4E<(LLA03
'.N('E'
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'6MP7 4O8E'6MP7 4O8E R/791E/1URE R/791E/1URE
/orte0/orte0
Para*orte0Para*orte0
MedullaMedulla
/apsule and $i&rous tra&e*ulae/apsule and $i&rous tra&e*ulae
SinusesSinuses
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1he *orte0: 2-one o$ lymph1he *orte0: 2-one o$ lymph
nodenodePrimary lymphoid $olli*lePrimary lymphoid $olli*le irgin 2 *ells and mature 2 *ellsirgin 2 *ells and mature 2 *ells Folli*ular dendriti* *ellsFolli*ular dendriti* *ells
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Organiation o$ Organiation o$ se*ondary lymphoid $olli*lese*ondary lymphoid $olli*le
Marginal one *ells "9gM#
Mantle one *ells "9gM;8#
Folli*le *enter *ells "9gM,9g<, 9g or 9gE, not 9g8#
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RE/19ERE/19E SS '6MP7OM'6MP7OM
E4SR7-PFKU9=>=?@?A, /79'8, ( 6RS, 28OM94' MSS ; MU'19P'E '6MP78E4OP176
KPP 'M28 2/'+
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/U1E 4O4 SP '6MP78E4919S /U1E 4O4 SP '6MP78E4919S
0EACT.5E0EACT.5E
C%ANGE'C%ANGE' :: 4icro organism4icro organism
Cell de+risCell de+ris 2oreign material2oreign material
*eri*al*eri*ala0illariesa0illaries
inguinalinguinal
Ma*rosMa*ros : Enlarged,: Enlarged,sollen, grey-red,sollen, grey-red,pain.pain.
Mi*rosMi*ros : 'ymphoid $oll: 'ymphoid $ollprominent, largeprominent, largegerminalgerminal*enter,histiosit,*enter,histiosit,
neutrophil.neutrophil.
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massa papa&el, *olli :massa papa&el, *olli :lim$onodi mem&esar :lim$onodi mem&esar :
radang dan neoplasma malignaradang dan neoplasma maligna"primer, sekuder#"primer, sekuder#
sitologi)sitopatologi ! diagnostiksitologi)sitopatologi ! diagnostikpendahuluan, &kn $inalpendahuluan, &kn $inal
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17E 1E/749BUES OF F417E 1E/749BUES OF F4
4eedle moed &a*k4eedle moed &a*kand $orth ithinand $orth ithintarget tissuetarget tissue
4egatie pressure4egatie pressure
released hilereleased hileneedle remains inneedle remains intarget tissuetarget tissue
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Acute Non specific Lymp$itisAcute Non specific Lymp$itis
Rea*tie *hangesRea*tie *hanges
/eri*al, a0illaries, inguinal, mesenteri*/eri*al, a0illaries, inguinal, mesenteri*
4orphology4orphology : enlarged, sollen, grey-red,: enlarged, sollen, grey-red,distended *apsdistended *aps tender.tender.
%istopathology%istopathology : 'ymph. Folli*les CC,: 'ymph. Folli*les CC,
'arge germ / ith mitoti* a*tiity,'arge germ / ith mitoti* a*tiity,neutrophil in$iltration. Sinuses *ellneutrophil in$iltration. Sinuses *ell hyperhypertrophi ) plasia.trophi ) plasia.
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Chronic Non 'pecific LympitisChronic Non 'pecific Lympitis
9nguinal, a0illaries, not tender.9nguinal, a0illaries, not tender.
%istopathology%istopathology::
$olli*ular hyperplasia-2 *ell$olli*ular hyperplasia-2 *ell
dark one, light one, plasma *ell,dark one, light one, plasma *ell,histiosit, PM4, Eosinophyl.histiosit, PM4, Eosinophyl.
2ollicular Lymphoma B2ollicular Lymphoma B
(. r*hi. 9nter $oll. 1 % Sinus(. r*hi. 9nter $oll. 1 % Sinus
+. ariation shape % sie nod+. ariation shape % sie nod
D. 8ark-'ight, Phago*yti*-ma*.D. 8ark-'ight, Phago*yti*-ma*.
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9.9. Folli*ular hyperplasiaFolli*ular hyperplasia
a*tiated 2 *ell, larged, round germinal *enter.a*tiated 2 *ell, larged, round germinal *enter.
99.99. Para*orti*al lymphoid hyperplasiaPara*orti*al lymphoid hyperplasiaRea*tie *hages 1 *ellRea*tie *hages 1 *ell
iral 9n$e*tion.iral 9n$e*tion.
999.999. Sinus histio*ytosis.Sinus histio*ytosis.
8istention-prominent sinusoid8istention-prominent sinusoid
'ymph node draining *an*er 'ymph node draining *an*er
Chronic Non 'pecificChronic Non 'pecific
LymphadenitisLymphadenitis
S O S'9MF8E4919S KRO49S
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'9MF8E4919S KRO49S'9MF8E4919S KRO49S4O4 SPES9F9K4O4 SPES9F9K
1.1. Gambaran jaringan kelenjar limfe denganGambaran jaringan kelenjar limfe dengansentrum germinativum membesar dansentrum germinativum membesar danaktif mengandung limfosit-limfosit mudaaktif mengandung limfosit-limfosit muda yang menunjukkan mitosis atau proliferasi yang menunjukkan mitosis atau proliferasi
sel-sel retikulum yang sering mengandungsel-sel retikulum yang sering mengandungkuman atau debris seluler yang telahkuman atau debris seluler yang telahdifagositosis.difagositosis.
2.2. Penambahan sel retikulum dan limfositPenambahan sel retikulum dan limfosit
dalam sinus disebut sinus catarrh.dalam sinus disebut sinus catarrh.3.3. Fibrosis diantara jaringan limfoid.Fibrosis diantara jaringan limfoid.
.. !apsul dari nodus limfatikus bisa!apsul dari nodus limfatikus bisamengalami periadenitis akan tampak tebalmengalami periadenitis akan tampak tebal
dengan infiltrasi sel-sel radang kronisdengan infiltrasi sel-sel radang kronis
'9MF8E4919S KRO49S
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'9MF8E4919S KRO49S'9MF8E4919S KRO49S4O4 SPES9F9K4O4 SPES9F9K
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Chronic specific LymphadenitisChronic specific Lymphadenitis
T()E0C(L8'AT()E0C(L8'A
4AC08'4AC08' BB
&ergerom&ol, pa*ked, *entral *aseous.&ergerom&ol, pa*ked, *entral *aseous.
4.C08'4.C08' BBtu&er*le, *heese, ne*roti*, langhans *ell,epitheloid *ell.tu&er*le, *heese, ne*roti*, langhans *ell,epitheloid *ell.
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MorphologyMorphology : &esar, multiple,: &esar, multiple,
&ergerom&ol, tdk nyeri, liide, $istel&ergerom&ol, tdk nyeri, liide, $istel7istopatology :tu&er*, epiteloid, *aseosa,7istopatology :tu&er*, epiteloid, *aseosa,langhans.langhans.
'okasi'okasi : 'eher, Supra*la, a0illa: 'eher, Supra*la, a0illa
Chronic specific LymphadenitisChronic specific Lymphadenitis
L34P%8.< NE8PLA'4AL34P%8.< NE8PLA'4A
'im$oma - 'eukemia'im$oma - 'eukemia
%< N%L
'9MF8E4919S KRO49S SPES9F9K'9MF8E4919S KRO49S SPES9F9K
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'9MF8E4919S KRO49S SPES9F9K'9MF8E4919S KRO49S SPES9F9K"12/#"12/#
1.1. "ampak struktur jaringan limfoid dengan"ampak struktur jaringan limfoid dengansarang-sarang tuberkel yang khas# berupasarang-sarang tuberkel yang khas# berupanekrosis perkejuan di tengah dikelilingi olehnekrosis perkejuan di tengah dikelilingi olehsel-sel yang tersusun epiteloid dan tampaksel-sel yang tersusun epiteloid dan tampakbeberapa sel datya $anghansbeberapa sel datya $anghans
2.2. Fibrosis disekitarnya dengan infiltrasiFibrosis disekitarnya dengan infiltrasi
limfosit yang padat.limfosit yang padat.
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.ntroduction.ntroduction
Lymphoproliferati*e malignancies originating from the )$Lymphoproliferati*e malignancies originating from the )$
cell )$N%L# or the T$cell lineage TN%L#cell )$N%L# or the T$cell lineage TN%L#
8epending on the *lini*al *ourse, *lassi$i*ation as high-grade8epending on the *lini*al *ourse, *lassi$i*ation as high-grade"aggressie# or lo-grade lymphoma is 3usti$ied."aggressie# or lo-grade lymphoma is 3usti$ied.
There is a worldwide epidemic of N%LsThere is a worldwide epidemic of N%Ls ith more than @=,===ith more than @=,===*ases diagnosed in the United States ea*h year.*ases diagnosed in the United States ea*h year.
<istri+ution B 4ale ! 2emale<istri+ution B 4ale ! 2emale
.C<$1 B C?"$C?? [email protected]<$1 B C?"$C?? C@11
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9ntrodu*tion9ntrodu*tion
'ymphoma re$ers to a *lonal tumor arising'ymphoma re$ers to a *lonal tumor arising$rom the malignant trans$ormation o$$rom the malignant trans$ormation o$mature or immature lympho*ytes "2 *ells,mature or immature lympho*ytes "2 *ells,
1 *ells, or 4K *ells#1 *ells, or 4K *ells#
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No 4alignancy 2reDuency(+DD?
@A>(=(((+
Lymphoma<astrointestinal<yne*ology2reastUrinary tra*t
7ead and ne*k1hyroidSkin /a'ung /aOsteosar*oma/4SSo$t tissue tumor 1otal
A "+=G# "(>G#+ "(G#+A "(+G#+ "(=G#
( "A.AG#(= ".DG# A"DG# @ "+.?G#
"(.AG# + "=.G# ( "=.G#+D+
Solid 1umor in+=((H
H 8ata Pathology anatomy 8epart RSM7Palem&ang
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No 4alignancy 2reDuency
(+D?
@A>(=((
<yne*ology2reastLymphoma7ead and ne*k /a<astrointestinal
So$t tissue tumor Urinary tra*tSkin /aOsteosar*oma'ung /a/4S1otal
(D= "++G# (( "(>G# ?= 1;# A "(DG# @?"((G#
D@ "@G# +? "G# +( "DG# ("+G# (("(.G# "=.AG# ?
Solid 1umor in +=(+H
H 8ata $rom Pathology natomy 8ept RSM7 Palem&ang
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/hara*teristi*H/hara*teristi*H
Age y# 4ale 2emale Total
I+=+= J +>D= J D>= J >
; F ;@@= J @> A=
@(=A
11D+
-@
7(-
"@G#(= "(@G#( "++G#(D "+=G#
1; "7# "@G#+ "DG#
D +? @+
H Population : 78 and 47' pts at 9nternal Med 8epart, in +=(( - +=(+
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/lini*al Features/lini*al Features
Su&3e*ties :Su&3e*ties :
Chief complain 2reDuency
Masses or nodal enlargement in *eri*al D+
Masses or nodal enlargement in a&domen >
8ysphagia or dyspnea
Masses or nodal enlargement in *eri*al,supra *lai*ula, a0illa and inguinal
+
Masses in shoulder (Masses in rm (
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/lini*al Features "*ontL.#/lini*al Features "*ontL.#
ide ariety o$ presentationside ariety o$ presentations
2 symptoms "$eers, night seats, t loss#2 symptoms "$eers, night seats, t loss#
Painless adenopathy, mostly in *eri*al regionPainless adenopathy, mostly in *eri*al region
9ntraa&dominal masses9ntraa&dominal masses8ysphagia8ysphagia
8yspnea8yspnea
O&stipationO&stipation
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Etiological & 0isk 2actorsEtiological & 0isk 2actors
9mmune de$i*ien*y syndromes9mmune de$i*ien*y syndromes
RE' /l i$i i $
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RE' /lassi$i*ation o$ RE' /lassi$i*ation o$ non-7odgkin lymphomasnon-7odgkin lymphomas
Pre*ursor lympho&lasti* lymphoma)leukemia
"2 or 1 *ell type#
Peripheral 2-*ell neoplasms
Peripheral 1-*ell % postulated 4K-*ell lymphoma
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9ntrodu*tion "*ontL#9ntrodu*tion "*ontL#
Non$%odgkins lymphoma N%L# BNon$%odgkins lymphoma N%L# B
is a heterogeneous group o$ lymphoproli$eratieis a heterogeneous group o$ lymphoproli$eratiemalignan*ies.malignan*ies.
47' results $rom *lonal e0pansion o$ tumor *ells47' results $rom *lonal e0pansion o$ tumor *ells
deried $rom 2, 1, or natural killer "4K# *ells.deried $rom 2, 1, or natural killer "4K# *ells.Most 47's, a&out ?G to >=G in the United States,Most 47's, a&out ?G to >=G in the United States,
are deried $rom 2 *ells.are deried $rom 2 *ells.47's are *hara*teried &y aria&le natural histories47's are *hara*teried &y aria&le natural histories
and therapeuti* responses.and therapeuti* responses.
1he *lini*al *ourses : ary greatly, ranging $rom1he *lini*al *ourses : ary greatly, ranging $romindolent to rapidly $atal.indolent to rapidly $atal.
47' is a disease predominantly o$ the elderly47' is a disease predominantly o$ the elderly
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PER9P7ER' 2 /E''PER9P7ER' 2 /E''
4EOP'SMS4EOP'SMS2-*ell S'')/'')P''2-*ell S'')/'')P''
'ymphoplasma*ytoid'ymphoplasma*ytoidlymphomalymphoma
Mantle *ell lymphomaMantle *ell lymphomaFolli*le *enterFolli*le *enterlymphomalymphoma
Marginal one 2 *ellMarginal one 2 *ell
lymphomalymphoma E0tranodal "M'1#E0tranodal "M'1# 4odalH4odalH
Spleni* marginal oneSpleni* marginal one2 *ell lymphomaH2 *ell lymphomaH
7airy *ell leukemia7airy *ell leukemia
Plasma*ytomaPlasma*ytoma8i$$use large 2 *ell8i$$use large 2 *elllymphomalymphoma
2urkitt lymphoma2urkitt lymphoma
7igh grade 2 *ell7igh grade 2 *elllymphoma, 2urkitt-lymphoma, 2urkitt-likeHlikeH
* Provisional entities
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>>
PendahuluanPendahuluan %1&%1&
'orfologi $' sel " ( tidak jelas'orfologi $' sel " ( tidak jelas
'orfologi $' sel ) ( sebagian bisa dikenal'orfologi $' sel ) ( sebagian bisa dikenal
*el " di korteks thymus ( "dt# +,1a# +,3#*el " di korteks thymus ( "dt# +,1a# +,3#+,# +,+,# +,
*el " mature ( +, atau +,/*el " mature ( +, atau +,/*el 0! ( ! %!iller nhibitory eceptor&*el 0! ( ! %!iller nhibitory eceptor&
PER9P7ER' 1 /E'' %PER9P7ER' 1 /E'' %
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PER9P7ER' 1 /E'' %PER9P7ER' 1 /E'' %POS1U'1E8 4K /E''POS1U'1E8 4K /E''
4EOP'SMS4EOP'SMS1-*ell /'')P''1-*ell /'')P''
'arge granular'arge granular
lympho*yte leukemialympho*yte leukemia 1 *ell or 4K *ell type1 *ell or 4K *ell type
My*osis $ungoidesMy*osis $ungoides
Peripheral 1 *ellPeripheral 1 *ell
lymphoma unspe*i$iedlymphoma unspe*i$ied
ngioimmuno&lasti* 1 ngioimmuno&lasti* 1*ell lymphoma*ell lymphoma
ngio*entri* lymphoma ngio*entri* lymphoma
9ntestinal 1 *ell9ntestinal 1 *ell
lymphomalymphoma dult 1 *ell lymphoma- dult 1 *ell lymphoma-leukemia, 71'(;leukemia, 71'(;
naplasti* large *ell naplasti* large *ell
lymphoma, 1 % null-*elllymphoma, 1 % null-*ell
naplasti* large *ell naplasti* large *elllymphoma, 7odgkin-likeHlymphoma, 7odgkin-likeH
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?(?(
$imfoma sel " mature$imfoma sel " mature %2&%2&
4tranodal 0! 5 " cell lymphoma nasal4tranodal 0! 5 " cell lymphoma nasaltypetype
nteropathy associated "-cell lymphomanteropathy associated "-cell lymphoma
6epatosplenic "-cell lymphoma6epatosplenic "-cell lymphoma
*ubcutaneous penniculitis like "-cell*ubcutaneous penniculitis like "-celllymphomalymphoma
'ycosis fungoides'ycosis fungoides
*e7ary syndrome*e7ary syndrome
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?+?+
$imfoma sel " mature$imfoma sel " mature %3&%3&
Primary cutaneous peripheral "-cellPrimary cutaneous peripheral "-celllymphomalymphoma
Peripheral "-cell lymphoma 08*Peripheral "-cell lymphoma 08*
9ngio immunoblastic "-cell lymphoma9ngio immunoblastic "-cell lymphoma
9naplastic large cell lymphoma# 9$!9naplastic large cell lymphoma# 9$!
positivepositive9naplastic large cell lymphoma# 9$!9naplastic large cell lymphoma# 9$!negativenegative
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?D?D
$imfoma sel " mature$imfoma sel " mature %3&%3&
Primary cutaneous peripheral "-cellPrimary cutaneous peripheral "-celllymphomalymphoma
Peripheral "-cell lymphoma 08*Peripheral "-cell lymphoma 08*
9ngio immunoblastic "-cell lymphoma9ngio immunoblastic "-cell lymphoma
9naplastic large cell lymphoma# 9$!9naplastic large cell lymphoma# 9$!
positivepositive9naplastic large cell lymphoma# 9$!9naplastic large cell lymphoma# 9$!negativenegative
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E0tranodal 4K)1-*ellE0tranodal 4K)1-*elllymphomalymphoma
(.(./lini*al $inding/lini*al $inding
+.+.MorphologyMorphology
D.D.9mmunophenotyping9mmunophenotyping
..<eneti* alteration<eneti* alteration?.?.1reatment1reatment
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E0tranodal 4K)1-*ellE0tranodal 4K)1-*elllymphomalymphoma
(.(./lini*al $inding/lini*al $inding
+.+.MorphologyMorphology
D.D.9mmunophenotyping9mmunophenotyping
..PrognosisPrognosis?.?.1reatment1reatment
Lethal midline granuloma
Location BNPrototype B Nose
$$$$$ENHTCL nasal typ
palate paranasal sinu
nasopharyn,N E,tra$nasal B
$$$$$ skin soft tissue G
testis
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E0tranodal 4K)1-*ellE0tranodal 4K)1-*elllymphomalymphoma4orphology B4orphology B
(.(.Ma3ority : polymorphousMa3ority : polymorphous H small, medium, large atypi*al lympho*ytesH small, medium, large atypi*al lympho*ytes
H in$lammatory *ells : lympho*ytes, plasma *ells,H in$lammatory *ells : lympho*ytes, plasma *ells,ma*rophages, neutrophilsma*rophages, neutrophils polymorphic reticulosispolymorphic reticulosis
malignant histiocytosismalignant histiocytosis
malignant reticulosismalignant reticulosis
'teward granuloma'teward granuloma
+. Prominent ne*rosis+. Prominent ne*rosis lethal midline granulomalethal midline granuloma
D.D. ngio*entri*ity ngio*entri*ity angiocentric T$cell lymphomaangiocentric T$cell lymphoma
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E0tranodal 4K)1-*ellE0tranodal 4K)1-*elllymphomalymphoma
4orphology B4orphology B (.(.Ma3ority : polymorphousMa3ority : polymorphous
H small, medium, large atypi*al lympho*ytesH small, medium, large atypi*al lympho*ytes
H lympho*ytes, plasma *ells, ma*rophages,H lympho*ytes, plasma *ells, ma*rophages,
neutrophilsneutrophils ----------+e careful of nasal+e careful of nasal
predilectionIIpredilectionII
+. Prominent ne*rosis -----sear*h $or+. Prominent ne*rosis -----sear*h $or atypicalatypical
cellscells
D.D. n io*entri*it n io*entri*it
TAHE %84E
4E''AGE 1#
1> yo female mass in nasal ca*ity
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;7%1"
y y
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;7%1"
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@(@(
8ther e4tra nodal lymphoma8ther e4tra nodal lymphoma
4tranodal 0!5"-cell lymphoma nasal4tranodal 0!5"-cell lymphoma nasaltypetype
nteropathy associated "-cellnteropathy associated "-celllymphomalymphoma
6epatosplenic "-cell lymphoma6epatosplenic "-cell lymphoma
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9ntrodu*tion "*ontL#9ntrodu*tion "*ontL#
%odgkins <isease B%odgkins <isease B
/hara*teried &y Reed-Stern&erg /ells/hara*teried &y Reed-Stern&erg /ells
1ends to o**ur in young adults1ends to o**ur in young adults
Mediastinal disease *ommonMediastinal disease *ommon
Spreads to *ontiguous nodesSpreads to *ontiguous nodes
/ommon to hae a lo*aliedQ/ommon to hae a lo*aliedQpresentationpresentation
7ighly *ura&le ith *urrent treatments7ighly *ura&le ith *urrent treatments
7 d ki 8i7odgkin 8isease
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7odgkin 8isease7odgkin 8isease
/hain nodes-spread *hara*teristi*/hain nodes-spread *hara*teristi*
<iant *ells,<iant *ells, Reed-Sten&erg *ellReed-Sten&erg *ell indu*edindu*ed
R5 lymph, histio*yt, granulo*yt.R5 lymph, histio*yt, granulo*yt.
4odular s*lerosis4odular s*lerosis
mi0ed *ellularitymi0ed *ellularity
lymph predominantlymph predominant
lympho*yte-depletedlympho*yte-depleted
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Reed-Sternberg cells and variantsReed-Sternberg cells and variants
Cytopathologic diversity of H-RS cellsCytopathologic diversity of H-RS cells
Diagnostic Reed-Sternberg cellsDiagnostic Reed-Sternberg cells
Mononuclear Hodgkin cellMononuclear Hodgkin cell
Lacunar cellLacunar cell
L&H cellL&H cell
Mummified cell apoptosis cells!Mummified cell apoptosis cells!
"leomorphic Reed-Sternberg cell"leomorphic Reed-Sternberg cell
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#-L"HL
L&H cell
#S-HL
Lacunar cell
MC-HL
Diagnostic RS cell
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$ppropriate cellular environment$ppropriate cellular environment
Depending on the specific subtype of HodgkinDepending on the specific subtype of Hodgkin
lymphoma% presence or absence of the folloing'lymphoma% presence or absence of the folloing' Small lymphocytes% ith fe or no immunoblastsSmall lymphocytes% ith fe or no immunoblasts
HistiocytesHistiocytes
"lasma cells"lasma cells
(osinophils and neutrophils(osinophils and neutrophils
)ibroblasts)ibroblasts
Hodgkin lymphoma'Hodgkin lymphoma'
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Hodgkin lymphoma'Hodgkin lymphoma'
*f the term of +Hodgkin, be replaced out%*f the term of +Hodgkin, be replaced out%
#odular lymphocyte predominant Hodgkin lymphoma#odular lymphocyte predominant Hodgkin lymphoma
#odular lymphocyte predominant large .-cell#odular lymphocyte predominant large .-cell
lymphomalymphoma
#odular sclerosis classical Hodgkin lymphoma#odular sclerosis classical Hodgkin lymphoma
Lacunar cell lymphoma ith sclerosisLacunar cell lymphoma ith sclerosis
Mi/ed cellularity classical Hodgkin lymphomaMi/ed cellularity classical Hodgkin lymphoma (.0-associated polymorphous large-cell(.0-associated polymorphous large-cell
lymphoproliferative disorderlymphoproliferative disorder
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Sel 8oroty Reed-/arl Sten&ergSel 8oroty Reed-/arl Sten&erg
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Sel 8oroty Reed /arl Sten&ergSel 8oroty Reed /arl Sten&erg
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7odgkin 8isease7odgkin 8isease
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7odgkin disease7odgkin disease
(==G kel lim$e(==G kel lim$e
1unggal1unggal menye&ar menye&ar
+=-= th"D=-D? th#+=-= th"D=-D? th#
enisenis 4odular s*ler.4odular s*ler. : @?G: @?G
Mi0ed *ellularityMi0ed *ellularity
: +?G: +?G
'im$ositik predominan'im$ositik predominan (=G(=G 'im$ositik depletion'im$ositik depletion
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'ympho*yte predominan*e
Mi0ed *ellularity
4odular s*lerosis
'ympho*yte depletion
4odular lympho*yte predominant
/lassi*al 7odgkin lymphoma
'ympho*yte-ri*h
Mi0ed *ellularity
4odular s*lerosis
'ympho*yte depletion
03E CLA''.2.CAT.8N J%8 CLA''.2.CAT.8N
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/lini*al staging o$ 78/lini*al staging o$ 78
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78 % 47'78 % 47'
7878 47'47'
'o*al lymph ./ER-'o*al lymph ./ER-ME.S1-P.ME.S1-P.
MU'19P7ER9P7ER'MU'19P7ER9P7ER'
/O419BU916/O419BU916 4O4O
E51R 4O8'E51R 4O8'
U4/OMMO4U4/OMMO4
/OMMO4/OMMO4
'8E6ER %'8E6ER %MESE41ER9/MESE41ER9/94O'E8 RRE94O'E8 RRE
/OMMO4/OMMO4
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4O8U'R S/'EROS9S4O8U'R S/'EROS9S
48'T C8448N =;$>;48'T C8448N =;$>; K 38(NGK 38(NG
PRO<4OS 29K, 'E7ERPRO<4OS 29K, 'E7ERSUPR/'9/U', ME89S194UM.SUPR/'9/U', ME89S194UM.
4O8U'R, R9414O8U'R, R941 R.SR.S.,., 'a*unar *ell'a*unar *ell,,*ollagen &and*ollagen &and,, diide lymphositis-nodule.diide lymphositis-nodule.
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Reed-Sten&erg *ellReed-Sten&erg *ell
4icroskopis B
0eed$sten+erg cell: &esar, &inukleus,&erhadap-ka*a,kadang-kadang multinu*, single lo&,sekitar halo area
Lacunar cell B
nodular sel
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4 7 d ki ' h4 7 d ki ' h
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4on 7odgkin 'ymphomas4on 7odgkin 'ymphomas
MU'19P'E M6E'OMMU'19P'E M6E'OM
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MU'19P'E M6E'OMMU'19P'E M6E'OM
P'SM /E''P'SM /E'' &one, skin '4.&one, skin '4.
C T , 9g C , prot 2en*e ones, Midle age "?=#.C T , 9g C , prot 2en*e ones, Midle age "?=#.
/lini* :/lini* :
Multiple &one destru*tMultiple &one destru*t ert, Ri&s, Skull, pelis, $emur, Rert, Ri&s, Skull, pelis, $emur, R &ulat oal,&ulat oal,
&atas&atas $ra*t. Patol.$ra*t. Patol.
Mi*ros : plasma *ell CC pleo morphi*, e0entri* nu*leusMi*ros : plasma *ell CC pleo morphi*, e0entri* nu*leus
plasma &lastplasma &last spleen, lier, kidney, lungsspleen, lier, kidney, lungs
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F li l l hF li l l h
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47' : paling sering"?G#47' : paling sering"?G#TVTV! deasa! deasa
Mi*ros : nodular struktur, small *ell irreg.Mi*ros : nodular struktur, small *ell irreg.
inti &igger *ell *hrom CC, nu*leoli Cinti &igger *ell *hrom CC, nu*leoli C/lini*al : Painless lim$adenopati general/lini*al : Painless lim$adenopati generale0tra nodul rare, median surial A-> the0tra nodul rare, median surial A-> th
10 : /hemoteraphy, radiasi, palliati 1010 : /hemoteraphy, radiasi, palliati 10
Foli*ular lymphomaFoli*ular lymphoma
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8i$$ ' 2 ll ' h8i$$us 'arge 2 *ell 'ymphoma
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8i$$us 'arge 2-*ell 'ymphoma8i$$us 'arge 2-*ell 'ymphoma
+=G 47'+=G 47'TTI, @= thI, @= th
Mi* :Mi* : 8i$$us patern8i$$us patern
'arge *ell : -?0 lim$ ke*il'arge *ell : -?0 lim$ ke*il 4u*lei : &ulat-oal, *leaed-lo&ulasi4u*lei : &ulat-oal, *leaed-lo&ulasi nak inti : +-D atau ( di tengah nak inti : +-D atau ( di tengah
/lin/lin ::
pem&esaran kel. lim$., kadang-kadang e0tra nodal : <it, &one,pem&esaran kel. lim$., kadang-kadang e0tra nodal : <it, &one,
&rain, skin.&rain, skin.P0 :P0 : elekelek
10 :10 : 9ntensie mi0 *hemo 109ntensie mi0 *hemo 10*omplete remission @=-=G, ?=G $or*omplete remission @=-=G, ?=G $orseeral years.seeral years.
2 *ell l mphoma2 *ell lymphoma
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2-*ell lymphoma2-*ell lymphoma
/hroni* lympho*iti* lymphoma/hroni* lympho*iti* lymphoma
Foli*ular lymphomaFoli*ular lymphoma
8i$$us large 2 *ell lymphoma8i$$us large 2 *ell lymphoma
2urkitt lymphoma2urkitt lymphoma
Plasma *ell neoplasm, et*.Plasma *ell neoplasm, et*.
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1 *ell lymphoma % natural killer *ell 41 *ell lymphoma % natural killer *ell 4
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1 *ell lymphoma % natural killer *ell 41 *ell lymphoma % natural killer *ell 4
(.(. Peri 1 *ell ' U4SPPeri 1 *ell ' U4SP
+.+. dult 1 *ell 'ymphoma dult 1 *ell 'ymphoma
D.D. My*osis $ungoidesMy*osis $ungoides
.. 7odgkin disease7odgkin disease
Pre*ursor 2 /ell % 1 *ell 4Pre*ursor 2 /ell % 1 *ell 4
*ut 'ympho&lasti* ' *ut 'ympho&lasti* '
Klasi$ikasi &erariasiKlasi$ikasi &erariasi
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mnrt : sal :sel 2,sel 1.mnrt : sal :sel 2,sel 1.
Struktur : FO',89F.Struktur : FO',89F.
ol.sel : 'R<E,SM.ol.sel : 'R<E,SM.
89FERE4S9S9 : ORK94< FROM.,RE'89FERE4S9S9 : ORK94< FROM.,RE'/'S.,RPPPOR1./'S.,RPPPOR1.
/U1 '9MFO2'S19/ '9MFOM)'EUKEM9 /U1 '9MFO2'S19/ '9MFOM)'EUKEM9
di S : +?== KSUS 2RU)17di S : +?== KSUS 2RU)17
I (? th, kulit putih +5I (? th, kulit putih +5
C atau W T, &alita, I (? th.C atau W T, &alita, I (? th.Mi* : Str 4orm kel li$ rusak, sel lim$o&las dominan : 2esar.Mi* : Str 4orm kel li$ rusak, sel lim$o&las dominan : 2esar.9nti 'o&ulated, Mitosis CC9nti 'o&ulated, Mitosis CC
/linn : nemia, 'emah, Panas/linn : nemia, 'emah, Panas a*ut. 9n$eksi, 2one pain,a*ut. 9n$eksi, 2one pain,
Spleen % lier enlargement, <eneral lim$adenopati, dllSpleen % lier enlargement, <eneral lim$adenopati, dll
Chronic lymphocitic / small cell limfomaChronic lymphocitic / small cell limfoma
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Chronic lymphocitic / small cell limfomaChronic lymphocitic / small cell limfoma
Sering pada deasaSering pada deasa
Small 2 *ell pd sirkulasi "leukemia#Small 2 *ell pd sirkulasi "leukemia#
Mi*ros : str 4' rusak, Small lim$osit predominan,Mi*ros : str 4' rusak, Small lim$osit predominan,
inti ke*il, kom&inasi dgan sel C &esarinti ke*il, kom&inasi dgan sel C &esar"prolim$ositi*#"prolim$ositi*#
/lin :/lin : C ?= tahunC ?= tahun TTI atau W , sering asimptom, 22X, lemah, anoreksi,I atau W , sering asimptom, 22X, lemah, anoreksi,
'ekosit CC, 'im$adenopatia, spleen; 'ier 'ekosit CC, 'im$adenopatia, spleen; 'ier
2urkitt lim$oma2urkitt lim$oma
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2urkitt lim$oma2urkitt lim$oma
Endemi*-sporadi*-agresi$ "$rika#.Endemi*-sporadi*-agresi$ "$rika#.Mi* : inasi intermed sie sel lim$osit, intiMi* : inasi intermed sie sel lim$osit, intioal-&ulat, nu*leoliC( kromatin kasar,oal-&ulat, nu*leoliC( kromatin kasar,
mitosisCC starry skymitosisCC starry skypatern" ma*rophages, ingest nu* de&ris#patern" ma*rophages, ingest nu* de&ris#
/lin :/lin :
e0tra nodal mani$es, mandi&ula, organ intrae0tra nodal mani$es, mandi&ula, organ intra &domen. &domen. /hildren, muda./hildren, muda.
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SP'EE4SP'EE4
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SP'EE4SP'EE4
SP'EE4SP'EE4
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SP'EE4SP'EE4
(?= <R : (+ 0 A 5 D /M(?= <R : (+ 0 A 5 D /M
M/ROS : KPSU' 19P9S, 2U-2UM/ROS : KPSU' 19P9S, 2U-2U 1R2EKU' P8. PRE4K9M MER71R2EKU' P8. PRE4K9M MER7
8<4 2ER/K PU197-791E PU'P. RE88<4 2ER/K PU197-791E PU'P. RE8PU'P. S94USSO98 8<4 KP9'ER 88PU'P. S94USSO98 8<4 KP9'ER 8819P9S19P9S
FU4<S9FU4<S9
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FU4<S9FU4<S9
(.(. Pem&entukan sel darah "diluar sumsumPem&entukan sel darah "diluar sumsumtulang#.tulang#.
+.+. Proses hemolisisProses hemolisis
D.D. Reseroir darah, mo&ilisasi &ila perluReseroir darah, mo&ilisasi &ila perlu
.. Reaksi pertahanan-keke&alan tu&uh,Reaksi pertahanan-keke&alan tu&uh,produksi lim$osit dan at antiproduksi lim$osit dan at anti
NeoplasiaMyeloproli$eratie and myelodysplasti*disorders, leukemia,
d l h
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and lymphoma%emolytic anemias
7ereditary sphero*ytosis, ellipto*ytosis
1halassemias, si*kle *ell anemiaAutoimmune disorders
utoimmune hemolyti* anemia1hrom&o*ytopenia, essential neutropeniaSystemi* lupus erythematosusRheumatoid arthritis
Sar*oidosis.nfections
9n$e*tious mononu*leosis, &ru*ellosis, et*.Malaria, to0oplasmosis, et*.'epsis
Congestion
/irrhosis o$ the lier 2udd-/hiari syndrome/hroni* *ongestie heart disease'torage diseases
<au*her disease, 4iemann-Pi*k diseaseAmyloidosis
@@(AD=
<angguan sirkulasi<angguan sirkulasi
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<angguan sirkulasi<angguan sirkulasi
(.(. 2endungan akut2endungan akut+.+. 2endungan menahun2endungan menahun
D.D. Sindroma &anti : splenomegali kongesti$Sindroma &anti : splenomegali kongesti$
CC, lekopeni, anemi.CC, lekopeni, anemi... 9n$ark : O&str. Em&oli *or single) multiple-9n$ark : O&str. Em&oli *or single) multiple-
2a3i.2a3i.
<amna-<andy &odies : &er*ak a&u+-*oklat<amna-<andy &odies : &er*ak a&u+-*oklat"$i&rosis; endapan pigmen# pd 2anti"$i&rosis; endapan pigmen# pd 2antisindromsindrom
SplenomegaliSplenomegali
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p gg
(.(. 9n$eksi : 1yp. 12/, Mal syph9n$eksi : 1yp. 12/, Mal syph
+.+. /ongesti : /irh, de*omp, portalthrom/ongesti : /irh, de*omp, portalthrom
D.D. 'im$o-hematogen dis.'im$o-hematogen dis.
.. 9mmunogeni*9mmunogeni*?.?. Storage dis : gau*her, niemann-Pi*kStorage dis : gau*her, niemann-Pi*k
@.@. 'ain : amyloid, neopl'ain : amyloid, neopl
4eoplasm : arang4eoplasm : arang
2enign : 7emangioma, 'im$angioma, $i&roma2enign : 7emangioma, 'im$angioma, $i&roma
histiositosis sel 'angerhanshistiositosis sel 'angerhans
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histiositosis sel 'angerhanshistiositosis sel 'angerhans
"histiositosis 5# !"histiositosis 5# !
- prol. sel '/, normal di- prol. sel '/, normal di
epidermis,epidermis,- &erakuola, sitoplasma- &erakuola, sitoplasma
&anyak, inti esikular, lon3ong&anyak, inti esikular, lon3ongatau &erlekuk,atau &erlekuk,
D klinikopatologik !D klinikopatologik !
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p g !p g !
- histiositosis '/ akut terse&ar- histiositosis '/ akut terse&ar"sindr. 'etterer-Sie#,"sindr. 'etterer-Sie#,
- histiositosis '/ uni$okal "gra.- histiositosis '/ uni$okal "gra.eosino$ilik#,eosino$ilik#,
- multi$okal "peny. 7ands*huller- multi$okal "peny. 7ands*huller
/hristian#/hristian#
8endriti* "antigen presenting#8endriti* "antigen presenting#
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8endriti* "antigen presenting#8endriti* "antigen presenting#*ells*ells
'angerhans *ell "skin#'angerhans *ell "skin#9nterdigitating dendriti*9nterdigitating dendriti**ell "1-one#*ell "1-one#
9ndeterminate *ell "skin#9ndeterminate *ell "skin#
eiled *ell "lymphati*#eiled *ell "lymphati*#
Folli*ular dendriti* *ellFolli*ular dendriti* *ell"2 *ell $olli*le#"2 *ell $olli*le#
Fi&ro&lasti* dendriti*Fi&ro&lasti* dendriti**ell "Y#*ell "Y#