TUMOR TULANG

3 PertanyaanLesi : tumor >< infeksiBenigna >< malignaPrimer >< sekunder ( metastase)

Tumor jelas pada X-Ray : OsteochondromaTumor ganas primer : - 1% - 15-20, > 40 tahunTumor ganas sekunder >>

Gambaran Ro :Besar- Korteks Bentuk- SpongiosaKontur- Reaksi periostDensitas - Jaringan lunak

Tipe tulang yang diserang :Tumor primer : semua tulangtapi terutama : pelvis, tulang panjang ( tulang sekitar hip dan knee joints)

2. Tumor sekunder ( metastase) : tulang axial

Umur : Osteosarkoma: 10-15, > 50 tahunEwingsarkoma: 5-15 thn

LesiSoliter : primer kecuali multiple osteochondromaMultiple : metastase

Bagian tulang yang diserang :Korteks: Fibrous cortical defect Non ossifying fibromaEpifisis: ChondroblastomaSubartikular: Giant cell tumorMetafisis : Osteosarkoma Diafisis: Ewingsarkom

Batas Lesi :Jinak :tegas korteks tipis reaksi periost (-)Maligna :tidak tegas korteks destruksi reaksi periost (+)Transition zone : Bila lebar tumor agresif infeksi

Metastase Letak lesi axialJumlah > 1Gambaran :osteolitik osteoblastik ( sklerotik)campuran Asal primer gambaran berbedaCa mama : campuranCa prostat: osteoblastikCa ginjal: soliter, osteolitik

OSTEOSARCOMAPaling sering : 10-25, > 50 thnLokasi : sekitar lututhumerus proksimalpelvisRo: - osteolitik, tidak tegas- korteks periost keluar- reaksi periost/Codman : Sunray Lamelar- Ukuran destruksiDD : 1. Osteomielitis2. Ewing sarcoma

Anteroposterior radiograph of a typical mixed sclerotic and lytic osteosarcoma arising from the right proximal humerus in a 16-year-old girl. The tumor has penetrated the bone and formed a soft tissue mass (stage IIB; see Table 4). Note the ossifications in the surrounding soft tissue (arrows).Lateral radiograph of a sclerotic osteosarcoma (arrow) arising in the proximal metaphyseal region of the right tibia in a 16-year-old boy.

Osteosarcoma arising from the right proximal humerus in a 16-year-old girl. (Left) Anteroposterior radiograph of the tumor (arrow) obtained before the institution of induction chemotherapy. (Right) Anteroposterior radiograph of the same tumor after two cycles of induction chemotherapy. Extensive calcification of the lesion (arrow) indicates a good response to treatment

EWING SARCOMAPada diafisis 5-15 thnRo : - Osteolitik, cepat korteks - reaksi periost : onion peel appearanceDD : 1. Osteosarcoma 2. Osteomielitis

Osteochondroma

RHEUMATOID ARTHRITISStage I : periarticular osteoporosis- soft tissue swellingStage II : Celah sendi Stage III: Destruksi cartilago + tulangStage IV : Ankilose

OSTEOARTHRITISOsteofitCelah sendi Subchondral osteosklerotik

GOUTY ARTHRITISCelah sendi Subchondral osteosklerotilLesi lusen ( punched out)Hypertrophic bone reactionAnkilose