EFUSI PLEURA PADA NODUL HEPAR MULTIPEL - Widianti; Sedayu (Fakultas Kedokteran UGJ Cirebon, 2024)
Pendahuluan: Hepatocelullar carcinoma (HCC) merupakan tumor ganas hati primer yang berasal dari hepatosit, demikian pula dengan karsinoma fibromelar dan hepatoblastoma. Ilustrasi Kasus: Pasien perempuan 57 tahun datang ke rumah sakit dengan keluhan perut membesar 2 bulan yang lalu. Keluhan disertai nyeri pada bagian perut sebelah kanan atas, mual, sesak, sesak, penurunan nafsu makan serta penurunan berat badan. Pada pemeriksaan fisik didapatkan keadaan umum tampak sakit sedang, kesadaran composmentis. Tanda-tanda vital didapatkan TD 140/90 mmHg, HR 105x/menit, RR 22x/menit, suhu 36,7oC dan SpO2 97% free air. Pada pemeriksaan fisik, inspeksi abdomen didapatkan venektasi, hepatosplenomegali, ascites, pitting edem ekstremitas inferior. Pemeriksaan laboratorium didapatkan hipoalbumin, peningkatan ureum, penurunan alfafetoprotein. Pemeriksaan rontgen thorax : diafragma dextra letak tinggi ec suspek proses infradiafragma dextra. Pemeriksaan ultrasonografi (USG) abdomen : ascites, hepatomegali dengan multipel nodul di kedua lobus hepar DD proses hepatal metastasis dan splenomegali. Pemeriksaan CT-Scan abdomen : efusi pleura bilateral, ascites, hepatomegali dengan massa di lobus dextra (segmen IVa-VIII) disertai pelebaran ringan ductus bilier intrahepatal sinistra ec sugestif cholangiocarcinoma tipe mass forming, disertai multiple nodul di kedua lobus DD proses metastasis, splenomegali. Tatalaksana : pemberian furosemide, spironolakton, laktulosa sirup, analgetik, dan gomino. Pembahasan: Hepatocelullar carcinoma (HCC) adalah tumor hati primer yang merupakan penyebab kanker paling umum kelima di seluruh dunia. Faktor risiko yang signifikan untuk HCC termasuk hepatitis virus B dan C, penyakit hati alkoholik, dan Non-alcoholic fatty liver disease (NAFLD). Pada kasus ini pasien perempuan 57 tahun terdiagnosis sugestif HCC. Seperti kebanyakan penyakit kanker, kejadiannya meningkat seiring bertambahnya usia. Kesimpulan: Metastatis ekstrahepatik HCC yang paling umum adalah ke paru-paru, kelenjar getah bening inta-abdominal, tulang, dan adrenal. Kata Kunci: Hepatocelullar carcinoma, tumor, metastasis. ABSTRACT Introduction: Hepatocelullar carcinoma (HCC) is a primary liver malignant tumor that originates from hepatocytes, as well as fibromellar carcinoma and hepatoblastoma. Case Illustration: A 57-year-old female patient came to the hospital with complaints of an enlarged abdomen 2 months ago. Complaints accompanied by pain in the right upper abdomen, nausea, tightness, shortness of breath, decreased appetite and weight loss. On physical examination, it was found that the general condition appeared moderately ill, composmentis consciousness. Vital signs obtained BP 140/90 mmHg, HR 105x/min, RR 22x/min, temperature 36.7oC and SpO2 97% free water. On physical examination, abdominal inspection revealed venectation, hepatosplenomegaly, ascites, pitting edema of inferior extremities. Laboratory examination revealed hypoalbumin, increased urea, decreased alphafetoprotein. Thorax X-ray examination: high dextra diaphragm suspected dextra infradiaphragmatic process. Abdominal ultrasonography (USG) examination: ascites, hepatomegaly with multiple nodules in both hepatic lobes DD metastatic hepatal process and splenomegaly. CT-Scan examination of the abdomen: bilateral pleural effusion, ascites, hepatomegaly with a mass in the dextra lobe (segment IVa-VIII) accompanied by mild dilation of the intrahepatal biliary duct sinistra ec suggestive of mass forming type cholangiocarcinoma, accompanied by multiple nodules in both lobes DD metastatic process, splenomegaly. Management: furosemide, spironolactone, lactulose syrup, analgesic, and gomino. Discussion: Hepatocelullar carcinoma (HCC) is a primary liver tumor that is the fifth most common cause of cancer worldwide. Significant risk factors for HCC include viral hepatitis B and C, alcoholic liver disease, and Non-alcoholic fatty liver disease (NAFLD). In this case, a 57-year-old female patient was diagnosed with suggestive HCC. As with most cancers, the incidence increases with age. Conclusion: The most common extrahepatic metastasis of HCC is to the lungs, inta-abdominal lymph nodes, bone, and adrenal. Keywords: Hepatocelullar carcinoma, tumor, metastasis.