Totok utoroDepartment of Pathology

Gadjah Mada University Faculty of Medicine

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EARExternal, Middle, & Temporal Bone

• Reflect the composition and environmental exposure of the ear’s constituent parts:

• the skin and sub cutaneous tissue• The cartilage of the external ear• The mucosa• Ossicles and bones• Nerves, muscle, and blood vessels of the middle ear and

mastoid• Specialized epithelium and nerves of the inner ear, which ,

encased in the temporal bone transmute sound & position sensation to electrical impulses and produce & regulate the flow of endolymph

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Lesi yang dikirim ke PA

• Kulit telinga luar: pinna, meatus, kanal biasanya dalam bentuk benjolan kulit

• Radang (dibandingkan dengan neoplasma 8:1)• Trauma • Lesi telinga tengah biasanya disertai hearing

loss, dan dengan otoskop dapat dilihat benjolan di belakang membrana timpani

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Frequency of Ear NeoplasmsNEOPLASMS BH AFIP YNH BPT

SQUAMOUS 48 53 66 61

BENIGN 3 4 6 17

Cyst 4 14

Papilloma., etc 2 3

MALIGNANT Squamous cell carcinoma 35 27 27 16

Basal cell carcinoma 10 22 26 11

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Frequency of Ear NeoplasmsNEOPLASMS BH AFIP YNH BPT

NEUROEPITELIAL/NEURAL 21 26 25 16

Nevi 2 6 12 8

Melanoma 1 2 9 2

Nerve sheath 3 12 4

Schwannoma 12 2

Neurofibroma <1 1

Granular cell 1 <1

Paraganglioma 14 4 3 0

Merkel cell tumor <1 <1

Meningoma 1 1

Heterotopic brain <1

neuroblastoma <1

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Frequency of Ear NeoplasmsNEOPLASMS BH AFIP YNH BPT

GLANDULAR 10 11 1 2

Adenoma 6 5 <1 <1

Auricle <1

External canal 3 2 <1

Middle ear 3 3 <1 <1

Adenocarcinoma 4 3 0 0

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Frequency of Ear NeoplasmsNEOPLASMS BH AFIP YNH BPT

MESENCHYMAL 12 11 5 24

Fibroushistiocytic 3 1 1

Leomyoma <1

Leiomyosarcoma <1

Rhabdomyosarcoma <1 2 <1 <1

Vascular 2 3 1 2

Bone/cartilage 7 4 1 1`

Langerhan’s cell granulomatosis <1 <1 <1

Lymphoproliferative 1 <1

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TUMORS OF THE EXTERNAL EAR• Basal cell carcinoma• Squamous cell carcinoma• Malignant melanoma• Fibrous histocytoma• Myxoma • Merkel cell tumor• Sarkoma Kaposi• Pleomorphic adenoma• Chondroma

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Benign epithelial tumor

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Squamous cell Papilloma

Malignant Epithelial Tumors

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Carcinoma in situ

Dysplasia

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Polyp

Low power High power

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Malignant epithelial tumor

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Squamous cell carcinoma

NEOPLASMA KANALIS AUDITORIUS

EKSTERNUS• Adenoid cystic carcinoma• Bone tumors (osteoma)• Neural tumors

(schwannoma & neurofibroma)

• Rhabdomyosarcoma• Meningioma• Paraganglioma

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Tumor Telinga Tengah

Tumor jinak• Inverted papilloma• Paraganglioma• AdenomaTumor ganas• Karsinoma sel

skuamosa• Rhabdomyisarcoma• Tumor metastasis

(melanoma maligna)15TUMS131212

Inverted Papilloma

The tumor mass is growing inward (inverted)TUMS131212 16

TUMOR METASTASIS• Melanoma maligna paling sering ke os temporalis• Urut-urutan asal tumor (tumor primer):

Payudara

ParuGinjalProstatLambungCervix & uterusPharynxNasopharnxLarynxThyroid

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Tumor Telinga Dalam

• Neurofibromatosis• Meningioma

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TUMOR MATA• Jarang primer, kebanyakan sekunder• Berdasarkan lokasi: tumor eksternal,

intra okular, dan retrobulbar

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1. Tumor Eksternal

• Tumor Palpebra: jinak & ganas• Tumor Conjunctiva: jinak & ganas

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Tumor Palpebra Jinak

• Nevus pigmentosus• Hemangioma

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Tumor Palpebra ganas

• Karsinoma sel basal• Karsinoma sel

skuamosa• Melanoma maligna

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Tumor konjungtiva jinak

• Nevus pigmentosus• Lipoma

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Tumor konjungtiva ganas

• Karsinoma sel squamosa• Melanoma maligna

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2. Tumor Intra-okular

• Tumor Intraokular Jinak• Tumor Intraokular Ganas

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Tumor Intraokular Jinak

• Nevus pigmentosus• Angioma retina• Hemangioma

khoroid• Hamartoma glia

tuberous sklerosis

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Tumor Intraokular Ganas

• Melanoma maligna• Retinoblastoma

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Inherited Cancer Syndromes

RETINOBLASTOMA• Carriers of mutant Rb

gene have a 10,000 fold increased risk of developing retinoblastoma (familial type)

• greatly increased of developing second cancer (ostreosarcoma)

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3. Tumor Orbita Jinak

• Neurofibromatosis• Meningioma• Astrositoma pilositik

juvenil (glioma nervus optikus)

• Tumor kelenjar lakrimal (adenoma pleomorfik)

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3. Tumor Orbita Ganas

• Rhabdomiosarkoma • Astrositoma grade III• Adenokarsinoma lakrimal• Tumor metastasis

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Malignant mesenchymal tumor

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Rhabdomyosarcoma

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Tumours of the nasal cavity andparanasal sinuses: Introduction

• The nose opens into the nasal cavity, which is divided into two nasal passages.

• Air moves through these passages during breathing. • The nasal cavity lies above the bone that forms the roof of the

mouth and curves down at the back to join the throat. • The area just inside the nostrils is called the nasal vestibule. • A small area of special cells in the roof of each nasal passage

sends signals to the brain to give the sense of smell.• Together the paranasal sinuses and the nasal cavity filter and

warm the air, and make it moist before it goes into the lungs. • The movement of air through the sinuses and other parts of

the respiratory system help make sounds for talking.35TUMS131212

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There are several paranasal sinuses named after the bones that surround them:

• The frontal sinuses are in the lower forehead above the nose.

• The maxillary sinuses are in the cheekbones on either side of the nose.

• The ethmoid sinuses are beside the upper nose, between the eyes.

• The sphenoid sinuses are behind the nose, in the center of the skull.

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Tumor of the nasal cavity & paranasal sinuses

• Different types of cells in the paranasal sinus and nasal cavity may become malignant.

• The most common type of paranasal sinus and nasal cavity cancer is squamous cell carcinoma. This type of cancer forms in the squamous cells (thin, flat cells) lining the inside of the paranasal sinuses and the nasal cavity.

• Other types of paranasal sinus and nasal cavity cancer include the following:

• Melanoma: Cancer that starts in cells called melanocytes, the cells that give skin its natural color.

• Sarcoma: Cancer that starts in muscle or connective tissue.• Inverting papilloma: Benign tumors that form inside the nose. A small

number of these change into cancer.• Midline granulomas: Cancer of tissues in the middle part of the face.

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Other types of paranasal sinus and nasal cavity cancer include the following:

• Melanoma: Cancer that starts in cells called melanocytes, the cells that give skin its natural color.

• Sarcoma: Cancer that starts in muscle or connective tissue.

• Inverting papilloma: Benign tumors that form inside the nose. A small number of these change into cancer.

• Midline granulomas: Cancer of tissues in the middle part of the face.

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Paranasal sinus and nasal cavity cancer is a type of head and neck

cancer

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• Image: Adenoid cystic carcinoma - Myoepithelial cells are arranged in cribriform pattern. A portion of normal parotid is on the left side.51TUMS131212

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