PATHOLOGY EXAMINATION

Department of Pathology Medicine Faculty Brawijaya University

Kasus
An. EC/ 2 tahun Keluhan utama: benjolan di kepala dan mata kiri, cepat membesar

HISTORY TAKING PHYS EXAM THERAPY

DIAG NOSIS

LAB EXAM R
EXAM

PA EXAM

CT Scan Kepala Brain Window

HASIL FNAB pada Lesi di Kepala

Rosette

Makroskopik: Tampak tumor di kepala yang meluas ke pelipis dan zygoma Mikroskopik: Hapusan hiperseluler terdiri dari sebaran sel-sel ganas berinti bulat kecil-kecil sebagian mengandung nucleoli prominen, sebagian tampak hyperkromatik dengan sitoplasma tipis. Sel-sel tersusun sebagian seperti Rosette dan Sebagian tampak tersebar difus. Kesimpulan: MALIGNANT SMALL ROUND CELL TUMOR kemungkinan EWING SARCOMA. DD: 1. NEUROBLASTOMA 2. LYMPHOMA MALIGNA SARAN: Open Biopsi Histo PA

USG Abdomen

Massa solid heterogen pada suprarenal kiri Sugestif Maligna

Marker VMA : Negatif

WDx: NEUROBLASTOMA Stage IV

Terapi: Kemoterapi dengan Doxorubicin Hasil: Perbaikan, massa primer dan metastatik pada skull mengecil, BB bertambah. Pasien kontrol poli hematologi untuk kemoterapi lanjutan.

Anatomic Pathology Examinations

Histopathologic Ex. - HistoPA routine Frozensection(Vries Coupe) - Pathology autopsy

Cytologic Ex.
- Exfoliative Cytl :Gyn and non gyn - FNAB

Histopathology Examination
Specimen from operation ( mastectomy, TAH BSO, appendectomy ,colon resection, nephrectomy, thyroidectomy etc . Excisional biopsy ( FAM, polyp < 3 cm) Incisional biopsy ( tumors > 3 cm ). Curretage ( from uterus , dentigerous cyst, etc ) TURP, TURB Autopsy specimens.

Preparation
Complete delivery form : patient identity, specimen type, fixation, location, clinical diagnosis, complete clinical information + draw location and size of tumor, history of the disease and lab examination. Fixation with 10 % formalin. Specimen label : name, regist number.

Receive specimens from patient

Frozen Section
Durante op ,Without fixation. From : ovary tumor, breast tumor, thyroid tumor, skin tumor, brain tumor, Hirschsprung disease. Decided benign or malignant, free margins Operation technic ( therapy management). GOLD STANDARD DX : histopathology paraffin block

HASIL VRIESCOUPE : Ganas (Infiltrating Ductal Carcinoma)

IMMUNOHISTO/CYTOCHE MISTRY
Indication : standard for tx and prognosis, decided tumor type. Example : ER/PR, HER2 for Breast Cancer, CD 4,8, 19, 20 for decide Non Hodgkin lymphoma type B or T. Vimentin, LCA, desmin, cytokeratin for differential diagnostic of malignant small round cell tumor,determine the origin of tumor cells .

Immunohistokimia Ca. Mammae Her2 Positif

Immunohistokimia Ca. Mammae ER Positif

-year-old man
Pleural fluid
Primary site: unknown lungstomach Cytological diagnosis: Primary lung cancer

CK7

CK20

Napsin

FINE NEEDLE ASPIRATION BIOPSY

Role of FNAB
Differentiate : non neoplastic and neoplastic lesion Differentiate : benign and malignant tumor Differentiate Malignant tumors : primary, metastatic, or recurrence. Rapid diagnosis for emergency case :spinal lesion with cord compression. Determine staging of tumor.

Close biopsy with FNAB

Simple , economical technique. Can be performed as an outpatient procedure. Few complications. Multiple sites. Rapid diagnosis & treatment planning Highly accurate

FNAB Procedure
PRECONDITION Clinical information. Conventional radiograph / CT scan / MRI /USG of the tumor Biopsy target can be located with palpation or guided by CT scan/ USG.

Material and Method

Needle 25 G/27 G/23G Spuit 10cc. Object glass. Alcohol 70 % Alcohol 95%.

1. Examine patient and Radiograph

2. Puncture Tumor
Desinfection. Tumor fixation with fingers. Puncture tumor without/with aspiration.

Make smear-fixation-staining

FNAB diagnostic : GCT of the Bone

Clinical Pictures: An KHA 12 thn, humeral tumor 6 yr

X-ray humerus (24/2/11) RS Saiful Anwar, Malang

Thank you for your attention