PAPER DEPARTEMEN ILMU KESEHATAN KESEHATAN MATA MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA FEBRYNA RIZKY RIZKY NIM : 110100006 110100006
BAB 1 PENDAHULUAN
1.1.
Latar Belakang Tumor Tumor p!p"#r p!p"#r $!% $!% #"&'o!& #"&'o!& m(( #&orm! #&orm! p$ p$ $"r% $"r% (")*+ (")*+rr m+ m+
$& )"!op) m+. Tumor p!p"#r #*( #"r(! $r* )u!*+, 'r*&-& *)+, 'r*&-& )"!"&'r, p"m#u!u% $r%, (r, mupu& $r* o+o+ (")*+r p!p"#r.1, Tumor p!p"#r $p+ $*)"!ompo))& m"&'$* +umor '*&) $& +umor -&(. Tumor '*&) p!p"#r (&-+ umum $& #"r+m#% #&) $"&-& m"&*&-)+& u(*. K"#&)& mu$% $*)"&!* ("r )!*&*(. Tumor -&( p!p"#r $*#-* m"&'$* $u, *+u +umor pr*m"r $& +umor m"+(++*) 2'r&-3.4 Tumor -&( &- p!*&- ("r*&- m"&-"&* p!p"#r $!% )r(*&om ("! #(!, )r(*&om ("! (5umou(, )r(*&om ("! ("#(", m"!&om, $& (r)om )po(*. S"$&-)& +umor '*&) p!p"#r ("p"r+* %"m&-*om $& &+%!"(m.4 Kr(*&om ("! #(! $& ("! ()umo( p!p"#r m"rup)& +umor -&( m+ p!*&- umum &- $*+"mu)&. Tumor *&* p!*&- ("r*&- +"r$p+ p$ or&- #"r)u!*+ +"r&- &- +"rp'& (*&r m+%r* ("r )ro&*). 789 )r(*&om p!p"#r #"r'"&*( ("! #(! ("$&-)& 89 & +"r$*r* +( )r(*&om ("! ()umo(, )r(*&om )"!"&'r m"*#om m"*#om,, $& +umo+ +umo++um +umor or !*& !*& &- 'r&-, 'r&-, ("p"r+ ("p"r+** )r(*& )r(*&om om ("! m"r)"! m"r)"! $& )r(*&om )"!"&'r )"r*&-+.4 M"!&om $!% +umor p!p"#r #"rp*-m"& &- 'r&- &- %ru( $*#"$)& $r* N";* $& )r(*&om ("! #(!. T"r$p+ p"&*&-)+& <9 )"'$*& m"!&om m!*-& &- $*$*-&o( ("+*p +%u&. A$ 81.<00 )(u( #ru m"!&om $*$*-&o( p$ +%u& 00 $"&-& =.>00 )"m+*&. 89 p(*"& m"!&om m!*-& $*'ump* p$ umur $* #?% <0 +%u&. Sr)om Kpo(* m"rup)& (!% (+u m&*"(+(* &- ("r*&- $*'ump* p$ p"&$"r*+ AIDS 2<93 $& 09 $r* (r)om $p+ m"&-"&* m+, *+u p!p"#r +(/#?% m"&"rup* %or$"o!um +u %"m&-*om $& p$ )o&'u&+*; or&*)(,
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PAPER DEPARTEMEN ILMU KESEHATAN KESEHATAN MATA MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA FEBRYNA RIZKY RIZKY NIM : 110100006 110100006
$& #u!#* #-*& *&"r*or *&"r*or 2m"&"rup* p"r$r%& p"r$r%& (u#)o&'u&+* (u#)o&'u&+*; ; -r&u!om -r&u!om +u %"m&-*om3. Tumor *&* #"r(*+ -r"(*, mu!+*o)! $& ("r*&- ) m#u%.7 1.2. Tujuan Penulisan Tu'u Tu'u& & pp"r pp"r *&* $*#u+ $*#u+ ("#-* ("#-* (!% (!% (+u (+u (r+ (r+ u&+u) u&+u) m"&"!" m"&"!"(* (*)& )& Pro-rm P"&$*$*)& Pro"(* Do)+"r $* D"pr+"m"& I!mu K"("%+& M+ F)u!+( K"$o)+ K"$o)+"r "r& & U&*;"r U&*;"r(*+ (*+( (
Sum+" Sum+"r r U+r/ U+r/ Rum% S)*+ Pu(+ H'* A$m A$m M!*) M!*)
M"$& $& paper *&* $*%rp)& $*%rp)& $p+ $*-u& $*-u&)& )& p"&u!* p"&u!*(( $& p"m# p"m# u&+u) m"&m#% *!mu, )%u(u(& m"&-"&* Tumor -&( p$ P!p"#r. 1.3. 1.3. Manfa Manfaat at Penul Penulis isan an A$pu& m&+ $r* p"&u!*(& *&* $!% : p!p"#r. 1. U&+u) m"&m#% p"&-"+%u& p"m# +"&+&- +umor -&( p$ p!p"#r. 2. M"&'$* (um#"r u&+u) $*!)u)& p"&"!*+*& +u p"&u!*(& )r *!m*% p$
m( m"&$+&-.
BAB 2 TINJAUAN PUTA!A PUTA!A
2
PAPER DEPARTEMEN ILMU KESEHATAN KESEHATAN MATA MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA FEBRYNA RIZKY RIZKY NIM : 110100006 110100006
$& #u!#* #-*& *&"r*or *&"r*or 2m"&"rup* p"r$r%& p"r$r%& (u#)o&'u&+* (u#)o&'u&+*; ; -r&u!om -r&u!om +u %"m&-*om3. Tumor *&* #"r(*+ -r"(*, mu!+*o)! $& ("r*&- ) m#u%.7 1.2. Tujuan Penulisan Tu'u Tu'u& & pp"r pp"r *&* $*#u+ $*#u+ ("#-* ("#-* (!% (!% (+u (+u (r+ (r+ u&+u) u&+u) m"&"!" m"&"!"(* (*)& )& Pro-rm P"&$*$*)& Pro"(* Do)+"r $* D"pr+"m"& I!mu K"("%+& M+ F)u!+( K"$o)+ K"$o)+"r "r& & U&*;"r U&*;"r(*+ (*+( (
Sum+" Sum+"r r U+r/ U+r/ Rum% S)*+ Pu(+ H'* A$m A$m M!*) M!*)
M"$& $& paper *&* $*%rp)& $*%rp)& $p+ $*-u& $*-u&)& )& p"&u!* p"&u!*(( $& p"m# p"m# u&+u) m"&m#% *!mu, )%u(u(& m"&-"&* Tumor -&( p$ P!p"#r. 1.3. 1.3. Manfa Manfaat at Penul Penulis isan an A$pu& m&+ $r* p"&u!*(& *&* $!% : p!p"#r. 1. U&+u) m"&m#% p"&-"+%u& p"m# +"&+&- +umor -&( p$ p!p"#r. 2. M"&'$* (um#"r u&+u) $*!)u)& p"&"!*+*& +u p"&u!*(& )r *!m*% p$
m( m"&$+&-.
BAB 2 TINJAUAN PUTA!A PUTA!A
2
PAPER DEPARTEMEN ILMU KESEHATAN KESEHATAN MATA MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA FEBRYNA RIZKY RIZKY NIM : 110100006 110100006
2.1. Anat"#i Pal$e%ra P!p"# P!p"#r r (up"r* (up"r*or or $& *&"r* *&"r*or or $!% $!% mo$** mo$**)( )(** !*p+ !*p+& & )u!*+ )u!*+ &- $p+ $p+
m"&u+up $& m"!*&$u&-* #o! m+ #-*& &+"r*or. B"r)"$*p m"!*&$u&-* )or&" $& )o&'u& )o&'u&-+* -+*; ; $r* $r* $"%*$r $"%*$r(*. (*. P!p"#r P!p"#r (up"r* (up"r*or or #"r)% #"r)%*r *r p$ p$ !*( !*( m+@ m+@ p!p"# p!p"#r r *&"r*or m"&+u $"&-& p*p*.< P!p"#r +"r$*r* +( !*m #*$&- 'r*&-& u+m. Dr* (up"r*(*! )" $!m +"r$p+ !p*()u!*+, !p*( o+o+ r&-) 2or#*)u!r*( o)u!*3, 'r*&-& r"o!r, 'r*&-& *#ro( 2+r(u(3, $& !p*( m"m#r& mu)o( 2)o&'u&-+*; p"!p"#r"3.< 1. Ku!*+ Ku!*+ p$ p!p"#r #"r#"$ $r* )u!*+ #-*& !*& +u#u% )r"& +*p*(, !o&--r, $& "!(+*(,$"&-& ("$*)*+ o!*)"! rm#u+, +&p !"m) (u#)u+&. 2. Mu()u!u( Or#*)u!r*( o)u!* Fu&-(* Fu&-(* mu()u! mu()u!u( u( or#*)u or#*)u!r !r*( *( o)u!* o)u!* $!% $!% m"&u+u m"&u+up p p!p"#r p!p"#r. . S"r+ S"r+("r ("r+ + o+o+& o+o+& m"&-"! m"&-"!*!* *!*&-* &-* *((ur *((ur p!p"# p!p"#r r ("r ("r )o&("&+ )o&("&+r*( r*( $& m"!u( m"!u( ("$*)* ("$*)*++ m"!"?+* +"p*& or#*+. S"#-*& ("r+ #"r'!& )" p*p* $& $%*. B-*& o+o+ &+"r$p+ $* $!m p!p"#r! $*)"&! ("#-* #-*& pr+r(!@ #-*& $*+( ("p+um or#*+ or#*+"" $!% $!% #-*& #-*& pr("p pr("p+! +!.. S"-m"& S"-m"& !ur !ur p!p"#r p!p"#r $*("#u $*("#u++ #-*& #-*& or#*+ or#*+.. Or#*)u!r*( o)u!* $*p"r(r* o!"% &"r;u( *!*(. 3. r*&-& Ar"o!r T"r$ T"r$p+ p+ $* #?% #?% mu()u! mu()u!u( u( or#*)u or#*)u!r !r*( *( o)u!*, o)u!*, #"r%u#u #"r%u#u&-& &-& $"-& $"-& !p*( !p*( (u#po&"uro+*) $r* )u!*+ )"p!.
3
PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA RIZKY NIM : 110100006
m#r 1. A&+om* )"!op) m+ po+o&-& (-*+!. 2(um#"r: Am"r*& A$"m o Op%+!mo!o-, 01. Orbital Anatomy, I&: Orbit, Eyelids, and Lacrimal System. C%p+"r 1. S"+*o& =. Am"r*& A$"m o Op%+!mo!o-.3
&. Tr(u(
4
PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA RIZKY NIM : 110100006
S+ru)+ur p"&o)o&- u+m $r* p!p"#r $!% !p*( 'r*&-& *#ro( p$+ &- $*("#u+ +r(u( (up"r*or $& *&"r*or. Tr(u( +"r$*r* +( 'r*&-& p"&o)o&)"!op) m+ $"&-& )"!"&'r M"*#om. '. Ko&'u&-+*; P!p"#r B-*& po(+"r*or p!p"#r $*!p*(* ("!p*( m"m#r& mu)o(, )o&'u&-+*; p!p"#r, &- m"!")+ "r+ p$ +r(u(.
m#r . A&+om* Mu()u!u( Or#*)u!r*( o)u!*. 2(um#"r: Am"r*& A$"m o Op%+!mo!o-, 01. Orbital Anatomy, I&: Orbit, Eyelids, and Lacrimal System. C%p+"r 1. S"+*o& =. Am"r*& A$"m o Op%+!mo!o-.3
P&'&- +"p*& #"#( p!p"#r $!% =40 mm $& !"#r mm. I $*p*(%)& o!"% -r*( )"!#u 2#+( mu)o)u+&3 m"&'$* +"p*& &+"r*or $& po(+"r*or. T"p*& &+"r*or +"r$*r* $r* #u!u m+, -!&$u! Z"*(( $& Mo!!.< Bu!u m+ mu&u! $r* +"p*& p!p"#r $& +"r(u(u& +"r+ur. Bu!u m+ +( !"#*% p&'&- $& !"#*% #&) $r* &- $* #?% $& m"!"&-)u&- )" +(@ #u!u m+ #?% m"!"&-)u&- )" #?%. !&$u! Z"*(( $!% mo$**)(* )"!"&'r ("#(" )"*! &- #"rmur $!m o!*)"! rm#u+ p$ $(r #u!u m+. !&$u! Mo!! $!% mo$**)(* )"!"&'r )"r*&-+ &- #"rmur )" $!m (+u #r*( $")+ #u!u m+.<
5
PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA RIZKY NIM : 110100006
T"p*& p!p"#r po(+"r*or #"r)o&+) $"&-& #o! m+, $& ("p&'&- +"p*& *&* +"r$p+ murmur )"*! $r* )"!"&'r ("#("( &- +"!% $*mo$**)(* 2-!&$u! M"*#om +u +r(!3.< Pu&)+um !)r*m!*( +"r!"+) p$ u'u&- m"$*! $r* +"p*& po(+"r*or p!p"#r, #"rup "!";(* )"*! $"&-& !u#&- )"*! $* pu(+ &- +"r!*%+ p$ p!p"#r (up"r*or $& *&"r*or. Pu&)+um *&* #"ru&-(* m"&-%&+r)& *r m+ )" #?% m"!!u* )&!*)u!u( +"r)*+ )" ()u( !)r*m!*(.< F*(ur p!p"#r" $!% ru&- "!*p( $* &+r )"$u p!p"#r &- $*#u). F*(ur *&* #"r)%*r $* )&+%u( m"$*!*( $& !+"r!*(. K&+%u( !+"r!*( )*r)*r 0,8 m $r* +"p*& !+"r! or#*+ $& m"m#"&+u) (u$u+ +'m.< S"p+um or#*+!" $!% (* $* #"!)&- #-*& mu()u!r*( or#*)u!r*( &+"r!"+) $* &+r +"p*& or#*+ $& +r(u( $& #"ru&-(* ("#-* (?r &+r p!p"#r or#*+. S"p+um or#*+!" (up"r*u( m"&+u $"&-& +"&$o $r* !";+or p!p"#r (up"r*or $& +r(u( (up"r*or@ ("p+um or#*+!" *&"r*u( m"&+u $"&-& +r(u( *&"r*or.< R"+r)+or p!p"#r" #"ru&-(* m"m#u) p!p"#r. D* p!p"#r (up"r*or, #-*& o+o+ r&-) $!% !";+or p!p"#r (up"r*or*(, &- #"r(! $r* p")( or#*+ $& #"r'!& )" $"p& $& #"r#&- m"&'$* ("#u% po&"uro(*( $& #-*& &!"#*% $!m &- m"&-&$u&- ("r+("r+ o+o+ po!o( $r* mu()u!u( Mu!!"r 2+r(!*( (up"r*or3. D* p!p"#r *&"r*or, r"+r+or u+m $!% mu()u!u( r")+u( *&"r*or, &m"&'u!ur)& 'r*&-& *#ro( u&+u) m"m#u&-)u( mu()u!u( o#!*5u( *&"r*or $& #"r*&("r(*o )" $!m #+( #?% +r(u( *&"r*or $& or#*u!r*( o)u!*. O+o+ po!o( $r* r"+r)+or p!p"#r" $*(r* o!"% &"r;u( (*mp+*(. L";+or $& mu()u!u( r")+u( *&"r*or $*p(o) o!"% &"r;u( o)u!omo+or*(.<,14 P"m#u!u% $r% &- m"mp"r$r%* p!p"#r" $!% . P!p"#r. P"r(r& ("&(or*) )"!op) m+ +( $*$p+)& $r* rmu( ro&+! &"r;u( , ("$&- )"!op) m+ #?% o!"% #&- )"$u &"r;u( .<,14
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PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA RIZKY NIM : 110100006
m#r 4. A&+om* ("p+um. 2(um#"r: Am"r*& A$"m o Op%+!mo!o-, 01. Orbital Anatomy, I&: Orbit, Eyelids, and Lacrimal System. C%p+"r 1. S"+*o& =. Am"r*& A$"m o Op%+!mo!o-.3
m#r <. A&+om* ;()u!r*((* )"!op) m+. 2(um#"r: Am"r*& A$"m o Op%+!mo!o-, 01. Orbital Anatomy, I&: Orbit, Eyelids, and Lacrimal System. C%p+"r 1. S"+*o& =. Am"r*& A$"m o Op%+!mo!o-.3
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PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA RIZKY NIM : 110100006
2.2. Tu#"r (anas Pal$e%ra 2.2.1. !arsin"#a el Basal 2.2.1.1 Definisi )an E$i)e#i"l"gi
Kr(*&om ("! #(! #"r(! $r* !p*(& #(! "p*+"! )u!*+ +u $r* !p*( !ur ("! o!*)"! rm#u+. B"rup #"&'o!& &- +r&(pr&, )$&- $"&-& p*&--*r &("p"r+* mu+*r. B-*& ("&+r! #"&'o!& +"r("#u+ !!u m"&")u&- $& %!u(, (")& )& m"&"m#u%. Tum#u%& !m#+ $"&-& u!("r(*. "&*( u!)u( ro$"&( +um#u% !"#*% "p+ $& $p+ m"&"##)& )"ru()& %"#+ $*(")*+r&.8 Kr(*&om ("! #(! m"rup)& +umor -&( p!*&- #&) $* )"!op) m+ $"&-& r")u"&(* 70 78 9 $r* ("!uru% +umor -&( $* )"!op) m+. Kr(*&om ("! #(! #&) #"r!o)(* $* )"!op) m+ #?% #-*& p*&--*r +u p!p"#r *&"r*or 280 60 93 $& $* $"r% )&+u( m"$*! 28 4093. S"!"#*%& 'u- #*( +um#u% $* )"!op) m+ +( +u p!p"#r (up"r*or 218 93 $& $* )&+u( !+"r! 28 93.8
2.2.1.2 *akt"r +esik"
P(*"& &- m"m*!*)* )+or r"(*)o +*&--* u&+u) +"r'$*& )r(*&om ("! #(! $!% &- m"m*!*)* or) )u!*+ pu+*%, m+ #*ru, rm#u+ p*r&-, u(* p"r+"&-%& $& u(* +u p$ )"+uru&& I&--r*(, Ir!&$*, S)o+!&$*, $& S)&$*&;*. P(*"& #*(& 'u- m"m*!*)* r*?+ +"rppr (*&r m+%r* $!m '&-) ?)+u !m p$ u(* $")$" $u )"%*$up&. R*?+ m"ro)o) "ru+u 'u- m"rup)& r"(*)o u&ru) +"r'$*& )r(*&om ("! #(!. P(*"& $"&-& )r(*&om ("! #(! ("#"!um&, m"m*!*)* )"mu&-)*&& !"#*% +*&--* u&+u) #"r)"m#&- m"&'$* )&)"r )u!*+.8 Kr(*&om ("! #(! +"r!*%+ m"&*&-)+ r")u"&(*& p$ p(*"& &- !"#*% mu$ $& $*+"mu)& !"(* -&( $* )"!op) m+ p$ p(*"& *&* +u m"r") &m"m*!*)* r*?+ )"!ur- $"&-& )"!*&& (*(+"m*) !*& ("p"r+* basal cell nevus syndrome +u xeroderma pigmentosum.Basal cell nevus syndrome (Gorlin syndrome) $!% )"!*&& u+o(om! $om*&&, )"ru()& mu!+*(*+"m &- $*+&$* $"&-& )r(*&om ("! #(! &";o*$ &- mu!+*p"! &- mu&u! !"#*% ?! $!m
8
PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA RIZKY NIM : 110100006
)"%*$up& &- $**)u+* $"&-& &om!* ()"!"+! )%u(u(& p$ m&$*#u!, m)(*! $& ;"r+"#r. "ro$"rm p*-m"&+o(um m"rup)& )"!*&& r"("(* u+o(om! &$*+&$* $"&-& (&-+ ("&(*+* +"r%$p ppr& (*&r m+%r* $& )"ru()& m")&*(m" repair +"r%$p (*&r m+%r* ("%*&-- m"r&-(&- )"ru()& DNA p$ ("! )u!*+.8
2.2.1.3 (ejala !linis
Tumor *&* umum& $*+"mu)& $* $"r% #"rm#u+, #"r(*+ *&;(*, 'r&m"mpu&* &) ("#r +u #"rm"+(+(*(. Dp+ m"ru() 'r*&-& $* (")*+r& +"ru+m #-*& p"rmu)& #%)& $p+ (mp* )" +u!&- 2#"r(*+ !o)! $"(+ru)+*3, ("r+ "&$"ru&- u&+u) r"(*$* !"#*% #*! p"&-o#+&& +*$) $")u+. U!("r(* $p+ +"r'$* &- m"&'!r $r* (mp*&- mupu& $r* r% $(r, ("%*&-- $p+ m"ru() #o! m+ (mp* or#*+.8 Kr(*&om ("! #(! m"rup)& +umor &- #"r(*+ r$*o("&(*+* $"&-& $*-&o(*( p(+* $*!*%+ $"&-& #*op(*. A&-) )"m+*& u&+u) )r(*&om ("! #(! $!% 4 9 )r"& +umor *&* 'r&- #"rm"+(+(*(.8
2.2.1.& !lasifikasi '
S"r )!*&*( $& ("r p+o!o-*, )r(*&om ("! #(! $* #-* m"&'$* "mp+ +*p", *+u : 3 Kr(*&om ("! #(! +*p" &o$u!r m"rup)& m&*"(+(* )!*&*( +"r#&) $r* )r(*&om ("! #(!, )"r(, #"r#+( +"-(, &o$u! ("p"r+* mu+*r $& $*("r+* $"&-& telangiectasia &$ ("&+r! u!)u(. S"r %*(+o!o-*, +umor *&* +"r#"&+u) $r* (")umpu!& ("! #(! &- (!& $r* !p*(& ("! #(! "p*+"!*um $& +"r!*%+ ("p"r+* p-r $* #-*& p*&--*r. P$ +%p p"rmu!&, (&-+ (u!*+ $*+"&+u)& m!% $p+ #"r?r& ("p"r+* )u!*+ &orm! +u m"&"rup* )u+*!.Kumpu!& ("! +*p*) m"ru() p"rmu)& "p*+"!, &")ro(*( $* +"&-%
)r"& !"#*% ")u&- $& +*m#u!
u!)u( #*! (u$% #"r$*m"+"r G 0,8 m &- p$ p*&--*r +umor ?!& 9
PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA RIZKY NIM : 110100006
#"r#"&+u) ppu!r, m"&*&--*, &u!r. B*! +"!% #"r)"m#&- !"#*% !&'u+, $p+ m"!")+ $* $(r&. D"&-& +rum r*&-& +u #*! )ru(+& $*&-)+ mu$% +"r'$* p"r$r%&. #3 Kr(*&om ("! #(! +*p" morp%" m"rup)& '"&*( &- p!*&- ("$*)*+ $*+"mu)&, +"+p* +umor *&* #"r(*+ !"#*% -r"(* )r"& $p+ #"r)"m#&!"#*% "p+ $r*p$ )r(*&om ("! #(! +*p" &o$u!r. L"(* +*p" morp%" #"r(*+ )"r(, !"#*% $+r $"&-& p*&--*r &- ("r )!*&*( (u(% $*+"&+u)&. S"r %*(+o!o-*, !"(* +*$) +"r!*%+ ("p"r+* p-r $* p*&--*r& +"+p* #"r#"&+u) ("p"r+* )?+ +*p*( &- m"&"#r $* $"r% p*&--*r. D* (")*+r (+rom +"r!*%+ pro!*"r(* $r* 'r*&-& p"&m#u&- m"&'$* po! *#ro(*(. Kr(*&om ("! #(! mu!* m"&(+*mu!(* *&!m(* )ro&*( $r* #-*& p*&--*r )"!op) m+ $& ("r*&- $*("r+* $"&-& ro&+o)& #u!u m+ 2m$ro(*(3. I&;(* $r* )r(*&om ("! #(! )" or#*+ #*( +"r'$* )r"& p"&-o#+& &- +*$) $")u+, )!*&*( &- +"r!m#+ $*+"mu)& ("r+ )r(*&om ("! #(! $"&-& +*p" morp%". 3 Kr(*&om ("! #(! +*p" u!("r+*;" $3 Kr(*&om ("! #(! +*p" mu!+*("&+r*) +u (up"r*(*! +"r'$* )*#+ #!"r*+*( )ro&*( $& #*( m"&"#r )" #-*& p*&--*r )"!op) m+ +&p $* ($r*. U)ur&& $p+ #"rup p!)+ $"&-& "r*+"m, ()um(* %!u( $"&-& p*&--*r &- -) )"r( ("p"r+* )?+ $& -) m"&*&--*. r&& $p+ %*+m #"r#*&+*)#*&+*) +u %omo-"&.
10
PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA RIZKY NIM : 110100006
m#r 8. "&*('"&*( )r(*&om ("! #(! 2(um#"r: Am"r*& A$"m o Op%+!mo!o-, 01. Orbital Anatomy, I&: Orbit, Eyelids, and Lacrimal System. C%p+"r 1. S"+*o& =. Am"r*& A$"m o Op%+!mo!o-.3
2.2.1.' Pat"fisi"l"gi
R$*(* +"!% +"r#u)+* m"&"##)& p"m#"&+u)& +umor m"!!u* $u m")&*(m". M")&*(m" p"r+m m"!*pu+* *&*(*(* $& pro!o&- ("!u!"r pro!*"r(*, $"&-& r $"m*)*& +"r'$* p"&*&-)+& )"(!%& +r&()r*p(* &- m"&"##)& +r&(orm(* ("!u!"r. M")&*(m" )"$u *+u ("r !&-(u&- m"ru() r"p!*)(* DNA, m"&"##)& mu+(* $r* ("! &- m"&-)+*)& pro+oo&)o-"& +u $")+*;(* +umor (upr"(or -"&4. Kr(*&om ("! #(! p$ )"!op) m+ $!% +umor "p*+"! &- p!*&umum, +"+p* p+o-"&"(*( $r* mo!")u!r -"&"+*) m(*% #"!um '"!(. Mu+(* $r* p84 2p$ )(u( *&*, o;"r")(pr"(* -"& p843 $p+ m"rup)& #-*& *&+"r-r! $r*
11
PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA RIZKY NIM : 110100006
(")u"&(*! &- p+o-"&*). Z%&- "+ ! m"&u&'u))& #%? ppr& (*&r U (p"(**) $p+ m"&-u#% &u)!"o+*$ $r* +umor (upr"(or -"& *+u p84 $& PTCH, )"$u& m"&-*mp!*)(*)& p"r)"m#&-& o&("+ &- "p+ $r* )r(*&om ("! #(!4. S"r
*mu&o!o-*,
m")&*(m"
ppr&
r$*(*
U
m"&"##)&
p"r)"m#&-& $r* )r(*&om ("! #(! m"!!u* (upr"(* (*(+"m *mu& )u!*+, $& +*$) r"(po&(*& (*(+"m *mu& +"r%$p +umor )u!*+. E") !o)!& #"rup p"&uru&& $r* ("! L&-"r%&, ("! $"&$r*+*) T"p*$"rm!, T%"!p"r, $& !"#*% 'u% !-* pro!*"r(* T (uppr"(or ("! $& m"!"p()& *mu&o(upr"(* )+or 2+umor &"ro(*( +or, *&+"r!"u)*&1, pro(+-!&$*&, *&+"r!"u)*&103, $*)*&* ("#-* -"& p+o-"&*) $!m p"r)"m#&-& )r(*&om ("! #(!4. S*&r U &- ("r )ro&*) m"&-"&* (+"m "!! )u!*+ m"&"##)& p%o+o-*&-,
*mu&o(upr"(*,
$&
o+o)r(*&o-"&.
Fo+o)r(*&o-"&
m"!*#+)&
p"m#"&+u)& o+o pro$u) &- m"ru() DNA. *) DNA r"p*r --!, m) )& +"r'$* mu+(* pro+oo&)o-"& m"&'$* o&)o-"& +u *&)+*;(* +umor (upr"((or -"&". A)umu!(* mu+(* )*#+ o+o)r(*&o-"& +"rm(u) -"&"+* $"!"+*o& m"&"##)& +*$) )+*& +umor (upr"((or -"&" &- m"&&$* p"m#"&+u)& pro+"*& p"&-%m#+ pro!*"r(* ("!. A)umu!(* mu+(* -"& *&*!% &- #"rp"r& $!m m"m*u +"r'$*& KSB.4 2.2.1., Tatalaksana
B*op(* $*p"r!u)& u&+u) m"&-)o&*rm(* )"ur*-& ("r )!*&*( $r* )r(*&om ("! #(!. D*-&o(*( &- (&-+ )ur+ #*( $*'m*& '*) p$ ("+*p #*op(* *&(*(*o&! 'r*&-& &- )& $*p"r*)(: 3 M"?)*!* )"$& !"(* ("r )!*&*( #3 U)ur& &- +"p+ u&+u) p"m"r*)(& ("r %*(+op+o!o-* 3 T*$) m"&m#% +rum +u )"ru()& $3 M"&-*)u+("r+)& 'r*&-& &orm! $* #-*& p*&--*r (")*+r $"r% &$*ur*-*
12
PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA RIZKY NIM : 110100006
B*op(* *&(*(* m"rup)& (!% (+u pro("$ur &- #*( $*-u&)& u&+u) m"&)o&*rm(* )"ur*-& +"r%$p +umor -&(. Ar" $r* #*op(* *&(*(* ("%ru(& $* po+r"+ +u $* -m#r $"&-& p"&-u)ur& ("%*&-- $"r% (! +umor m"&'$* +*$) (u!*+ u&+u) $*+"mu)& p$ (+ pro(" p"&-&-)+& +umor #"r*)u+&.8 B*op(* ")(*(* #*( m"&'$* p"r+*m#&-& )"+*) !"(* $* )"!op) m+ )"*! $& +*$) +"r!*#+& $"r% $* p*&--*r )"!op) m+ +u (+ !"(* $* p*&--*r )"!op) m+ &- #"r!o)(* $* ("&+r! 'u% $r* )&+u( !+"r! +u pu&-+um !)r*m!. B*op(* ")(*(* %ru( $*r%)& ("r ;"r+*)! ("%*&-- +*$) +"r'$* +r)(* p$ )"!op) m+. *) p*&--*r $r* $"r% )"!op) m+ &- $* ")(*(* po(*+* +"r$p+ ("! +umor, m) r" &- +"r!*#+ %ru( $* r"")(*(* ("r p"m#"$%& $"&-& +")&*) o!s micrograp!ic u&+u) m"&-"+%u* #+( #?% +u +")&*) "ro#en$section u&+u) m"&-"+%u* #+( (mp*&-.8 U&+u) m"&+!)(& )r(*&om ("! #(! $p+ $ #"#"rp p*!*%& +"rp*, $*&+r& : 3 B"$% $*!)u)& $"&-& m"&-")(*(* +umor (mp* $"&-& #"&r#"&r m"&*&--!)& (*(. P*!*%& +"rp* #"$% : •
E)(*(* $"&-& po+o&- #")u 2roJ"& ("+*o&3
•
B"$% m*)ro-r* Mo%(
•
B"$% $"&-& !("r CO
•
E)(*(* +&p po+o&- #")u
B"$% m"rup)& p*!*%& +"rp* $r* )r(*&om ("! #(! $* )"!op) m+. B"$% ")(*(* m"m#"r*)& )"u&+u&-& $r* $*&-)+& +umor ("r )"("!uru%& $"&-& #+( r"& $*)o&+ro! ("r %*(+o!o-*. T*&-)+ )")m#u%& +umor p$ +"rp* #"$% !"#*% ("$*)*+ $& !"#*% 'r&- '*) $*#&$*&-)& '*) $*+"rp* $"&-& mo$!*+( +"rp* !*&.8 K"+*) )r(*&om ("! #(! #"r+"mp+ $* $"r% )&+u( m"$*!, (*(+"m !*r& *r m+ 'u- #*( +"r&-)+ '*) $*!)u)& "r$*)(* +umor ("r )omp!"+. *) (*(+"m $r*&(" *r m+ +"!% +"r&-)+ ("+"!% pro("( "r$*)(* +umor, r")o&(+ru)(*
13
PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA RIZKY NIM : 110100006
(*(+"m !*r& )"!ur *r m+ +*$) #*( $*!)u)& (mp* p(*"& #"&r#"&r #"#( $r* +umor. B"#"rp +umor #*( m"&"#r )" $"r% (u#)u+& $& +*$) $p+ $*)"+%u* ("#"!um op"r(*.8 Km#u%& +umor &- (u$% $*&-)+ ("r +o+!, *&*!+r(* &- !"#*% $!m, +u +umor +*p" morp%" $& +umor &- #"r$ $* )&+u( m"$*! $*)"!o! $"&-& r #"$% m*)ro-r* Mo%(. r*&-& $*&-)+ ("r !p*( $"m* !p*( $& $*#u+ +*p*( &- $*!"&-)p* $"&-& -m#r 4 $*m"&(* u&+u) m"&-&-)+ +umor. R"(")(* +umor ("r m*)ro-r*) Mo%( p!*&- ("r*&- $*-u&)& u&+u) m"&-")(*(* )r(*&om ("! #(! $& )r(*&om ("! ()umo(.8 M*)ro-r* ")(*(* #*( m"&'m*& ("r m)(*m! 'um!% 'r*&-& &- ("%+ u&+u) +*$) +"r!*#+ ("%*&-- %& r" +umor &- +"r&-)+ ("r )omp!"+. K")ur&-& $r* #"$% m*)ro-r* Mo%( *&* $!% $!m m"&-*$"&+**)(* #+( +umor )"+*) +umor (u$% m"&-*&;(* $"r% or#*+.8 S"+"!% $*!)u)& r"(")(* +umor, )"!op) m+ ("%ru(& $*r")o&(+ru)(* $"&-& pro("$ur o)u!op!(+*) &- +"r(+&$r. R")o&(+ru)(* *&* p"&+*&- ?!upu& #u)& m"rup)& %! &- m"&$"(), p"m#"$%& ?! #"r+u'u& u&+u) m"!*&$u&-* ("r m)(*m! #o! m+ !!u $**)u+* $"&-& m"mp"r#*)* (*( )"!op) m+ &m(*% #*). *) r")o&(+ru)(* +*$) #*( $*!)u)& ("-"r, )or&" %ru( $*!*&$u&-* $"&-& r m"&"mp"!)& +u ("m"&+r $"&-& r m"&u+up )"!op) m+. *) $"")& )"*!, m) -r&u!(* 'r*&-& ("r (po&+& #*( m"&'$* !+"r&+* +"rp*.8 U&+u) !"(* &- &o$u!r, &-) )")m#u%& '*) $*+"rp* $"&-& cryot!erapy !"#*% #"(r $r*p$ ("+"!% $*+"rp* ("r p"m#"$%&. S+ ryot!erapy $*-u&)& u&+u) m"&&-&* di""use sclerosing lesion, &-) )")m#u%& +*&--*. S"!*& *+u, ("r %*(+o!o-* p*&--*r r" +*$) #*( $*";!u(* $"&-& cryot!erapy. A)*#+&, mo$!*+( +"rp* *&* $*%*&$r* u&+u) !"(* &- )m#u%, !"(* $"&-& $*m"+"r !"#*% $r* 1 m, $& !"(* +*p" morp%". L-*pu!, cryot!erapy m"&*m#u!)& $"p*-m"&+(* $& +rop* p$ 'r*&-&. M) $r* *+u, cryot!erapy u&+u) )r(*&om ("! #(! p$ )"!op) m+ $*'$*)& $&-& +"rp* u&+u) p(*"& &- *&+o!"r& +"r%$p
14
PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA RIZKY NIM : 110100006
p"m#"$%& ("p"r+* p(*"& &- (&-+ +u &- )+**+(& +"r#+( $* +"mp+ +*$ur, +u p(*"& $"&-& )o&$*(* m"$*( &- ("r*u( &- )o&+r*&$*)(* u&+u) $*!)u)& *&+"r;"&(* #"$%.8 *) +umor +"r#+( p$ $&")( $*!)u)& ")(*(* 48 mm $r* #+( m)ro()op*(. S"$&-)& '*) +umor (u$% m"&-*&;(* or#*+, m) $ $u p*!*%& +"rp* ("r ")("&+r(* *+u $"&-& m"&-&-)+ ("!uru% #o! m+ $*("r+* $"&-& $&")( m+ $"&-& m"&*&--!)& #-*& +u!&- (', ("!*& *+u 'u- #*( $*!)u)& r$*o+"rp*. *) (u$% m"&-*&;(* *&+r)r&*! %ru( $*)o&(u!+(*)& )" #-*& #"$% (r.8
m#r 6. T")&*)+")&*) #*op(* 2(um#"r: Am"r*& A$"m o Op%+!mo!o-, 01. Orbital Anatomy, I&: Orbit, Eyelids, and Lacrimal System. C%p+"r 1. S"+*o& =. Am"r*& A$"m o Op%+!mo!o-.3
15
PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA RIZKY NIM : 110100006
#3 No& #"$% $*!)u)& '*) !o)(* u)up (u!*+ u&+u) $*!)u)& p"m#"$%&, r"(po& $r* +"rp* &o& #"$% u)up #-u( +"+p* m"m*!*)* "") (mp*&- &- u)up #&). P*!*%& +"rp* &o& #"$% *+u : •
R$*o+"rp*
•
K"mo+"rp*
•
I&+"r"ro&
T"rp* r$*(* 'u- #*( $*p"r+*m#&-)& ("#-* +"rp* p!*+* +"+p* u&+u) !"(* p"r*or#*+ ("#*)& $*%*&$r*. S"p"r+* cryot!erapy, +"rp* r$*(* 'u- +*$) #*( $*-u&)& u&+u) m"m&+u r" p*&--*r +umor ("r %*(+o!o-*. A&-) )")m#u%& '*) $*+"rp* $"&-& r$*(* 'u- !"#*% +*&--* '*) $*#&$*&-)& $"&-& +"rp* p"m#"$%&. D*+m#% !-*, )")m#u%& ("+"!% r$*(* (u!*+ u&+u) $*$"+")(*. K")m#u%& *&* +*m#u!& !"#*% !m ("+"!% +"rp* ?! $& !"#*% (u!*+ u&+u) m"&&-&* ("r p"m#"$%& )r"& +"!% +"r'$* p"ru#%& $r* (+ru)+ur 'r*&-& &- +"!% $*r$*(* ("#"!um&.8 Komp!*)(* &- +"r'$* )*#+ +"rp* r$*(* $*&+& $!% +*m#u!& (*)+r*) p$ )"!op) m+, p"m#"&+u)& scar p$ $r*&(" *r m+ $*("r+* $"&-& o#(+ru)(*, %eratitis sica. R$*(* 'u- m"r&-(&- +*m#u!& )"-&(& #ru +u "$"r p$ #o! m+ &- +*m#u! '*) #o! m+ +*$) $*!*&$u&-* ("!m +"rp*.8 2.2.2. !arsin"#a el kua#"sa M"rup)& +umor -&( )"!op) m+ +"r("r*&- )"$u. I&(*$"&(*& %&
89 'u% !"#*% )"*! $r* *&(*$"&(* )r(*&om ("! #(!. Umum& ("r*&- mu&u! $r* #+( )"!op) m+ 2-#u&-& )u!*+ $"&-& mu)o(3 p$ p(*"& &- +u. Dp+ m"&-"&* )"!op) m+ +( $& #?%. "'! )!*&*( $p+ mu&u! $!m #"&+u) *+u ("#u% !u) $"&-& #+( +*&--* $& )"r( &- p!*&- ("r*&-. K"$u $!% #"&+u) ("p"r+* 'mur +u po!*p ;"ru)o( +&p $ !u), +"+p* 'r&- mu&u!. Kr(*&om ("! ()umo( $p+ #"rm"+(++*( )"
)"!"&'r -"+% #"&*&-
pr"ur*)u!r $& (u#m&$*#u!r. P"&"mu& %*(+o!o-*& $*+&$* $"&-& pro!*"r(* +*$) +"r+ur $r* ("! "p*$"rm*( +uru& )" ("! $"rm*(. D!m #"&+u) ("mpur&&, ("!
16
PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA RIZKY NIM : 110100006
-&( *&* #"r#"&+u) !*&-)r& ("p"r+* mu+*r &- +"&-%& +"r$*r* $r* !p*(& )"r+*& &- +*p*(. U&+u) p"&-o#+& )r(*&om ("! ()umo( (m $"&-& p"&-o#+& )r(*&om ("! #(!.
m#r =. Kr(*&om ("! ()umo( 2(um#"r: Am"r*& A$"m o Op%+!mo!o-, 01. Orbital Anatomy, I&: Orbit, Eyelids, and Lacrimal System. C%p+"r 1. S"+*o& =. Am"r*& A$"m o Op%+!mo!o-.3
2.2.3. !arsin"#a kelenjar se%asea 2.2.3.1 E$i)e#i"l"gi )an Eti"l"gi
E+*o!o-* $r* )r(*&om )"!"&'r ("#(" $!% *$*op+*). r&- mu&u! p$ &)&), $"&-& r")u"&(* +"r+*&--* mu&u! p$ or&- $"&-& umur 60=7 +%u&. Kr(*&om )"!"&'r ("#(" m"rup)& )"-&(& )""mp+ p$ $"r% )"!op)
17
PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA RIZKY NIM : 110100006
m+ $* Am"r*) S"r*)+ 2Kr(*&om ("! #(!, Kr(*&om ("! ()umo(, $& m"!&om m"rup)& 4 )(u( +"r+*&--*3 $& m"rup)& )"-&(& +"r+*&--* )"$u $* C*& 2Kr(*&om ("! #(! )(u( +"r+*&--*3.1< I&(*$"& )r(*&om ("! ("#(" $!% 4,9 $*&+r +umor -&( $& 0,>9 $r* ("!uru% +umor p!p"#r. A&-) )"m+*&& #"r)*(r (")*+r 9. Kr(*&om ("! ("#(" p!*&- ("r*&- +"r'$* p$ p"r"mpu& $*#&$*&-)& !"!)*, +"ru+m p$ u(* =0 +%u& )"+(.6
2.2.3.2 (ejala )an Tan)a
Kr(*&om )"!"&'r ("#(" #*( m"&u&'u))& -m#r& )!*&*( #"r(p")+rum !u(. B*(&, #"r#"&+u) &o$u! &- )"*!, )"r( ("p"r+* )%!J*o&. S"r*&- +"r!*%+ ("p"r+* )%!J*o& &- +*$) )%( +u #"ru!&-, m"&u&'u))& )o&(*(+"&(* &)"&!. B"#"rp p(*"& $"&-& )r(*&om )"!"&'r M"*#om m"mpu&* p"&"#!& #"r#"&+u) p!) &- $*u( $r* +r(u( +u ("#u% p"r+um#u%& #"r#"&+u) 'mur +u pp*!!om m"&"rup* pp*!!om ("! ()umo( +u )r(*&om ("! ()umo( pp*!!.= T"mp+ pr"$*!")(*& +"r$p+ p$ p!p"#r (up"r*or $& +"r!*%+ m(( #"?r& )u&*&- &- #"r*(* !"m), m(( *&* 'u- $p+ #"rup pp*!pp*!.
4,<
Tumor p$ p*&--*r p!p"#r #*(& m"&"##)& %*!&-& #u!u m+. B*(&, !"(* +*$) &"r*, #"r*&$ur(* +u #"ru!)u( $**)u+* $"&-& %*!&-& (*!* p$ $"r% )%!J*o& #"ru!&-.= P$
)o&$*(*
*&!m(*
("p"r+*
#!"p%roo&'u&-+*;*+*(
+u
)"r+o)o&'u&-+*;*+*( 'u- $p+ m"&"r+* )r(*&om ("! ("#(".=
18
PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA RIZKY NIM : 110100006
m#r >. Kr(*&om )"!"&'r ("#(" 2(um#"r: Am"r*& A$"m o Op%+!mo!o-, 01. Orbital Anatomy, I&: Orbit, Eyelids, and Lacrimal System. C%p+"r 1. S"+*o& =. Am"r*& A$"m o Op%+!mo!o-.3
2.2.3.3 Diagn"sis
U&+u) m"&"-))& $*-&o( p(+* $r* )r(*&om ("! ("#(" *&* $*!)u)& #*op(*.6
2.2.3.& Diagn"sis %an)ing
D*-&o(*( #&$*&- )r(*&om ("! ("#(" $p+ $*#-* m"&'$* $u. Y*+u, m"&uru+
-"'!
)!*&*(
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+u
$*
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$p+
$*$*-&o( #&$*&- $"&-& )r(*&om ("! #(!, )r(*&om mu)o"p*$"rmo*$ $& %"m&-*om.6
19
PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA RIZKY NIM : 110100006
2.2.3.' Tatalaksana
P$ p"&+!)(&& )r(*&om ("! ("#(" $*!)u)& +"rp* #"$%. P"&-o#+& #"r+u'u& u&+u) m"&-&-)+ !"(* &- -&( u&+u) m"&"-% p"&"#r& !o! +upu& (*(+"m*). P"&-o#+& $r* )r(*&om )"!"&'r ("#(" $!% op"r(* ")(*(* &- $")u+, $"&-& #+(& op"r(* &- !u( $"&-& o&+ro! po+o&-& #")u ("-r u&+u) m"&--m#r)& p*&--*r& +umor. E;!u(* &o$u! !*m+*) $*p"r!u)& u&+u) m"&*!* m"+(+(".6,18 *) +"r$p+ )"+"r!*#+& $*u( $r* )"$u #o! m+ +( $& #?%, $*p"r!u)& +*&$)& ")("&+r(*. Bu+)& #*op( p$ r" )o&'u&-+*; &%p"r"m* &- $*ur*-* )r(*&om )"!"&'r ("#(" p$ ?)+u op"r(*.6
2.2.3., Pr"gn"sis
Kr(*&om )"!"&'r ("#(" $r* )"!op) m+ $p+ #"r%u#u&-& $"&-& #-*& &- -r"(* $& pro-&o( &- #uru). I$"&+**)(* )+or)+or r*(*)o $"&-& p(+* m"m#&+u m"&"mu)& p(*"&p(*"& &- mu&-)*& m"mp"ro!"% )"u&+u&-& $r* +"rp* &- !"#*% -r"(*.6,= I&$*)+or*&$*)+or pro-&o( #uru), )"+"r!*#+& )"!op) m+ +(, $ur(* -"'! !"#*% $r* 6 #u!&, #"&+u) p"r+um#u%& &- *&*!+r+*;", $*"r"&(*(* ("#(" ("$&- (mp* #uru), (! mu!+*("&+r*), )r(*&om *&+r"p*+"! 2p"&"#r& p-"+o*$3, *&;(* ;(u!r $& (!ur& !*m+*), *&;(* )" or#*+, u)ur& !"#*% $r* 10 mm.6 D"&-& ")(*(* !u( $& +&p #u)+* m"+(+(", %(*! op"r(* $p+ m"&"-% )"-&(&. M"()*pu& $"m*)*&, !"(*!"(* ("#(" m"mpu&* *&(*$"& )")m#u%& $& m"+(+(".6
2.2.& Melan"#a Maligna Pal$e%ra 2.2.&.1 E$i)e#i"l"gi
M"!&om $!% +umor p!p"#r #"rp*-m"& &- 'r&- &- %ru( $*#"$)& $r* N";* $& )r(*&om ("! #(!. T"r$p+ p"&*&-)+& <9 )"'$*&
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PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA RIZKY NIM : 110100006
m"!&om m!*-& &- $*$*-&o( ("+*p +%u&. A$ 81.<00 )(u( #ru m"!&om $*$*-&o( p$ +%u& 00 $"&-& =.>00 )"m+*&. 89 p(*"& m"!&om m!*-& $*'ump* p$ umur $* #?% <0 +%u&.10 M"!om %& $*+"mu)& 19 $r* )"("!uru%& !"(* p!p"#r. K"&+&&, ?!upu& %& 49 $r* ("mu )&)"r )u!*+ m"!&om, *&* (&-+ p"&+*&- )r"& !"#*% $r* $u p"r+*- $r* ("mu )"m+*& )*#+ )&)"r )u!*+ &- $*("##)& m"!&om m!*-&. O!"% )r"& *+u, p"&+*&- u&+u) m"&-"&!* !"(* '*&) $& -&( )"!op) m+, +"ru+m )"+*) #"rp*-m"&.11
2.2.&.2 *akt"r +isik"
M"r") &- p!*&- #"r*(*)o u&+u) #"r)"m#&-& m"!&om $!% )"!ompo) &- m"mpu&* r*?+ m"!&om $!m )"!ur- $& p(*"& $"&-& &";u( $*(p!(+*). K"!ompo) #"r*(*)o +*&--* $!% p(*"& $"&-& "ro$"rm p*-m"&+o(, p(*"& $"&-& !*mom &o& Ho$-)*&, $& p(*"& $"&-& +r&(p!&+(* or-& +u AIDS. P(*"& m"!&om m"m*!*)* r*(*)o +*&--* !*m )!* !*p+ u&+u) m"&-*$p m"!&om )"$u.10
m#r 7. M"!&om
21
PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA RIZKY NIM : 110100006
2(um#"r: Am"r*& A$"m o Op%+!mo!o-, 01. Orbital Anatomy, I&: Orbit, Eyelids, and Lacrimal System. C%p+"r 1. S"+*o& =. Am"r*& A$"m o Op%+!mo!o-.3
2.2.&.3 Diagn"sis
C*r* )%( $r* m"!&om m!*-& $!% p*-m"&+(* ;r*#"! 2*+u ("#u% !"(* $"&-& +*&-)+ ?r& o)!+, m"r%, pu+*%, #*ru +u %*+m -"!p3 #+( +*$) +"-(, u!("r(* $& p"r$r%&. M"!&om p!p"#r &- m"!*#+)& )o&'u&-+*; #*(& !"#*% -r"(* $r*p$ &- +"r#+( $* )u!*+ p!p"#r.11 P"ru#%& +mp*!& p$ !"(* #"rp*-m"& m"m"r!u)& #*op(* ")(*(* p$ !"(*. E;!u(* (*(+"m*) u&+u) m"+(+(*( r"-*o&! +u 'u% $*p"r!u)& #*! $*$*-&o(*( m"!&om.11 C!r) $& Br"(!o? m"m#-* )"$!m& *&;(* )" $!m !*m +*&-)+ &+om*(:11 • • • • •
T*&-)+ 1 %& +"r#+( p$ "p*$"rm*( 2*& (*+u3. T*&-)+ m"&"m#u( pp*!"r $"rm*(. T*&-)+ 4 m"&-*(* pp*! $"rm*(. T*&-)+ < m"!u( )" r"+*u!r $"rm*(. T*&-)+ 8 +umor m"!u( )" $!m 'r*&-& (u#)u+&.
2.2.&.& Penatalaksanaan
T"rp* #"$% $p+ $*!)u)& u&+u) !(& )o(m"+*) +u )"ur*-& )"-&(& p$ !"(* '*&) #"rp*-m"&. Pro("$ur p*!*%& u&+u) p"&-o#+& m"!&om m!*-& )u!*+ )"!op) m+ $!% ")(*(* #"$% !"#r $"&-& 1 m mr-*& )u!*+ $*)o&*rm(* o!"% %*(+o!o-*. P"mo+o&-& )"!"&'r -"+% #"&*&- r"-*o&! %ru( $*!)u)& u&+u) +umor &- !"#*% #"(r $r* 1,8 mm ("r m"&$!m $& / +u u&+u) +umor &- m"&u&'u))& #u)+* p"&"#r& ;()u!r +u !*m+*).11 L("r $p+ $*-u&)& u&+u) !"(* #"rp*-m"& )"!op) m+ +"r+"&+u, ("#u% p"&"!*+*& +"r#ru +"!% m"&u&'u))& )(u( u;"*+*( #*!+"r! ("+"!% +"rp* !("r p$ !"(* )"!op) m+ #"rp*-m"&.11
22
PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA RIZKY NIM : 110100006
2.2.&.' Pr"gn"sis
T*&-)+ < +u T*&-)+ 8 m"!&om -&( )u!*+ p!p"#r #*(& m"mpu&* pro-&o(*( #uru). Br"(!o? m"&-"m#&-)& m"+o$" )u&+*++* $"&-& m"&-u)ur )"$!m& *&;(* $"&-& m*!*m"+"r. P(*"& $"&-& +"#! +umor )ur&- $r* 0,=8 mm m"m*!*)* pro-&o(*( (&-+ #*) $"&-& $p+ #"r+%& %*$up 8 +%u& ("#"(r 1009. P(*"& $"&-& !"(* 0,=8 mm (mp* 1,8 mm m"m*!*)* pro-&o(*( &- u)up #*), $& p(*"& $"&-& +umor !"#*% $r* 1,8 mm m"m*!*)* pro-&o(*( &- #uru) $"&-& )"+%&& %*$up 8 +%u& ("#"(r 809 (mp* 609.11
2.2.'
ark"#a Pal$e%ra
2.2.'.1 E$i)e#i"l"gi
Sr)om Kpo(* m"rup)& (!% (+u m&*"(+(* &- ("r*&- $*'ump* p$ p"&$"r*+ AIDS 2<93 $& 09 $r* (r)om $p+ m"&-"&* m+, *+u p!p"#r +(/#?% m"&"rup* %or$"o!um +u %"m&-*om $& p$ )o&'u&+*; or&*)(, $& #u!#* #-*& *&"r*or 2m"&"rup* p"r$r%& (u#)o&'u&+*; -r&u!om +u %"m&-*om3. Tumor *&* #"r(*+ -r"(*, mu!+*o)! $& ("r*&- ) m#u%.1 P$ +%u& 1>=, Kpo(* m"!por)& (r)om multiple$pigmented $r* )u!*+ &- *$*op+*). Sr)om Kpo(* "&$"m*) !J*m $* Ar*) T"&-%, +"ru+m m"mp"&-ru%* !)*!)* mu$ $"&-& !"(* )u!*+ &- -r"(* $& ;*("r!.1
2.2.'.2 Eti"l"gi
P"&"##& #"!um $*)"+%u* p(+*, +"+p* #"#"rp )+or +"r!*#+ &$*+"mu* p$ p(*"& (r)om Kpo(*:1 •
Hum& %"rp"(;*ru(> 2HH>3 DNA +u (r)om Kpo(* +"r)*+ ;*ru( %"rp"( 2KSH3 +"!% $*+"mu* p$ p(*"& &- HI&"-+* $& HI po(*+*;".
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PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA RIZKY NIM : 110100006
•
L)*!)* %omo(")(u! $"&-& HI m"mpu&* r*(*)o &- +*&--*. R*(*)o
•
*&* m"&*&-)+ +'m $"&-& 'um!% p(&-& &- #&). P(*"& &- (u$% p"r&% +r&(p!&+(* or-&, $& m"&--u&)& -"& *mu&o(upr"(* $& (+"ro*$ #"r*(*)o +*&--*.
2.2.'.3 Pat"fisi"l"gi
Sr)om Kpo(* )"mu&-)*&& #"(r $*("##)& o!"% #"#"rp )+or, +"rm(u) ")(pr"(* $"r"-u!(* $r* o&)o-"&
$&
-"&
o&o(uppr"((or o!"%
KSH/HH> $*)om#*&(*)& $"&-& p"&uru&& )")"#!& +u#u% $& p"!"p(& (*+o)*& 2*&+"r!"u)*& IL 63 $& )+or p"r+um#u%& $r* HI #"r+*&$) )" +( +"r'$*& *&")(* ("!. IL6 m"&-*&$u)(* signal transducers andactivators o" transcription & (S'A'&), ("%*&-- m"&"##)& ")(pr"(* o&)o-"&. M"()*pu& m")&*(m" &-
+"p+ +"&+&-
KSH/HH>
#"r+*&$) ("#-*
p"r&+r
o&o-"&"(*( #"!um ("p"&u%& $*)"+%u*, #&) KSH/HH> o&)o-"& ;*ru( &+"!% $*)+)& $p+ m"&"##)& &"op!(*.1
2.2.'.& Diagn"sis
Sr)om Kpo(* p$ m+ #*(& (*mp+om+*), )$&-)$&- $*("r+* *r*+(* r*&-&. Tumor (r)om Kpo(* #"r?r& )"m"r%m"r%&, p$+, $"&-& -m#r& pro!*"r(* ;()u!"r, ("!("! spindle $& ("r+("r+ r"+*)u!*&, $*$u- #"r(! $r* "&$o+"!.1 U&+u) m"&-*$"&+**)(* )+or r*(*)o p$ (r)om Kpo(*, $o)+"r %ru( &m&"( +"&+&- %!%! #"r*)u+:1 • • • • • •
D"mo-r* S++u( )")"#!& L"(* )u!*+ S"#"!um& P"&-o#+& ("#"!um& u&+u) (r)om Kpo(* R*?+ *&")(* opor+u&*(+*) P"&--u&& o#+ (+ *&*.
"'! (r)om Kpo(* $!% ("#-* #"r*)u+:1
24
PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
• • • • • • • • • •
NAMA : FEBRYNA RIZKY NIM : 110100006
S)*+ Fo+oo#* M+ m"r% +u p"r$r%& #"ru!&Ir*+(* $& ("&((* #"&$ (*&Ep*p%or K"r*&- m+ K"!ur& mu)opuru!"& K"!op) m+ )"r( +u #"&-)) K"+*$)mmpu& u&+u) m"&u+up m+ P"&-!*%+& )#ur
P"m"r*)(& F*(*) 1 •
P"m"r*)(& m+ p"&u% %ru( m"&)up ("#-* #"r*)u+: I&(p")(* $& ";"r(* )"!op) m+ $& #u!u m+. L)u)& (!*+ !mp #*om*ro(op. P"r*)( p!p"#r! $& )o&'u&-+*; #u!#* $& or&*)( $"&-&
•
+"rp"r*&*. P!p(* )"!"&'r !)r*m!, $& p"m"r*)(& p$ m((. L"(* &- m"r% )"u&-u& %*&-- m"r% +"r&- $"&-& p"m#u!u%
•
+"!&-*")(++*) (")*+r&, mu&-)*& m)u!, ("p"r+* p!), +u &o$u !r. Du-"! $)) m"&-ur*)& 4 +%p& )!*&*( &- $p+ m"m#&+u +"rp* !&-(u&-: T%p I $& II, +umor m"r+ $& $+r. L"(* *&* m"m*!*)* +*&--* )"+"#!& )ur&- $r* 4 mm ;"r+*)! $& +*m#u! )ur&- $r* <
#u!&. T%p III, +umor &o$u!r $& )"&*)& +*&--* ;"r+*)! &- !"#*%
•
#"(r $r* 4 mm, "&$"ru&- +*m#u! !"#*% $r* < #u!&. L"(* (r)om Kpo(* o+!m*) $*+"mu)& $* )"!op) m+, )o&'u&-+*;,
•
$& 'r&- $*+"mu)& $* $!m or#*+!. K"+"r!*#+& )o&'u&-+*; $p+ $*("r+* p"&$r%& (u#)o&'u&+*;, *&'")(*, $& )"mo(*(.
P"m"r*)(& L# 1 P$ p(*"& $"&-& (r)om Kpo(* $**&$*)(*)&: •
HI "&Jm"!*&)"$ *mmu&o(or#"&+ ((
25
PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
•
NAMA : FEBRYNA RIZKY NIM : 110100006
HI "(+"r& #!o+
B"r%u#u&- $"&-& )u!*+ +u )o&'u&-+*;, #*op(* $r* !"(* mu&-)*& $*p"r!u)& u&+u) $*-&o(*( p(+*.
m#r 10. Sr)om )po(* 2(um#"r: Am"r*& A$"m o Op%+!mo!o-, 01. Orbital Anatomy, I&: Orbit, Eyelids, and Lacrimal System. C%p+"r 1. S"+*o& =. Am"r*& A$"m o Op%+!mo!o-.3
2.2.'.' Penatalaksanaan
T*$) $ p"&-o#+& (p"(**) u&+u) ()om Kpo(*, %& #"r(*+ p!*+*. R$*o+"rp* m"m#"r*)& r"(po& &- #*) p$ 741009 p"&$"r*+ $"&-& (r)om Kpo(*.1 Tu'u& +"rp* p$ p(*"& $"&-& (r)om Kpo(* $!% u&+u) m"r*&-&)& *r*+(* m+, "") m((, $& )"ru()&&. Sr)om Kpo(* "&$"ru&- u&+u) m"mpu&* r"(po& +"r%$p)"mo+"rp*. *) p(*"& m"m*!*)* )"+"r!*#+& (*(+"m*) &- m"m#u+u%)& )"mo+"rp*, !"(* m+ ("r*&-)!* +"r+(* +u #"r)ur&- $r(+*( ("+"!% m"mu!* +"rp* *&*. Nmu&, #*(& +"r'$* )")m#u%& #"r*)u+ ("+"!% p"&-%"&+*& )"mo+"rp*.1 P"&-o#+& $"&-& I&+"r"ro& %& 109 m"m#"r*)& r"(po& #*), 09 m"m#"r*)& r"(po&( pr+*! ("$&-)& ("#-*& #"(r p"&$"r*+ +*$) m"m#"r*)&
26
PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA RIZKY NIM : 110100006
%(*! &- #*).7 I&$*)(* u&+u) ")(*(* !o)! m"&)up !"(* m"&--&--u ("r )o(m"+*), )"+*$)&m&&, $& o#(+ru)(* p"&-!*%+& $r* #-*& +"r#"(r +umor. P"r+*m#&-& $!m m"&-o#+* !"(* u&+u) m"&"-% p"m#"&+u)& "&+rop*o& $"&-& +r*)*(*( $& )"r+op+* ")(po(ur $& u!)u( )or&".1
2.2.'., !"#$likasi
K"+"r!*#+& p$ )"!op) m+ $p+ m"&"##)& )"ru()& $& $*(u&-(* )"!op). L-o+%!mo( $& +r*)*(*( $p+ m"&"##)& *r*+(* m"&$!m $& )")"r*&-&, *&")(*, $& 'r*&-& pru+ p$ )or&". K"+"r!*#+& )o&'u&-+*; $p+ m"&-)*#+)& p"&$r%& (u#)o&'u&+*; #"ru!&-. P$ )%*r&, p"&-!*%+& #*( %*!&- $r* $*(u&-(* )"!op), p"ru#%& p"rmu)& )or&", +u o#(+ru)(* p"&-!*%+&.1
BAB 3 !EIMPULAN
Tumor p!p"#r $!% #"&'o!& m(( #&orm! p$ $"r% (")*+r m+ $& )"!op) m+. Tumor p!p"#r #*( #"r(! $r* )u!*+, 'r*&-& *)+, 'r*&-& )"!"&'r, p"m#u!u% $r%, (r, mupu& $r* o+o+ (")*+r p!p"#r.1, Tumor -&( &- p!*&- ("r*&- m"&-"&* p!p"#r $!% )r(*&om ("! #(!, )r(*&om ("! (5umou(, )r(*&om ("! ("#(", m"!&om, $& (r)om )po(*. S"$&-)& +umor '*&) p!p"#r ("p"r+* %"m&-*om $& &+%!"(m.4 Kr(*&om ("! #(! #"r(! $r* !p*(& #(! "p*+"! )u!*+ +u $r* !p*( !ur ("! o!*)"! rm#u+. B"rup #"&'o!& &- +r&(pr&, )$&- $"&-& p*&--*r &("p"r+* mu+*r. Tumor *&* umum& $*+"mu)& $* $"r% #"rm#u+, #"r(*+ *&;(*, 'r&- m"mpu&* &) ("#r +u #"rm"+(+(*(. Dp+ m"ru() 'r*&-& $* (")*+r& +"ru+m #-*& p"rmu)& #%)& $p+ (mp* )" +u!&- 2#"r(*+ !o)! $"(+ru)+*3, ("r+ "&$"ru&- u&+u) r"(*$* !"#*% #*! p"&-o#+&& +*$) $")u+. U&+u) m"&+!)(& )r(*&om ("! #(! $p+ $ #"#"rp p*!*%& +"rp*, $*&+r& $!% #"$% ")(*(* $"&-& po+o&- #")u 2roJ"& ("+*o&3, #"$%
27
PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA RIZKY NIM : 110100006
m*)ro-r* Mo%(, #"$% $"&-& !("r CO, $& ")(*(* +&p po+o&- #")u. P*!*%& +"rp* &o& #"$% *+u : R$*o+"rp*, K"mo+"rp*, $& I&+"r"ro&. Kr(*&om ("! ()umo( m"rup)& +umor -&( )"!op) m+ +"r("r*&)"$u. I&(*$"&(*& %& 89 'u% !"#*% )"*! $r* *&(*$"&(* )r(*&om ("! #(!. Umum& ("r*&- mu&u! $r* #+( )"!op) m+ 2-#u&-& )u!*+ $"&-& mu)o(3 p$ p(*"& &- +u. Dp+ m"&-"&* )"!op) m+ +( $& #?%. "'! )!*&*( $p+ mu&u! $!m #"&+u) *+u ("#u% !u) $"&-& #+( +*&--* $& )"r( & p!*&- ("r*&-. K"$u $!% #"&+u) ("p"r+* 'mur +u po!*p ;"ru)o( +&p $ !u), +"+p* 'r&- mu&u!. Kr(*&om )"!"&'r ("#(" $!% )r(*&om &- +um#u% $r* )"!"&'r m"*#om p$ )"!op) m+. E+*o!o-*& $!% *$*op+*). r&- mu&u! p$ &) &), $"&-& r")u"&(* +"r+*&--* mu&u! p$ or&- $"&-& umur 60=7 +%u&. Kr(*&om )"!"&'r ("#(" #*( m"&u&'u))& -m#r& )!*&*( #"r(p")+rum !u(. B*(&, #"r#"&+u) &o$u! &- )"*!, )"r( ("p"r+* )%!J*o&. S"r*&- +"r!*%+ ("p"r+* )%!J*o& &- +*$) )%( +u #"ru!&-, m"&u&'u))& )o&(*(+"&(* &- )"&!. P$ p"&+!)(&& )r(*&om ("! ("#(" $*!)u)& +"rp* #"$%. P"&-o#+& #"r+u'u& u&+u) m"&-&-)+ !"(* &- -&( u&+u) m"&"-% p"&"#r& !o! +upu& (*(+"m*). P"&-o#+& $r* )r(*&om )"!"&'r ("#(" $!% op"r(* ")(*(* &$")u+, $"&-& #+(& op"r(* &- !u( $"&-& o&+ro! po+o&-& #")u ("-r u&+u) m"&--m#r)& p*&--*r& +umor. E;!u(* &o$u! !*m+*) $*p"r!u)& u&+u) m"&*!* m"+(+(".6,18 M"!&om $!% +umor p!p"#r #"rp*-m"& &- 'r&- &- %ru( $*#"$)& $r* N";* $& )r(*&om ("! #(!. C*r* )%( $r* m"!&om m!*-& $!% p*-m"&+(* ;r*#"! 2*+u ("#u% !"(* $"&-& +*&-)+ ?r& o)!+, m"r%, pu+*%, #*ru +u %*+m -"!p3 #+( +*$) +"-(, u!("r(* $& p"r$r%&. P"&+!)(&& p$ m"!&om $!% +"rp* #"$% u&+u) !(& )o(m"+*) +u )"ur*-& )"-&(& p$ !"(* '*&) #"rp*-m"&. S"$&-)& +"rp* !("r $p+ $*-u&)& u&+u) !"(* #"rp*-m"& )"!op) m+ +"r+"&+u. Sr)om Kpo(* m"rup)& (!% (+u m&*"(+(* &- ("r*&- $*'ump* p$ p"&$"r*+ AIDS 2<93 $& 09 $r* (r)om $p+ m"&-"&* m+, *+u p!p"#r
28
PAPER DEPARTEMEN ILMU KESEHATAN MATA FAKULTAS KEDOKTERAN USU/ RSUP H. ADAM MALIK MEDAN
NAMA : FEBRYNA RIZKY NIM : 110100006
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