RE F E R AT

C A P A R U Oleh : Ratna Amelia

Pembimbing : dr. Rury
Rahmawati, Sp. Rad (K
) Abd

LAB/SMF RADIOLOGI
RSUD Dr. HARYOTO LUMAJANG
2022
CA PARU

ru-paru
Kanker paru-paru (kanker pa
dikenal
primer), atau sering jika agak salah
adalah
sebagai karsinoma bronkogenik,
subtipe
istilah luas yang merujuk pada
ru-paru
histologis utama dari keganasan pa
dengan
primer yang terutama terkait
p rokok
karsinogen yang dihirup, dengan asa
sebagai penyebab utamanya.
 EPIDEMIOLOGI
Prevalensi Ca paru Yang juga
primer sama dengan merupakan
Ca mamae penyebab kematian
di dunia, sebnyak
20% dari seluruh
total kematian di
Perbandingan pada dunia risiko utama
Faktor
Pria : wanita 11:15 penyebab adalah
rokok
 - Pasien dengan kanker paru-paru mungkin
GEJALA KLINIS
tanpa gejala hingga 50% kasus
- Batuk dan dispnea adalah gejala yang agak
tidak spesifik yang umum di antara penderita
kanker paru-paru
-Tumor sentral dapat menyebabkan A
hemoptisis dan lesi perifer dengan nyeri B
dada pleuritik.
- Pneumonia, efusi pleura, mengi,
limfadenopati tidak jarang terjadi. C
-Gejala lainnya sekunder terhadap metastasis
(tulang, paru kontralateral, otak, kelenjar
adrenal, dan hati,
 PATOLOGI
non-small cell
small cell
lung cancer (NSCLC) (80%)
• adenocarcinoma (35%) lung cancer (SCLC)
• most common cell type overall •  (20%)
Almost always in smokers
• most common in women • Metastasizes early
• most common cell type in non-smokers• Most common primary lung
but still most patients are smokers
malignancy to cause 
• peripheral
• squamous cell carcinoma (30%)
paraneoplastic syndromes and 
• strongly associated with smoking SVC obstruction
• most common carcinoma to cavitate • Worst prognosis
• poor prognosis
• large-cell carcinoma (15%)
• peripherally located 
• very large, usually >4 cm
STAGI
NG
STAGI
NG
 01
Squamous Cell
Carcinoma Of The
Lung
Squamous cell carcinoma (SCC)

⦿ Squamous cell carcinoma (SCC) adalah salah satu non-

small cell carcinomas pada paru , disusun oleh sel
adenocarinoma merupakan jenis Ca paru yang sering ditemui
 Epidemiology
• Karsinoma sel skuamosa menyumbang ~ 30-35% dari
semua kanker paru-paru dan dalam banyak kasus
disebabkan oleh MEROKOK BERAT.
• Secara umum, karsinoma skuamosa lebih sering ditemui
pada perokok pria, dan adenokarsinoma pada perokok
wanita.
 Manifestasi Klinis

Presentasi klinis tergantung pada lokasi tumor dan sebagian besar tidak bergantung pada
histologi.
⦿ Tumor sentral dengan invasi dan obstruksi bronkus biasanya mengakibatkan kolaps distal
yang mungkin disertai infeksi. Batuk kronis
dan hemoptisis mungkin ada.
⦿ Lebih banyak tumor perifer, jika tidak ditemukan secara kebetulan pada pencitraan, biasanya
muncul ketika lebih besar, menyerang ke dinding dada (misalnya tumor Pancoast)
⦿ Penyakit metastatik mungkin merupakan tanda pertama keganasan (misalnya metastasis
serebral, fraktur patologis, dll)
 Pathology
⦿ Although squamous cell carcinoma of the lung is traditionally known to
arise centrally (66-90%), the incidence of peripherally located S C C is
increasing .
⦿ Macroscopically these tumours tend to be off-white in colour, arising from,
and extending into a bronchus. They invade the surrounding lung
parenchyma and can extend into the chest wall. Larger tumours have a
tendency to undergo central necrosis.
⦿ Four subtypes are recognised :
⦿ papillary
⦿ clear cell
⦿ small cell (not to be confused with small cell lung cancer)
⦿ basaloid
Metastases
Daerah paling sering terjadi metastasis:
⦿ Regional lymph nodes
⦿ Adrenal glands (see adrenal gland tumours)
⦿ Brain (see cerebral metastases)
⦿ Bone (see skeletal metastases)
⦿ Liver (see liver metastases)
 Gambaran Radiologi
⦿ Chest radiograph
⦿ The appearance depends on the location of the lesion..When the
right upper lobe is collapsed and a hilar mass is present, this is
known as
the Golden S sign.
⦿ A more peripheral location may appear as a rounded or
spiculated mass. Cavitation may be seen as an air-fluid level.
⦿ A pleural effusion may also be seen, and although it is associated
with a poor prognosis,
(a) and bronchogram (b) show the characteristic growth pattern of these
tumors in a patient with a squamous cell carcinoma of the night main stem
bronchus. Note the irregular narrowing (arrow) of to bronchial lumen, which
may result in postobstructive pneumonia or atelcısis
Squamous cell carcinoma in a 57-year-old man.
PA (a) and lateral (b) chest radiographs demonstrate a complete
consolidation of the right upper lobe. At bronchoscopy, an endobronchial
tumor of the r ı t main stem bronchus was identified.
Squamous cell carcinoma in a 63-year-old woman with dysphagia and weight
loss. (a) Frontal chest radiograph demonstrates opacification of the left
hemithorax and ipsilateral mediastinal shift consistent with complete atelectasis of
the left lung. Lack of visualization of the left main stem bronchus suggests
central occlusion. (b) Contrast-enhanced chest CT scan (mediastinal window)
demonstrates a softtissue mass (in), which narrowed and obstructed the left main
stem bronchus, left lung atebectasis, and left pleural effusion. At bronchoscopy, a
circumferential, friable obstructing endobronchial lesion was found.
Squamous cell carcinoma in a 62-year-old man with left shoulder pain. (a, b) Thin-
section chest CT scans (lung window) show an endobronchial nodule (arrow in a)
within the right lower lobe bronchus.
There is involvement of the adjacent lung parenchyma with associated volume loss of
the night lower lobe.
Note the bobulated mass (arrowhead in b) that displaces the major fissure. (C)
Gross specimen of the resected right lower lobe shows the endobronchial
component of the tumor
Squamous cell carcinoma in a 72-year-old man
with left arm pain, chest pain, and increasing dyspnea.
(a) PA chest radiograph demonstrates a large rounded cavitary
mass with an air-fluid level in the superior segment of the left lower lobe. Note the
nodular, irregular contour of the inner wall of the cavity. (b) Contrast-enhanced chest
CT scan (mediastinal window) demonstrates the air-fluid level within the lesion and the
irregular aspect of its inner wall.
⦿ CT
⦿ Cavitation is a frequent finding in primary lung
S C C but can also be encountered in metastatic
SCC. Cavitation is secondary to tumoral
necrosis. In other instances, S C C can have a
central scar with peripheral growth of tumor.
⦿ Differential diagnosis
⦿ The differential diagnosis depends on the location and
appearance of the mass.
⦿ hilar mass (unilateral): differential for a hilar mass
⦿ solitary pulmonary nodule: differential for a solitary
pulmonary nodule
⦿ pleural effusion: differential for a pleural effusion
 02
Adenocarcinoma Of
The Lung
Adenocarcinoma of the lung
⦿ Adenocarcinoma of the adalah salah satu non-small
cell carcinomas of the lung dan merupakan tumor
ganas dengan diferensiasi kelenjar atau produksi
musin.
⦿ Tumor menunjukkan berbagai pola dan derajat
diferensiasi, termasuk lepidik, asinar, papiler,
mikropapiler, dan padat dengan pembentukan musin.
⦿ Epidemiology
⦿ Sekarang dianggap sebagai subtipe histologis yang paling umum dalam hal
prevalensi

⦿ Manifestasi Klinis
⦿ Gejala awal berupa kelelahan dengan dispnea ringan diikuti batuk
kronis dan hemoptisis pada tahap selanjutnya.
Gambaran Radiologi
• Kadang-kadang tidak mungkin membedakan secara radiografis
antara jenis kanker paru histologis lainnya.
• Nodul paru-paru adalah daerah bulat atau tidak beraturan dengan
peningkatan pelemahan yang berukuran kurang dari 3 cm. Jumlah
redaman selanjutnya dapat mengklasifikasikan nodul sebagai kaca
tanah, sub-padat atau padat
Adenocancinoma in an asymptomatic 58-year-old male smoker with a radiographic
abnormalitfound incidentally on a preoperativeradiograph obtained before cataract
surgery.
(a) Posteroantenior (PA) chest radiograph shows alobulated 1.5-cm solitary nodule
(arrow) in theright upper lobe overlying the first anterior rib
(b) Chest computed tomographic (CT) scan (lungwindow) shows large bullae
surrounding a wellmarginated,lobulated soft-tissue nodule.
Adenocarcinoma in a 41-year-old man with right shoulder pain for several
months. (a) Apical brdotic
chest radiograph demonstrates a right apical mass with poorly
marginated borders. (b) Chest CT scan
(lung window) shows a homogeneous peripheral right upper lobe mass with
irregular borders. There is tumon
involvement of a posterior rib (arrow).
 03
Large Cell Carcinoma
Of The Lung
 Large cell carcinoma of the lung

⦿ Large cell carcinoma of the lung is one of the histological

type
of non-small cell carcinomas of the lung.

Epidemiology
⦿ Diperkirakan mencapai sekitar 10% dari bronchogenic carcinoma .

Manifestasi Klinis
⦿ Pasien mengalami dyspneu, batuk kronis, dan haemoptysis.
⦿ Gambaran Radiologi
⦿ Karsinoma sel besar paru-paru biasanya muncul sebagai massa
perifer yang besar dengan atenuasi padat dan batas tidak
teratur. Nekrosis fokal dapat hadir. Karakteristik lain termasuk
pertumbuhan yang cepat dan metastasis awal.
large cell carcinoma in a 61-year-old woman with blood-streaked
sputum and weight loss. (a) PA chest radiograph demonstrates a
large peripheral mass of the left upper lobe,
which abuts the pleural surface and has a bobubated contour. (b) Cut
surface of the gross specimen demonstrates
a 7-cm tumor that extends to the pleural surface.
large cell carcinoma in a
57-year-old man with weight loss, orthopnea, and a painful palpable mass of
the anterior chest wall on the
left side. (a) Contrast-enhanced chest CT scan (mediastinal window) demonstrates
a large mass of heterogeneoUs
attenuation, which produces mass effect on the mediastinal structures. (b) Cut
surface of the neoplasm
shows a large central area of necrosis,
 04
small cell carcinoma
of the lung
Small cell lung cancer (SCLC)
⦿ Small cell lung cancer (SCLC) (juga dikenal sebagai kanker paru-paru sel
oat) adalah subtipe dari karsinoma bronkogenik dan dianggap terpisah dari
kanker paru-paru non sel kecil (NSCLC) karena memiliki presentasi unik,
penampilan pencitraan, pengobatan, dan prognosis.
⦿ Small cell lung cancers umbuh dengan cepat, sangat ganas, bermetastasis
luas dan menunjukkan respons awal terhadap kemoterapi dan radioterapi.
⦿ SCLCs memiliki prognosis yang sangat buruk dan biasanya tidak dapat
dioperasi.
Epidemiology
⦿ Small cell lung cancers anker paru-paru sel kecil mewakili 15-20%
kanker paru-paru dan sangat terkait dengan merokok.
Manifestasi Klinis

⦿ Presentasi klinis dapat sangat ⚫ hoarseness (recurrent laryngeal nerve

palsy)
bervariasi dan dapat muncul dengan ⚫ stridor (airway compression)
cara berikut. ⚫ SVC obstruction
⦿ constitutional ⚫ rib erosion
⚫ fever ⦿ metastatic spread (affecting ~70%
⚫ weight loss
of patients are presentation)
⚫ malaise
⚫ bone pain (bone metastases)
⦿ primary tumour ⚫ focal neurological deficit (CNS
⚫ cough involvement)
⚫ haemoptysis ⚫ right upper quadrant pain (liver
⚫ dyspnoea metastases)
⦿ local invasion ⦿paraneoplastic syndromes
⚫ dysphagia (oesophageal compression)
⦿ Pathology
⦿ Small cell carcinoma is considered a neuroendocrine tumour of the
lung. It arises from the bronchial mucosa. Local invasion occurs in the
submucosa with subsequent invasion of peribronchial connective
tissue. Cells are small, oval, with scant cytoplasm and a high mitotic
count.
⦿ It is the most common lung cancer subtype to produce
necrosis, superior vena cava (SVC) infiltration/SVC obstruction,
and paraneoplastic syndromes.
Location
⦿ Approximately 90-95% of SCLCs occur centrally, and usually arising
in a lobar or main bronchus .
Gambaran Radiologi

⦿ Small cell cell tumours are located centrally in the vast majority
of cases (90%). They arise from main- stem of lobar bronchi,
and thus appear as hilar or perihilar masses . They frequently
have mediastinal lymph node involvement at presentation.
Plain film
⦿ Appearances on chest x-rays are non-specific. They may be
seen as a hilar/perihilar mass usually with mediastinal widening
due to lymph node enlargement 2. In fact, the mediastinal
involvement is often the most striking feature and the primary
mass may be inapparent.
⦿ CT
⦿ On CT mediastinal involvement may appear
similar to lymphoma, with numerous
enlarged nodes. Direct infiltration of
adjacent structures is more common. Small
cell carcinoma of the lung is the most
common cause of SV C obstruction, due to
both compression/thrombosis and/or direct
infiltration .
⦿ Necrosis and haemorrhage are both
common.
Only rarely do small cell carcinomas present
as a solitary pulmonary nodule.
⦿ CT is able to stage small cell cell lung
cancer.
Small cell carcinoma in a 41-year-old woman with persistent cough and
weight loss.
(a) PA chest radiograph shows a lobulated right hilar mass. (b) Frontal
linear chest tomogram shows smooth
narrowing of the bronchus intermedius due to extrinsic compression by the
hilar mass, which represented
lymph node metastases from small cell carcinoma.
Small cell carcinoma in a 72-year-old man with a history of dyspnea.
(a) Chest CT scan demonstrates a spiculated nodule in the right upper
lobe.
(b) Contrast enhanced chest CT scan (mediastinal window) shows massive
mediastinal lymphadenopathy secondary to lymph node metastases.
⦿ Differential diagnosis
⦿ Imaging imaging differential considerations
include
•⦿non small-cell lung cancer
⚫ squamous cell carcinoma of the lung
⚫ adenocarcinoma of the lung
⚫ undifferentiated large-cell carcinoma of the lung
•⦿lymphoma
•⦿pulmonary sarcoma (rare)
•⦿pulmonary metastases
•⦿benign lung lesions
Thank You