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Manajemen Terapi pada Pasien dengan Adenoid Cystic Carcinoma Sinonasal: Laporan Kasus Berbasis Bukti
Abstract
Latar Belakang:Adenoid cystic carcinoma (ACC) sinonasal merupakan keganasan yang jarang dengan karakteristik pertumbuhan infiltratif lokal, invasi perineural, dan risiko metastasis jauh yang dapat muncul terlambat. Seorang perempuan berusia 54 tahun datang dengan benjolan wajah kiri yang progresif selama satu tahun, disertai sumbatan hidung unilateral, epistaksis berulang, nyeri kepala, dan gangguan penglihatan. Pemeriksaan menunjukkan massa maksila kiri, massa memenuhi kavum nasi sinistra, dan proptosis kiri sekitar 2 cm berdasarkan perkiraan klinis. MSCT sinus paranasal dengan kontras menunjukkan massa sinonasal luas dengan destruksi tulang, keterlibatan orbita, dan ekstensi intrakranial. Foto toraks menunjukkan nodul multipel bilateral yang dicurigai sebagai metastasis paru. Biopsi mengonfirmasi ACC. Berdasarkan pencitraan yang tersedia, tumor primer paling sesuai dikategorikan sebagai cT4b karena terdapat ekstensi intrakranial; pemeriksaan leher secara klinis menunjukkan N0, sedangkan temuan paru memerlukan konfirmasi sebelum menetapkan M1. Laporan kasus berbasis bukti disusun menggunakan telaah literatur terstruktur terhadap publikasi tahun 2022–2025 dengan penilaian kritis terhadap luaran terapi dan penerapannya pada kasus. Bukti yang tersedia mendukung reseksi tumor semaksimal mungkin dengan margin negatif bila memungkinkan, diikuti radioterapi pascaoperasi pada pasien berisiko tinggi terpilih. Pada penyakit sangat lanjut atau metastatik, tujuan terapi perlu diindividualisasi dan pembedahan dapat ditujukan untuk kontrol lokal atau mengurangi gejala, bukan selalu untuk kuratif. Pasien menjalani maksilektomi medial melalui pendekatan rhinotomi lateral. Hasil histopatologi definitif pascaoperasi, terapi adjuvan, dan follow-up jangka panjang tidak tersedia dalam rekam medis yang ditinjau. Staging yang akurat dan perencanaan terapi individual sangat penting pada ACC sinonasal lanjut, terutama ketika metastasis jauh dicurigai.
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DOI: https://doi.org/10.33024/jmm.v10i3.25634
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