PATOFISIOLOGI SISTEM MUSKULOSKELETAL

Nursiswati

TULANG

Tulang mbntuk rangka penunjang dan pelindung bagi tbh dan tempat u/ mlekatkn otot-otot yg mgerakkan kerangka tbh.

Ruang di tengah-tengah tulang ttt berisi jaringan hematopoetik.

Mrp tempat primer u/ mnyimpan & m’atur kalsium & fosfat.

Mrp jar dinamis t’diri dr 3 sel :Osteoblas: mbangun tlg dg mbtk

kolagen tipe 1 & proteoglikan sbg matriks tlg atau jar osteoid mel proses osifikasi.– Ketika sdg aktif mbtk osteoid,

osteoblas msekresi sejml besar fosfatase Alkali yg bperan dl mengendapkan calsium & fosfat ke dl matriks tlg.

Osteosit : adl sel2 tlg dewasa yg b’tindak sbg suatu lintasan u/ ptukaran kimiawi mel tlg yg padat.

Osteoklas : adl sel2 besar berinti banyak yg memungkinkn mineral & matriks tlg dpt diabsorbsi.–Mengikis tlg dg mhslkn enzim2

proteolitik yg memrcahkn matriks & bbrp asam yg mlarutkn mineral tlg, shg kalsium & fosfat tlepas ke dl aliran drh.

KEGANASAN ST MUSKULOSKELETAL

OSTEOSARCOMA

In the United States, the incidence of osteosarcoma is 400 cases per year (4.8 per million population <20 y).15 The overall 5-year survival rate for patients diagnosed between 1974 and 1994 was 63% (59% for males, 70% for females).

Osteosarcoma is the most common type of malignant bone cancer, accounting for 35% of primary bone malignancies. There is a preference for the metaphyseal region of tubular long bones.

50% of cases occur around the knee. It is a malignant connective (soft) tissue tumor whose neoplastic cells present osteoblastic differentiation and form tumoral bone.

The causes of osteosarcoma are not known.

Questions remain about whether radium, or fluoride, in drinking water can act as "environmental triggers" for increasing the incidence of the disease.[citation needed] A low selenium or Vitamin D3 level or a high level of inflammation, as measured by interleukin-6, interleukin-8, or Nf-kB,

Tumor Necrosis Factor Alpha may have a significant role as tumor suppressors and tumor initiators respectively.

Recent studies show that an increased level of c-Fos can lead to osteosarcoma.

since c-Fos is ubiquitous in its over expression it can not only increase the osteoblast resulting in the symptoms of osteosarcoma.

Therefore it is recently believed that a biological effect that may cause osteosarcoma is an error in the molecular pathway that controls c-Fos, causing an overexpression with no other counter stimuli to stop over production

The exact cause of osteosarcoma is unknown. However, a number of risk factors are apparent, as follows

Rapid bone growth: Rapid bone growth appears to predispose persons to osteosarcoma, as suggested by the increased incidence during the adolescent growth spurt, the high incidence among large-breed dogs (eg, Great Dane, St. Bernard, German shepherd), and osteosarcoma's typical location in the metaphyseal area adjacent to the growth plate (physis) of long bones.

Environmental factors: The only known environmental risk factor is exposure to radiation. Radiation-induced osteosarcoma is a form of secondary osteosarcoma and is not discussed further in this article.

Genetic predisposition: Bone dysplasias, including Paget disease, fibrous dysplasia, enchondromatosis, and hereditary multiple exostoses and retinoblastoma (germ-line form) are risk factors.

The combination of constitutional mutation of the RB gene (germline retinoblastoma) and radiation therapy is associated with a particularly high risk of developing osteosarcoma, Li-Fraumeni syndrome (germline p53 mutation), and Rothmund-Thomson syndrome (autosomal recessive association of congenital bone defects, hair and skin dysplasias, hypogonadism, and cataracts).

JENIS SARKOMA: OSTEOSARKOMA. KONDROSARKOMA, SARKOMA EWING

Osteosarcoma SUNBURSTChondrosarcoma PERIFER ATAU

SENTRAL, ro: PENGAPURANSarcoma ewing sumsum tulang

GIANT CELL TUMOR

STROMA VASKULER DAN SELULER

TUMOR JINAK, NAMUN MEMILIKI BBRP DERAJAT KEGANASAN

PD JENIS YG GANAS, TUMOR INI MJD ANAPILAKTIK DG DAERAH2 NEKROSIS &PERDARAHAN

SERING PD DEWASA MUDA>> PD WANITACENDERUNG KAMBUHTERSERING: UJUNG2 TLG

PANJANG, TERUTAMA LUTUT & UJUNG BWH RADIUS

GEJALA PLG SRG: NYERI DISERTAI KETERBATASAN GERAKAN SENDI DAN KELEMAHAN

OSTEOMA

MRP LESI TULANG YG DITANDAI O PERTUMBUHAN TLG YG ABNORMAL

JINAKTDK NYERIPD RO: OSTEOMA perifer

TAMAPAK SBG RADIOPAK YG MELUAS DR PERMUKAAN TLG

OSTEOMA SENTRAL TAMPAK SBG SUATU MASSA SKLEROTIK BERBATAS TEGAS DI DL TULANG

INTERVENSI: EKSISI SBG DIAGNOSTIK

KONDROBLASTOMA

JARANGPD ANAK LAKI2 REMAJAPD EPIFISISSERING: HUMERUSGEJALA: NYERI SENDIPEMBEDAHAN

THANKS