MAKROSKOPIK

Batas tepi area

perdarahan/liquifektif tegas-
rata
X Massa darah tidak ada
pembungkus (neomembrane ) saat
dikerok fragil
X Ada
neomembrane
Leptomening menebal, keruh,
sulkus & girus tak nyata di bag.
konveks
Leptomening tebal,
keruh, compang-
camping
 Sulkus dan girus nyata
Predileksi lesi di basal, dimana saraf
kranial keluar
Massa tumor berkapsul ekstra aksial
 Operasi massa tumor area
hiperostosis.
Infiltrasi bukan petanda
degenerasi ganas, kecuali ke
arah parenkim otak
X
Operasi intoto

kapsul terangkat
MIKROSKOPIK
SUSUNAN SARAF PUSAT SUSUNAN SARAF PERIFER

 HISTOLOGIK JINAK,  SEL SCHWAN

 KLINIK GANAS  JARAS SARAF/
 DAMPAK SSPst PLEKSUS
 UNSUR SARAF
PERIFER LAIN :
* medulla adrenal
* ganglion
17
Tipe Usia Lokasi Gamb klinik Survival RT Kemot
h
Astrositom Adult>chil ST Lambat, berthn 5 th MS Yes At recur
d
Astro anapl Adult ST Tumbuh cepat 2.5 th MS Yes Yes
GBM adult, ST Cepat, >> ganas 1 th MS Yes At recur
elder
Oligodendr Any ST, sering Kejang 5 th MS Yes Yes
fron
BS glioma Child>adu BS tu pons Defisit n.cranial 1 th MS Yes Seldom
lt
Piloctyc Idem Cerebe,hipot Cure total reseksi 80% 10 th Yes Yes
Ast
Ependymo Child, Vent 4, cauda Idem, nyebar 70% 5 th Yes Seldom
adult LCS
meduloBla Child>adu
ST : supratentorial, Cerebelum
BS : brainstem, NyebarMS
RT : Radioterapi, via :LCS
median 55% 5 th
survival Yes Yes
s lt
Meningio Adult Konvex, Cure total reseksi Long term Yes Rare
 TUMOR TYPE
Symptoms
Low grade Malignant Meningioma Primary CNS
glioma glioma lymphoma
Headache 40 % 50 % 36 % 35 %
Seizure 65-95 % 15-25 % 40 % 17 %
Hemiparesis 5-15 % 30-50 % 22 % 24 %
Mental status 10 % 40-60 % 21 % 61 %
abnormalities
YANG SERING DIJUMPAI

 ASTROSITOMA
 OLIGODENDROGLIOMA
 EPENDIMOMA

20
 TERSERING DIJUMPAI
 GRADING
 KERNOHAN
 ST. ANNE-MAYO
 WHO

21
 4 TIER
 3 TIER
 WHO: 3 TIER
 ANAPLASIA
 MITOTIK
 PROLIFERASI ENDOTEL
 NEKROSIS

22
 DERAJAT KEGANASAN RENDAH (GR. 1-2)
 SUBTIPE BANYAK

23
24
Astrositoma Fibriler
(Jaras fibriler) Astrositoma Protoplasmik
(Kista mikrokistik)

25
Pleomorf, ada spider web, small gemistositik dan
Kista mikro = Astrositoma protoplasmik WHO gr.2

26
 The tumor is moderately cellular, composed of
neoplastic protoplasmic
 astrocytes showing mild nuclear pleomorphism (HE).
Blood vessels are sparse; mitoses and necrosis are
absent
 Gemistocytic astrocytoma: large, plump, neoplastic
astrocytes with glassy pink cytoplasm and eccentrically
placed nucleus (HE).
 haemorraghic
ASTROSITOMA
GRADE 4 :

 ANAPLASIA necrosis

 MITOSIS
 NEKROSIS
PERDARAHAN
 PROLIFERASI
ENDOTEL

28
29
 Peningkatan Sellularitas

Astrositoma Glioblastoma
derajat rendah

30
 Glioblastoma, cytological features. A. Densely
populated area of small, poorly differentiated
glial cells (HE). B. Fusiform cells
 forming loose bundles displaying large atypical glial
cells (HE).
Gemistocyte cells
Dedifferentiated

32
Area nekrosis

33
Area nekrosis

34
Tumor Jinak epitel
selaput otak
(meningotel)

35
 Saat ini dikenal 15 varian
WHO : ada 3 gradasi, gr. 3 ganas

36
 Meningothelial (syncytial) meningioma. Moderately
large, oval nuclei are surrounded by round or
polygonal cytoplasm with poorly defi ned borders. The
cells typically are arranged in whorls (HE). The center
of some whorls display a psammona body (HE).
Fibrous meningioma consists of fi brillated
spindle cells arranged in interlacing bundles (HE)
38
Dept. Anatomical Pathology 39
 Percabangan vestibular saraf kranial ke-8
 Dekat ganglion vestibular
 Tersebar di seluruh tubuh

40
 Berkapsul
 Area hiperselular (Antoni A)
 Area hiposelular (Antoni B)
 Jinak
 Degenerasi miksoid

41
Dept. Anatomical Pathology 42
Antoni A

43
Palisading Area
Verrocay Body

Dept. Anatomical Pathology 44

 Multipel= Neurofibromatosis
Peny. Von Recklinghausen

Tunggal, nodular

45
 Tak berbatas tegas/tak berkapsul
 Defek NF1
 Dapat multi nodul lokal (Plexiformis)
Malignant Peripheral
 Degenerasi Ganas :
Nerve Sheath Tumor
 Sukar dibedakan antara MPNST dan
Neurofibroma
 Sel atipik bukan keganasan
 Aktivitas Mitosis (Indeks mitosis) : sesuai
ketentuan ganas pada jaringan lunak

46
Schwannoma : area hipo - Neurofibroma: selularitas
dan hiperselular homogen

47
48
49