11. Dr. Karuniawan - Tumor Muskuloskeletal Desember 2012 (Indonesia)

7/23/2019 11. Dr. Karuniawan - Tumor Muskuloskeletal Desember 2012 (Indonesia)

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Tumormuskuloskelet

alKaruniawan Purwantono

KA Departemen BedahFakultas Kedokteran

Universitas Kristen Indonesia



Pendekatan diagnosis Tumor

Tulang Dasar- dasar diagnosisa. Pengertian Umumb. Informasi klinis relevan

1.Tael !"roup usiac. Korelasi radiologis1. Tael !lokasi# letak tumor di tulang

$. Tael ! lokasi tulang pan%ang

&. Tael -"rowth Patterns

'. Tael -T(pes o) Periosteal *ea+tion

,. Tael -T(pes o) Tumor atrid. Penilaian lesi histologis pada umumnya



General considerations

Tumor tulang dapat diedakan

• Tumor Primer

•Tumor Sekunder



Secondary Tumor

Diedakan lagi /

• Tumor etastasis

•

Tumor akiat dari pen(earanneoplasma %aringan lunak di sekitarn(a

• Tumor erasal dari lesi %inak (angertrans)ormasi men%adi ganas

Sebagian besar keganasan /tumorganas ditemukan di tulang



va kval !a "ammae



Tumor Sekunder

Sebagian besar keganasanmenyebabkan metastases di tulang

Dewasa0 'tahun

+ar+inomas o) the prostate2reast2 kidne(2 lung andmelanoma

Anak

3 1tahun

4eurolastoma2

rhadom(osar+oma2 andretinolastoma



Tumor Sekunder

*adiographi+ appearan+e o) themetastati+ tumors

• Purel( l(ti+ 5kidne(2 lung2 +olon2 andmelanoma6

• Purel( lasti+ 5prostate and reast

+ar+inoma6• ied l(ti+ and lasti+ 5most +ommon

appearan+e6



"etastases !a "ammaeke femur



"etastases tulang belakang"etastases #" di tltengkorak



"etastases prostat di vertlumbal !a Paru di vertebra multiple



Tumor Primer

Tumor Primer tulang memilikikarakter s

• Paling sering ter%adi pada dekade & .

• 7etak paling sering 2 aik tumur %inak

dan ganas adalah distal femur andpro$imal tibia

• penampilan khas radiologis .



Tumor Primer

• tumor Benigna# %inak % malignan

5osteo+hondroma2 non-ossi)(ing 8roma2and

en+hondroma6

• 9angat sulit menilai / enigna ataumalignan

• Insiden tertinggi ganas / osteosar+omadan multiple m(eloma 2 selan%utn(a+hondrosar+oma dan :wing;s sar+oma.



(iagnosis

)elevant clinical

information• USI&

• *+)I

• #SI "U#TIP#

• #,K&SI SK#T&#

• SIT ,- #,*G ',*I*,#"*T

• T+PS ,-P)I,ST&#)&!TI,*

• P&TT)*S ,-"&T)I"I*)&#I0&TI,*



Tumor Primer

(U& P*&"PI#&* penting tumortulang /

• Kemampuan melakukan di)erensiasi

5 +ontoh en+hondroma atau low-grade+hondrosar+oma trans)ormasi men%adihigh-grade sar+oma6

• Ke+enderungan high-grade sar+omasmen%adi # menimulkan a.damagedbone 1pada daerah infark22.radiation osteitis and +.Paget;s disease



Tumor Primerinformasi klinis )elevan

• &ge• most important

+lini+al +lue




pain• Gro3ing lesions. This +ategor(

in+ludes lo+all( aggressive lesions 5eg.2aggressive osteolastoma and "<T62and malignant tumors

• Pathologic fracture +ompli+ating

either enign or malignant tumor• 9igni8+ant local tissue reaction to

the tumor




"U#TIP# #SI,*S

• )adiological!orrelation

• P#&I* )&(I,G)&P4

• !,"PUT)T,",G)&P4+

• ")I is a method ofchoice for localstaging.

• ',*

S!I*TIG)&P4+ is ahighly sensitive butrelatively non5speci6c techni7ue




• 9K:7:TA77=<ATI=4



Primary boneinformasi klinis )elevan

• #okasitumor ditulang

pan8ang

P&TT)*S ,- G),9T4 and



P&TT)*S ,- G),9T4 and',*

(ST)U!TI,*geographic pattern !ortical e$pansion.

P&TT)*S ,- G),9T4 and



P&TT)*S ,- G),9T4 and',*

(ST)U!TI,*

:"oth5eaten: pattern Permeative pattern



T>P:9 =F P:*I=9T:A7*:A<TI=4

-ocal cortical thickening !odman;s triangle



T>P:9 =F P:*I=9T:A7*:A<TI=4

:onion5skinning: and

spiculated :hair5on5end: types



P&TT)*S ,- "&T)I"I*)&#I0&TI,*

,steoid• alignant osteoid

• +loudlike

• =r• ill-de8ned amorphous

• densities withhapha?ard

• minerali?ation.



P&TT)*S ,- "&T)I"I*)&#I0&TI,*

,steoid !hondroid



<ontoh kasus

Solitary 'one !yst 1S'!2 osinophilic Granuloma 1G2



*on5,ssifying -ibroma 1*,-2 -ibrous (ysplasia



!hondroblastoma Giant !ell Tumor of 'one



9urgi+al staging



Pengoatan

*on bedah

• *adioterap(

• ra+h(therap(

• <hemotherap(• Ad%unavt <hemoth#

• 4eo ad%uvant+hemoth#

• <r(osurger(

'edah

• :ksisi

• <uretage

• Amputasi• *eseksi @ one

repla+ement #gra)t

• *eseksi @

arthroplast(



Prosedur edah



'one e$cision !uretage



Treatment

*on surgical Surgical

• :+isional



And so)t tissue

11. Dr. Karuniawan - Tumor Muskuloskeletal Desember 2012 (Indonesia)

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