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NEOPLASMA SEL DARAH
PUTIH
Dr. Wien Wiratmoko. SpPA
Instalai PA - RSU.Dr. H. Ab!l Moeloek
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"one marro# aala$ sat! or%an t!b!$
&an% terapat paa sel!r!$ trabe'!la
t!lan% ( me!la t!lan% pan)an%Tempat !tama proses $ematopoesis &an%
mempro!ksi sel ara$
"M a#al ber#arna mera$*komponeneritrosit+ % bertamba$ !sia ber!ba$
k!nin% *lemak+
Akan kembali )i mera$ paa konisi
- perara$an $ebat
- $ipoksia
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,e%anasan &an% berasal ari komponen
$ematopoetik #$ite bloo 'ells "M
inamakan LE,EMIA
Se'ara !m!m neoplasma W" 'ells iba%i
/. Neoplasma Lim0oi Ho%kin Lim0oma an Non$o%kin Lim0oma
1. Neoplasma mieloi &an% men%enai
'ells 2ran!losit3 Er&trosit3 Trombosit 4LMA3 2an%%!an mieloproli0erati0 kronik
an Sinrom mieloisplastik
. Neoplasma Histiositik.
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Proliliferative Disorders Neoplastik
/. Le!kemia M&eloblastik Ak!t *AML+
T!mor itanai en%an proli0erasi sel mieloiimat!r *mieloblast+ &% men!mp!k lm "M
1. M&eloproli0erati5e DisorersT!mor itanai ole$ proli0erasi mat!r6e0erensiasi terminal3 tk terkenali3men!mp!k "M
. Sinrom M&eloisplasti'
2an%%!an i0erensiasi terminal &% tak terat!r
Ditanai aan&a sel pre'!rsor "M ( sitopenia
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Lekemia m&eloi mrp pen&akit ke%anasan
&an% itanai proli0erasi sel sistem$ematopoetik3 !tama i bone marro#
kem!ian t!mpa$ kealam sirk!lasi ara$.
Ta$!n 1778 USA aa /9.:17 kas!sPen&akit en%an spektr!m per)alanan
m!lai &an% !ntreate3 rapil&*0atal+ ; slo#l&
%ro#in%Se'ara traisional ibeakan A<UT (
<HRONI<
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LATIHAN
Rema)a atan% % emam /7 $ari3 pemeriksaan 0isik t = <3perara$an ber!pa petekia i baan an ekstrimitas3
$epatome%ali3 splenome%ali3 lim0aenopati. Lab. Hb. /31
%6l3 Lekosit /=:76 mm 3 Hit!n% )enis se%men netro0il /
>3 Lim0osit ?= >3 Monosit / >. "iopsi s!ms!m t!lan%normal. Dia%nosa &an% ses!ai aala$
a. ALL b. AML '. Anemia aplastik . ITP e. In0eksi "akteri
Pemba$asan
"iopsi s!ms!m t!lan% normal3 apa e0inisi Le!kemia &ait!neoplasma s!ms!m t!lan%3 )ai $ar!sn&a ia $ipersell!ler kan.
"akteri &an% san%at 5ir!len bisa mn&ebabkan )!mla$ lekosit
t!r!n misaln&a in0eksi salmonela *t$&p$oi+
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A'!t M&eloi Le!kemia
In'iensi 396 /77.777 per t$.
Laki @ #anita 838
Etiolo%i Hereiter3 Raiasi *eBpos!re : ;C t$+3 ba$an kimia benena3 $erbisia3
pesti'ia
Obat kemoterapi *alkilatin% a%ent+Sem!a i$!b!n%kan en%an penin%katan
RESI,O
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Tana an %e)ala klinis timb!l karena
/. UN2SI --- tiak aa sel mat!r2ran!losit m!a$ 4 In0eksi
Trombosit 4 Perara$an
1. HIPERFIS,OSITAS --- mieloblast i sirk!lasi ara$3 in5asi ke or%an
,linis s!a$ m!n'!l selama G bln
Sinrom prelekemia i)!mpai p 1: >
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UIS
Neoplasma mieloi aala$ pert!mb!$an&an% tiak terkenali men%enai sel-sel
iba#a$ ini ,E<UALI APA A
2ran!losit Er&trosit3
Trombosit
Histiosit
MonositHistiosit aala$ sel makro0a% &% aa i )arin%an mana sa)a3
)ai ia b!kan pen!!k asli "M *s!ms!m t!lan%+.
Neoplasma mielo sinonim % le!kemia
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/. Le!kemia M&eloblastik Ak!t *AML+
,lasi0ikasi A" *l!as ipakai klinisi+
M7 AML3 minimall& i00erentiate
M/ AML #it$o!t mat!ration
M1 AML #it$ mat!ration
M A'!te prom&elo'&ti' le!kemia
M8 A'!te m&elomono'&ti' le!kemia
M: A'!te monoblasti' le!kemiaM9 A'!te er&t$roi le!kemia
MC A'!te me%akar&oblasti' le!kemia
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SOAL A
Men!r!k ,lasi0ikasi A"3 Ak!t Mielo%eno!sLe!kemia imana %ambaran $ap!san ara$
tepi tanpa aan&a bent!k mat!rasi keara$
ne!trop$ils3 sel "last iapatkan @ ?7 >3
mioloblast en%an n!'leoli prominent3sitoplasma tampak %ran!la a!ropilik aala$ M/
M:
M9
MC
M7
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MI,IR SE"ENTAR O, AML mer!pakan neoplasma ara$ &an% itanai en%an
proli0erasi sel JJJJJ&% men!mp!k lm "M6S!ms!m T!lan%
Sel apaka$ it!
Mielosit
Monosit
Mieloblast Lim0oblast
"enar sem!a
Ingat yang jadi neoplasma adalah sel muda (blast) dengan
variasi adanya maturitas sel (prognosa lebih baik) maupun tanpamaturitas sama sekali (prognosa jelek) Gampang kan, itu maksud dari
klasifikasi F!"
#imfoblast penduduk asli jaringan limfoid yang sekunder, seperti
kelenjar getah bening"
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,lasi0ikasi WHO 177/
AML #it$ re'!rrent %eneti' abnormalities
AML #it$ m!ltilinea%e &splasia AML an MDS3 t$erap&-relate
AML3 not ot$er#ise spe'i0ie
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ADA SOAL DULU
Diba#a$ ini "U,AN mer!pakan klasi0ikasi
Ak!t Mielo%eno!s Le!kemia men!r!t WHO3
aala$
AML #it$ re'!rrent %eneti' abnormalities AML #it$ m!ltilinea%e &splasia
AML an MDS3 t$erap&-relate
AML not ot$er#ise spe'i0ie
AML #it$o!t mat!ration
Ha0al n%%ak K &a be%inila$ sekola$ ikeokteran
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,elainan %enetik paa AML
AML #it$ t*=1/+*1111+ * $#%&'+
AML #it$ abnormal bone marro#eosinop$ils in5*/9+*p/11+ or t*/9/9+*p/11+ **!F+&$-%%+ A'!te prom&elo'&ti' le!kemia *AML #it$
t*/:/C+*11/1+*P$#&../ + an5ariants AML #it$ //1 *$##+ abnormalities
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AML #it$ t*=1/+*1111+ * $#%&'+
- Morp$olo%i'all& M1
AML #it$ abnormal bone marro# eosinop$ils
in5*/9+*p/11+ or t*/9/9+*p/11+
**!F+&$-%%)
- Morp$olo%i'all& M8 A'!te prom&elo'&ti' le!kemia *AML #it$ t*/:/C+
*11/1+*P$#&../ + an 5ariants
- Morp$olo%i'all& M
AML #it$ //1 *$##+ abnormalities
- Morp$olo%i'all& M:
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,lasi0ikasi A"
M0. AML, minimally differentiated
Lekemia ak!t itanai tk aan&a
i0erensiasi sel m&eloi * li%$t mikroskop+
M&eloi linea%e iperiksa men%%!nakan
imm!nop$enot&pi' or !ltrastr!'t!ral st!&
Positi5e <D/3 <D3 <D//C3 <D8Ne%ati5e <D//3 <D/:
-6 MPO * onl& in 0e# blasts+
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M1. AML without maturation
A'!te le!kemia tanpa aan&a bent!k
mat!rasi keara$ ne!trop$ils"lasts iapatkan @ ?7 >
M2. AML with maturation A'!te le!kemia en%an mat!rasi bent!k
ne!tro0il lm berba%ai stai!m
"M bila i biopsiM&eloblasts 17 >
Ne!trop$ils /7 >
Mono'&tes G 17 >
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M/. A'!te m&elo%eno!s le!kemia3 men!r!t A"
m&eloblast kromatin $al!s3 n!kleoli prominent % %ran!la a!ropilik i
sitoplasma
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M3. Acute promyelocytic leukemia
,linis serin% iapatkan sitopenia ( DI<Mor0olo%i % "M aspirasi
Abnormal $&per%ran!lar prom&elo'&tes
N!'le!s kine&-s$ape or bilobe
<&toplasm ab!nant3 3 bri%$t pink3 ensel&
pa'ke %ran!les3 b!nles o0 A!er ros *0a%%ot
'ell+
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M A'!te prom&elo'&ti' le!kemia ; A"
bbrp sel inti bilobe3 m!ltiple neelelike a!er ros *'enter+3 %ran!la
a!ropilik
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M4. Acute myelomonocytic leukemia
A'!te le!kemia isertai proli0erasi
ne!trop$il an pre'!rsor mono'&te"M
Total blasts 17 >
Ne!trop$il an pre'!rsors 17 >
Mono'&te an pre'!rsors 17 >
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M5. Acute monoblatic and monocyticleukemia
A'!te le!kemia &an% itanai pop!lasiseln&a =7 > aala$ mono'&ti' linea%e
M:A monoblasts *!s!all& @ =7 >+
M:" promono'&tes
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M:b. A'!te mono'&ti' le!kemia ; A"
sat! monoblast an : promono'&te % membran inti &% melek!k
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LATIHAN SOAL DULU
Laki-laki DEWASA kel!$an perara$an paa %!si m!l!t &an%s!a$ berlan%s!n% min%%!3 pemeriksaan 0isik iapatkanpenebalan paa %in%%i5a3 bila kena tekanan m!a$ berara$3$epatosplenome%ali3 lim0aenopati paa le$er3 lipat pa$a anketiak.Lab. Hb. //31 %6l3 Hmt. 3?>3 Trombosit ?:.7776mm3Lekosit 8:776mm3 Hit!n% )enis 1:> se%men3 /7> batan%3
::> lim0osit3 = > monosit. "iopsi s!ms!m t!lan% Hipersell!ler3ominant sel blast. Dia%nosa &an% palin% m!n%kin aala$ Ak!t Me%akar&ositik Le!kemia Ak!t Lim0oblastik Le!kemia Ak!t Monositik Le!kemia Ak!t Er&troblastik Le!kemia
Ak!t Promielositik Le!kemia
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M!. Acute erythroid leukemia
Er&t$role!kemiaEr&t$roi pre'!rsors :7 > ari total n!'leate
'ells an
M&eloblasts 17 > mrp non-er&t$roi 'ells
P!re er&t$roi le!kemia
Er&t$roi pre'!rsors =7 > men!mp!k i "Mtanpa )!mla$ m&eloblast &% si%ni0ikan
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M". Acute me#akaryoblatic
leukemia
A'!te le!kemia imana :7 > ari
pop!lasi blasts aala$ me%akar&oblasts
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0" $yeloproliferative Disorders
Menin%katn&a proli0erasi sel pro%enitor4 m&eloilinea%es i "M menyebar ke or#an ekunder
$%& *$ati3 lien3 k%b+
Relati0 normal ok memperta$ankan i0erensiasi
terminal en%an $ematopoiesis &an% e0e'ti5e*eritrosit, platelet, granulosit, monosit,1 limfosit +
Tk $eran bila tana !taman&a aala$
Hepatome%ali an t!. splenome%ali sebab
$emopoesis ekstrame!la3 lim0aenopat$i rin%an
an elemen neoplastik i ara$ peri0er
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M&eloproli0erati5e isorers *MPDs+
WHO Classification 2001
/. Le!kemia Mielo%enosa ,ronik *LM,+
a. <$roni' m&elo%eno!s le!kemia
b. <$roni' ne!trop$ili' le!kemia'. <$roni' eosinop$ili' le!kemia
1. Pol&'&t$emia 5era
. Primar& m&elo0ibrosis *metaplasia mieloi en%an
mielo0ibrosis+8. T$rombo'&t$emia Essential
:.<$roni' m&eloproli0erati5e isease3 !n'lassi0iable
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1. Leukemia Mielo#enoa 'ronik (LM')
A!lt !sia 1:-97 t$ % insiensi p!n'akekae 8 ata! :
/: ; 17> ai sem!a le!kemia
Dia%nosisData klinis
Laboratori!m
"one marro# biops&
2eneti's st!& 0or t*?11+
O''asional imm!nop$enot&pi' st!&
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AWAS Seoran% Laki e#asa atan% keokter en%an
kel!$an ben)olan paa re%io 'olli3 aBilla m!ltipleiameter 1 ; 9 'm3 soli3 l!nak. Paa pemeriksaan0isik T /C76/77 mmH%3 t C 7<3 lien terabamembesar3 Lab. Hb. /731 %6L3 Hmt 73: >3 M<F ?7 !m. Trombosit 1.7776mm3 Lekosit
/.776mm3 biopsi s!ms!m t!lan% normal. Dia%nosa&an% ses!ai keaaan iatas aala$ In0eksi monon!'leosis In0eksi m&'oba'teri!m T" Anemia Hipoplastika
,ronik Lim0ositik Le!kemia Ak!t Lim0oblastik Le!kemia
In%at sekali la%i "M normal3 ,ronik lim0ositik le!kemia aala$neoplasma sel lim0oi i )arin%an lim0oi sek!ner *,2"+ nantikala! s!a$ pen!$ t!mpa$ )!%a ke sirk!lasi ara$ tepi. Qeniskronik p oran% e#asa3 ak!t paa anak-anak.
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LM,
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Pato%enesa
?:> LM, 4 kromosom P$3 t *?311+men&ebabkan terbent!kn&a %en 0!si "<R-
A"L men%koe protein 0!si ba%ian "<R
an omain tirosin kinase &% akti5itasn&atk tekenali
Aan&a prek!rsor %ran!lositik *palin%ominan+3 eritroi3 me%akariositik3 lim0osit" seba%ian T 4 mrp b!kti LM, berasalari sel pl!ripoten
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LATIHAN U,
Le!kemia Mielo%enosa kronik ?:> item!kan kromosom
P$ilaelpia3 ter)ai kelainan apa paa kromosomn&a nin% K
Translokasi ,romosom */?3 11+
!si %en "<R ; A"L
M!tasi titik
M!tasi S!presor %en
M!tasi Protoonko%en
Ter)ai translokasi kromosom ?3 11
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Chr 22
BCR
e/JJ e// e12 e13 e14 e15 e16 e17 e18 e19 e20
b1 b2 b3 b4 b5
majorC1 c2 c3 c4
muminor
Chr 9
a1 a2 a3 a4 a5 a6 a7 a8 a9 a10 a11
ABL
b1 b2 b3
ba1 0!sion---p1/7 protein
p1/7 "<R-A"L
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b2a2 or b3a2 fusions
of the BCR-ABL genes
*ncreain# cell proliferation
+ecreain# cell death
*nducin# independence from #rowth
factor
$educin# adheion of affected cell to
troma
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IN2AT LO
,romosom P$ilaelpia paa LM, memi'! ter)ain&a
kelainan-kelainan iba#a$ ini3 ,E<UALI
Menin%katn&a proli0erasi sel
Men!r!nn&a kematian sel
Menin%katn&a se'ara bebas t$ 2ro#t$ a'tors
Menin%katn&a ikatan *a$esion+ antara sel anstroma
Men!r!n&a apoptosis sel
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,linis
2e)ala a#al tak spesi0ik3 pro%resi0 lambat
Splenome%ali &% ekstrem3 r!pt!r3 in0arkLekosit @ /77.7776!L ominan netro0il an
mielosit tapi baso0il3 eosino0il )!%a tampak
Trombositosis
"M 4 $ipersel!ler % t!r!nan %ran!lositik an
me%akariositik
Tana k$as LM, kromosom P$ an
menin%katn&a baso0ilDapat men%alami trans0ormasi
Seikit komplikasi m&elo0ibrosis
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Terapi
Da$!l! terapi paliati0 an kemoterapi3 tkmen'e%a$ ke krisis blast
De0initi0 Transplantasi "M 4 C7> semb!$bila onor 'o'ok
Terapi onkoprotein STI- :C/ *2lee5e'+ 4analo% aenosin tri0os0at men%$ambatker)a tirosin kinase termas!k protein 0!si
"<R-A"R
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Soal !l!
Paa saat ini terapi &an% palin% !m!m
ilak!kan ter$aap neoplasma sel ara$
p!ti$ aala$
Pembea$an ( Raioterapi
Raioterapi ( ,emoterapi
,emoterapi ( Transplantasi
Transplantasi ( Im!noterapi Sem!a benar
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SOAL MANIN2 ,AN2
Hal &an% palin% s!lit ikenalikan alamta$ap-ta$ap terapi Le!kemia aala$ In0eksi oport!nistik
Perara$an Serebri Trombosis Mikrosirk!lasi
Sem!a bisa ikenalikan
Qa#aban A " < benar
Qai pasien menin%%al b!kan karenale!kemian&a3 s!lit sekali &a. Qai perl!monitorin% ketat
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LATIHAN SOAL LA2I A
an% imaks! en%an respon komplit *<omplete
Response+ pasien le!kemia &an% menapatkan terapi
se'ara meis aala$
Tiak iapatkankann&a Sel Neoplasma Lekosit
Q!mla$ lekosit abnormal G :7776!L
Q!mla$ Lekosit G /7.7776!L3 mor0olo%i normal
,aar Hb normlal3 Trombosit G /7.7776!L
Sem!a ,omponen ara$ G /7.7776!L
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1. Pol&'&t$emia 5era *PF+
Dibeakan
/. PF primer6 Er&tositosis Absol!t1. PF se'!ner
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Category I : 1. Increased erythrocyte volume
(>36 ml/kg in male, >32 ml/kg in female)
2. Arterial oxygen saturation > 92%
3. Slenomegaly
Category II : 1. !latelet count > "##$### ul
2. &eucocytosis > 12$###ul
3. Increased &A!&eucocyr Al'ali !hosatese scorewithout fever or infection
". Serum (it 12 > 9## gml
or unboundvit b12-binding capacity > 22pg/ml
Polcite!ia "era #riteria $% &
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Pol&'&t$emia 5era *PF+
,riteria Dia%nosti'
2emua *ategory I
or
% 3 0 in *ategory I an 0 *ategory II
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Pol&'&t$emia 5era WHO 'riteria
A1: Elevated RC ma!! "#25 $ above mean%& 'b # 18(5 in men and #16(5 in )omen%
A2: *o cau!e o+ !econdar, er,t-roc,to!i!
A3: ./lenomeal,A4: Clonal enetic abnormalit, ot-er t-an CRA in
marro) cell!
A5: Endoenou! er,t-roid colon, +ormation in vitro
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1: -romboc,to!i! # 400&000
2: C # 12&000
3: anm,elo!i! in bone marro) bio/!, )it-/rominent er,t-roid and meaar,oc,tic
/roli+eration
4: o) !erum er,t-ro/oietin level!
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Pol&'&t$emia 5era WHO 'riteria
Dia%nosis PF
A/ A1 an& A
or
A/ A1 an& 1 o0 "
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MAU TANA APA S 2 TANA
,riteria minimal &% ipakai mene%akkania%nosa Polisitemia Fera ADALAHen%an men%%!nakan stanart WHO Sem!a A "/ ata! "1
A/ A1 sala$ sat! A lain A1 sem!a "
A/ sem!a "
Sem!a "
2ampan% &a kala! $a0al3nanti kala! )ai okter
l!pa tin%%al b!ka b!k! n%%ak aa &% melaran%
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Splenome%ali Masi0 717 %ram *N /:7-177 %ram+
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Pol&'&t$emia 5era
Pat$olo%& i "MH&per'ell!lar trilinea%e marro#3 re5erse
ME or ME G 1/
In'rease er&t$roi 'ells3 all kins o0normoblasts
In'rease me%akar&o'&tes3 mil to
moeratePleomorp$i' 0orm o0 me%akar&o'&tes
an mil 0ibrosis
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Per)alanan pen&akit
Insiensi @ 87 t$ ; 97 t$
Menin%katn&a 5ol!me an kekentalan ara$
akibat Er&topoesis
Serin% timb!l $ipertensi3 sakit kepala3 sal!ran
'erna3 $ematemesis3 melena
"ila tiak menapat terapi berta$an bbrp b!lan
setela$ DB,omplikasi 4 trombosis ( in0ark *'or3ren3lien+
M&elo0ibrosis ter)ai G /7> kas!s
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Terapi
Ter%ant!n% Qenis
P$lebotomi 'ara seer$ana bisa berta$an/7 t$
Mielos!presi0 TB '$emot$erap& ( 0os0or
raioakti0 4 e0ek m!ta%enik
PR l
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PR !l! Laki e#asa en%an kel!$an sakit kepala an p!sin%
se)ak b!lan &an% lal!3 kaan% m!n'!l %atal-%atalsel!r!$ t!b!$ an "A" #arna ke$itaman. P t 93:7 <3 T /976?: mmH%3 $epar ( lien tak teraba. Sample0eses positi0 aan&a eritrosit3 Hb 113 %6l3 $ematokrit 9C3/ >3 M<F ?8 !m3 trombosit 8:.7776 mm3Lekosit C=776mm. Apa ia%nosa ses!ai
Sinrom Mieloisplastik
Er&trole!kemia
<ML
Polisitemia Fera
Disseminate Intra5as'!ler <oa%!lation *DI<+
P$lebotom& serin% )!str! meran%san% pro!ksi er&trosit makin
menin%kat3 ok 'ari pen&ebab&a. "ila Smoker polisitemia &a
istop rokokn&a an biasan&a tiak isertai % splenome%ali
- i Mi l fib i
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. -rimary Mielofibroi
Mrp %an%%!an mieloproli0erati0 kronis spent p$ase ter)ai paa a#al per)alanan
pen&akit 4 ibrosis "M
Hematopoesis intrame!la ber%eserekstrame!la *tk berat!ran ( ine0isien+
men&ebabkan anemia sean% ; berat (
trombositopenia
ibrosis isebabkan ole$ kelainan
$ematopoetik t! Me%akariosit
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Pen'et!sn&a aala$ stim!lasi !tk
berproli0erasi ter!s mener!s ole$ P2 (
Trans0ormin% %ro#t$ 0a'tor &%
iprooksi ole$ me%akar&osit neoplastikPaa !m!mn&a pasien atan% s!a$
iapatkan ibrosis "M ( Hematopoesis
ekstrame!la
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Mor0olo%i
Hepatoslenome%ali men'apai 877 %r *$ati (
,2" rin%an+ 4 ekstrame!la $ematopoesis
Histolo%is ter)ai proli0erasi ari normoblast3
pre'!rsor %ran!losit an me%akariosit
"M tampak $iposel!lar an 0ibrosis l!as
Me%akariosit tampak palin% menon)ol ba$kan
men%alami isplastik
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'hro!bocte!ia Pri!ar (ielofibrosis
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<. Sinrom m&eloisplasti'
Mrp %an%%!an mat!rasi s$% $ematopoesistiak e0ekti0 an memp!n&ai resikoter)ain&a trans0ormasi LMA
"M i%anti ole$ sel pro%enitor m!ltipoten&% m!tan &% memperta$ankan
kemamp!an beri0erensiasi men)ai SDM3%ran!losit an trombosit % 'ara &% tiakterat!r ( ine0ekti0 4 Hipersel!ler ata!normosel!ler tepi ara$ tepi Pansitopenia
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8. T$rombo'&temia *san%at )aran%+
Sito%enetik ter)ai elesi kromosom : ata!
C
Insiensi ekae : ; C t! laki-laki
/7 -87> tran0ormasi LMA sisan&a
menerita in0eksi3 anemia ok tak aan&a selm&eloi i "M
Ptro%nosis berta$an antara ? ; 1? b!lan
Respon kemoterapi )elek
N l Hi ti itik
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Neoplasma Histiositik*Lan%er$ans <ell Histio'&tosis+
Immat!re enriti' 'ell *Lan%er$ans 'ell+
EBpress S-/773 <D /a
N!'lei linear %roo5e or 0ol
<&toplasm "irbe'k %ran!le *EM+
L $ ll $i ti t i
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Lan%er$ans 'ell $istio'&tosis
An ele'tron mi'ro%rap$ s$o#s rolike "irbe'k %ran!les #it$ '$ara'teristi' perioi'it&
an ilate terminal en.
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PERTANAAN DULU Pasien anak3 kel!$an !tama lesi er!psi k!lit an
emam. Sat! ta$!n &an% lal! perna$ menerita Otitismeia an s!a$ iterapi. Pemeriksaan 0isikiapatkan lim0aenopati3 $epatosplenome%ali3 $asilbiops& tampak "irbe'k %ran!la paa sitoplasma sel.Dia%nosa &an% ses!ai aala$
Ak!t Lim0oblastik Le!kemia
M!ltiple M&eloma
Lan%er$ans <ell Histiositosis
Ho%kin isease
NonHokin isease
Tin%%al i$a0alkan sa)a nin% ; akan%3 mas - mbak
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Letterer ;Si#e Disease
M!lti0o'al3 m!ltis&stem L<H
G 1 &rs
Skin ∼ seborr$ei' er!ption on tr!nk (
s'alp
$epatosplenome%al&3 l&mp$aenopat$&3
p!lmonar& lesion osteol&ti' bone lesion
<$emo tB → :7> pB s!r5i5e : &ears
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Eosinop$ili' %ran!loma
Uni0o'al 6 m!lti0o'al3 !nis&stem L<H
Histio'&te3 Eosinop$il 3 l&mp$o'&te3
plasma 'ell3 ne!trop$il
Uni0o'al skeletal s&stem in oler'$ilren or a!lts
M!lti0o'al m!ltiple erosi5e bone mass
in &o!n% '$ilrenHans-)chuller-Christian tria 'al5arial
bone e0e't iabetes in'ipi!s
eBop$t$alm!s
Pemeriksaan "M
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Pemeriksaan "M
Dibeakan Aspirasi an "iopsi masin%-masin%memp!n&ai ke!n%%!lann&a
Inikasi aala$ kelainan ara$ tepi3
pen&akit ke%anasan3sta%in% paa t!mor paat3
In0eksi UO6 0e5er o0 !nkno#n ori%in3
pen&akit metabolik
Lokasi paa anak sem!a ekstrimitas sean%
e#asa proksimal ekstremitas3 krista iliaka anteriorata! posterior
Man!bri!m sterni ok ketebalan /'m 4 Aspirasi
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Hemopoiesis
2ran!lopoiesis
Er&t$ropoiesis
Me%akar&o'&tes
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B*+ - $,)PO)ABL* A()H,$,-'.P*
BO+*-(ARROW B,OP). +**$L*
a!shi/i bone !arro asiration an/
bios nee/le
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"IOPSI
ASPIRASI
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