BURJ KHALIFA

WILMS' TUMOR
= Nephroblastoma
= , umur median 2 th 11 bln
Ka = Ki, 5 % bilateral
15 % + kelainan kongenital :
Anomali UG
Hemihipertrofia
Aniridia
ETIOLOGI : Diduga kongenital
3

KLINIS :

Flank mass
Flank pain
Trias
Hematuria
Hipertensi
Anorexia, Nausea, Vomiting
Kelainan kongenital lain

LABORATORIUM :
Hematuri
Anemia
4

RADIOLOGIS :
BNO

: - Kesuraman salah satu sisi

perut
- Usus terdesak oleh massa
IVP
massa /
USG

: Collecting sytem terdesak

distorsi
: Massa padat dalam ginjal
5

PATOLOGI :
Campuran Epithelial, Stromal, Blastematous
( Immature Mesnchyma )
2 kelompok :
- Favorable histology
- Unfavorable H

89 %
11 %

Prognosa kurang baik

STAGING ( Menurut NWTS ) :

I.

Terbatas dalam ginjal, eksisi sempurna

II.

Keluar ginjal, eksisi sempurna

III. Sisa tumor dalam abdomen

IV. Metastase jauh
V.

Bilateral

DD

:
Neuroblastoma
Teratoma
Hamartoma
Hidronefrosis
Cystic kidneys

TERAPI :
Radical nephrectomy
Chemotherapy : vincristine + Actinomycin D
( adriamycine)
Radiasi ; terutama UH
6

PROGNOSA
Stage
I
II
III
IV
V (30 Px)

2Y Relapse free

2 YSR

88 %
78 %
70 %
49 %

95 %
90 %
84 %
54 %
87 %

GRAWITZ' TUMOR

Renal cell Ca
Adeno Ca ginjal
Hypernephroma = Clear cell Ca
Pria : Wanita = 2 : 1
Sering pada dekade 5 -6
85% of all renal neoplasms
Penyebab ?
Faktor resiko

10

RISK FACTORS ASSOCIATED WITH RCC

Cigarette smoking (>35%)

Hypertension
Elevated body weight
Medications (e.g., diuretics)
Acquired renal cystic disease
Occupational exposures (e.g., asbestos, petroleum, cadmium,

lead)
Genetic predisposition (e.g., von HippelLindau disease)

Copyright 2002 by Lippincott, Williams & Wilkins

LOCATION OF POTENTIAL CHROMOSOMAL CHANGES IN

RENAL CELL CARCINOMA
Tumor
Conventional (clear cell) RCC
Papillary RCC
Chromophobe RCC
Collecting duct carcinoma

Copyright 2002 by Lippincott, Williams & Wilkins

Affected Chromosomes
3p,17
3q,7,12,16,17,20,Y
1,2,6,10,13,17,21
1q,6p,8p,13q,21q

Tanda dan Gejala :

Trias :

- Gross hematuria
- Flank pain
- Flank mass

11

PARANEOPLASTIC SYNDROMES ASSOCIATED

WITH RENAL CELL CARCINOMA
Erythrocytosis
Anemia
Hypercalcemia
Hypertension
Acute hepatic dysfunction
Amyloidosis Thrombocytosis

Copyright 2002 by Lippincott, Williams & Wilkins

Pemeriksaan Penunjang
Laboratorium :
- Hematuria
- Serum ferritin (meningkat 10%)
- Anemia (normocytic normocromic)
- Eritropoitin (meningkat 63%)
- LED
Radiologi :
- IVP
: distorsi PCS
- USG
: massa di ginjal
- Angiografi
: hipervascularisasi
- CT Scan/ MRI
: massa di ginjal

Axial view of computed

tomography scan

Three-dimensional
computed tomography
reconstruction

12

Terapi :
- Nefrektomi Radikal

Terapi Ajuvan :
- Radiasi
- Hormonal
- Kemoterapi

13

14

TUMOR BULI-BULI
Tumor yang tumbuh dari epitel buli-buli
Jenis : - Transitional cell Ca
- Epdermoid Ca
- Adeno Ca

90 %
5 - 10 %
2%

Pria : Wanita = 2,7 : 1

15

Penyebab : Belum jelas

Faktor resiko :
Merokok
Pekerja yang berhubungan dengan ;
Bahan kimia

Cat
Karet
Bensin
Kulit

Trauma fisik :
Infeksi
Instrumentasi
Batu
16

Tanda dan Gejala :

Painless, gross hematuria 90 %
Polakisuria, dysuria, urgency
Nyeri tulang, nyeri pinggang
Massa supra pubis

17

Diagnosis :
Urinalysis
Sitologi urine
IVP

: hematuria
: klas IV - V
: filling defect dalam buli-buli

Komplikasi :
Anemia
Gagal ginjal kronis

18

Penatalaksanaan :
TUR Buli
Sistektomi partial
Sistektomi total
Kemoterapi intravesikal
Radiasi
Kemoterapi

19

20