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Rizki Hanriko
Laboratorium Anatomi-Histo-PA
FK UNILA
2016
Ross MH. Nerve Tissue Histology.2011
Ross MH. Nerve Tissue Histology.2011
Parenchym otak terdiri dari:
Neuron
Neuroglia
Mikroglia
NEURON
Membentuk unit dasar dari sistem saraf
bersama dengan axon, dendrit dan
Synaps
Neurosyphilis
Treponema pallidum, approx 25% of
cases of syphilis. mild or even
asymptomatic, but it may be severe with
transient cranial nerve palsies and
convulsions.
Lyme disease
Tick-borne spirochaete Borrelia burgdorferi. It is a
systemic illness characterized by skin lesions and
neurological features.
Viral encephalitis
Fungal infections
Rare and occur mainly in the immunosuppressed
(e.g. associated with chemotherapy, steroid
treatment, acquired immune deficiency syndrome—
AIDS), but some organisms, e.g. Cryptococcus
neoformans, can produce disease in the absence of
immunosuppression.
Protozoal infection
Toxoplasmosis
Amoebae.
Plasmodium falciparum.
Trypanosomes.
Multiple sclerosis
Commonest demyelinating disorder of the CNS
50 per 100 000 in the UK. Peak incidence is between
20 and 40 years with a slight female predominance.
MS is characterized by relapsing and remitting
episodes of immunologically mediated demyelination
within the CNS. Recovery from each episode of
demyelination is usually incomplete, leading to
progressive deterioration.
Association with HLA antigens (A3, B7, DR2 & DQ1).
Aetiology is unknown but current theories are:
Myelin abnormality.
Autoimmune disorder.
Toxin damage.
Viral infection of the CNS, e.g. measles.
Degenerative disorders
Alzheimer’s disease
Most common cause of dementia in Western countries. over 65
years, and 15% of people over 80 years; females more than
males.
Increase in incidence of sporadic cases in individuals with
ApoEe4 genotype on chromosome 19.
The amyloid precursor protein (APP) gene on chromosome 21
has been implicated in the familial cases.
Aetiology and pathogenesis are unknown; some cases (5%) are
familial but most (95%) are sporadic.
Iodine deficiency
Hypothyroidism; >> affect the CNS in children.
In the fetus, severe iodine deficiency causes
cretinism characterized by dwarfism, mental defect,
and spastic diplegia.
This can be prevented by iodine supplements during
pregnancy.
Toxins
Carbon monoxide
CO binds irreversibly to Hb rendering
erythrocytes incapable of oxygen transport.
CO poisoning, therefore, results in brain
damage due to hypoxia.
>20%—Dyspnoea and slight headache.
30%—Severe headache, fatigue, and
impaired
judgement.
60–70%—Loss of consciousness.
>70%—Rapidly fata
Methanol
Highly toxic to the CNS, lipid soluble, so it
readily diffuses into the CSF and aqueous
humour in concentrations higher than in
plasma.
Methanol is metabolized into formic acid and
formaldehyde.
Acute—sudden death with multiple
haemorrhagic lesions in the cerebral
hemispheres.
Chronic—atrophy of retinal ganglion cells with
secondary degeneration of the optic nerve.
Tumor dari neuroglia
Astrosit => Astrocytoma
Anaplastic astrocytoma
Glioblastoma multiforme
Pilocytic astrocytoma
Oligodendrocytes => Oligodendroglioma
Ependyma and its homologues => Ependymoma
Myxopapillary
ependymoma
Subependymoma
Tumor dari neuron
Neuroblastoma
Ganglioneuroblastoma
Ganglioneuroma
Lymphoma
Primer
Sekunder
Tumor malformasi
Craniopharyngioma
Epidermoid cyst
Dermoid Cyst
Colloid cyst
Tumor metastase
Sebanyak 25-30% tumor di dalam otak
adalah tumor metastase yang berasal dari
organ lainnya. Terbanyak adalah dari jenis
karsinoma.
Tumor yang sering bermetastase ke otak
adalah:
Paru-paru
Payudara
Kulit
Ginjal
GIT
Astrocytoma
usia pertengahan
60 thn => anaplastic
70 thn => glioblastoma multiforme
Makros:
masa putih abu-abu
infiltratif
padat, lunak, gelatinous
bbrp cm
lokalisasi: hemispher cerebri
Mikros:
Sel-sel uniform
Protoplasmic-fibrillary-gemistocytic.
Bentuk anaplastic:
hypercelluler
nukleus pleomorf, ireguler, hyperchromatis
proliferasi dan hyperplasia dari endotel
kapiler
Glioblastoma Multiforme
Terdapat bermcm2x: kdg2x tdpt area putih
padat, kuning lunak nekrosis, kista,
hemorhagis.
Mikros: anaplastic
- kapiler mbtk “cluster”
Lokasi tersering astrositoma:
Pd dewasa di hemisphere, kdg2x di med.
Spinalis
tidak pernah di cerebellum
Prognosis: jelek
Pilocytic Astrocytoma
Khas tjd pd anak-anak dan dewasa muda
Lokasi: cerebellum, dasar dan dinding
ventrikel III, N. Optikus, hemisphere cerebri
(jarang).
Makros: kistik kdg2x padat
Mikros:
Bipolar sel dengan prosesus panjang dan
halus
Prolif. Vasculer.
Tumor tumbuh lebih lambat.
Oligodendroglioma
5% dr seluruh glioma
Umur pertengahan
laki-laki = perempuan
Makros:
Berbatas tegas
Gelatinous, keabuan, dgn bgn2x kistik,
hemoragis fokal, kalsifikasi
Penyebaran ke ruang subarach.
Mikros:
Tdd sel-sel yg berkelompok dengan inti
spheris bergranul
Sytoplasma ber-halo
Kapiler-kapiler yang bersambungan
memisahkan sel-sel tumor mjd
kelompok2x
Type anaplastik: - progresif
- nukleus pleomorf
Penderita dpt hidup ± 5 thn.
Ependymoma
Berasal dari sel-sel epitel yg melapisi
ventrikel & canalis spinalis
Mengenai usia 10-20 thn.
Seringkali pd ventrikel IV
Pd usia pertengahan sering di medula
spinalis.
Makros:
Di ventrikel IV, bentuk padat atau papillary
=> reseksi sulit
Intraspinal - berbatas tegas => dpt
Mikros:
Sel-sel oval-bulat atau “carrot shaped” nuclei,
granular chrom.
Membentuk gambaran ependymal
canal/rossete
Pathognomonis: blepharoplast basal bodies
of cilia ( w: PTAH )
Klinis:
Fossa posterior ependymoma disertai:
hidrocephalus, obstruksi V. IV, invasi ke pons
& medulla
Tumbuh lambat, prognosa buruk.
Subependymoma
Padat, kalsifikasi
Bentuk nodule yg melekat pd ddg
ventrikel
Kadang2x: - asymptomatic
- hidrocephalus
Tdpt pd V. lateral dan V. IV
Choroid Plexus Papilloma
Tjd pd tempat plexus choroideus
Srg pd anak-anak
Ventrikel lateral
Dws - pd ventrikel IV
Makr: plexus choroid normal
tumbuh papilifer
Mikr: jaringan ikat dilapisi epitel kuboid,
columner + cilia
Klinis: - disertai hidrocephalus
- obstruksi ventrikel oleh tumor
Neuroblastoma
Tjd pd hemispher cerebri
Anak-anak
Mikr: rossete
Ganglioglioma
dan Gangliocytoma
Makr:
Ganglioneuroma berupa massa berbatas
tegas + kalsifikasi
Pd ventr. III, hipotalamus atau lobus
temporalis
Mikr:
Sel-sel ganglion dipisah oleh stroma yang
tidak terlalu seluler.
Medulloblastoma
Tjd di cerebellum
Dekade 2 kehidupan (25%)
Kdg2x pd usia lebih tua
Menimbulkan disfungsi cerebellar atau
hidrocephalus
10 ysr 50%
Makr:
Masa putih keabuan
Pd anak tdpt di vermis cerebell. Pd dws:
hemisphere lateral
Penyebaran mll CSF ke ependym & suarachnoid
Mikr:
Kelompokan sel-sel padat dg inti kecil, pleomorf,
sitoplasma sedikit.
Kdg2x membentuk Homer Wright rossete
(diferensiasi neuronal).
Gambaran utama adalah adanya diferensiasi
neuronal dan glial.
Meningioma
Tumor yg tumbuh pd atap arachnoid
20% dr slrh tumor primer intra cranial
Lokasi tersering: ½ bgn depan kepala
tmsk lengkung hemisphere, falx cerebri,
tulang sphenoid, foramen olfactorius.
Jarang: - ventrikel
- cerebellopontine angel
- foramen magnum
- med. spinalis.
Makros:
iregular
melekat pd dura
kdg2x mbtk “plate like form” dsbt meningioma
enplaque
tumor solid, dg permukaan kasar
Mikros:
WHO Grade I: Meningothelial, Fibrous, Transitional,
Psamomatous, Microcystic, Secretory,
Limphoplasmacytic-rich, Metaplasia.
WHO Grade II: Atypical, Clear cell, Chordoid
WHO Grade III: Papillary, Rhabdoid, Anaplastic
(Malignant)
Colloid Cyst of Third Ventricel
dws muda
2% dr tumor primer intracran.
Ø 1-4 cm di anterior ventrikel III
tdd kapsel fibrosa dilapisi epitel kuboid /
kolumnar kdg bersilia / goblet sel
dpt menyebabkan: - obstruksi for.
Monro
- blok aliran CSF
- hidrocephalus
Metastatic Tumors
25-30% tumor intracran.
terutama carcinoma (80%): - paru
- mamma
- melanoma
- ginjal
- GIT
membentuk massa yg berbatas pd
cortico-white matler junction
dikelilingi daerah udema
Saraf Tepi