Tumor Tulang Fkk Umj

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Transcript of Tumor Tulang Fkk Umj

TUMOR TULANG

TUMOR TULANGDr Moh Adib Khumaidi, SpOT

Tumor : benjolanNeoplasma : pertumbuhan sel baru, abnormal, progresif, immatur

TUMOR TULANG : kelainan pada sistem muskuloskeletal yang bersifat neoplastikPENDAHULUANTumor tulang:Tumor ganasTumor jinak

Tumor ganas tulang:PrimerSekunder

Tumor ganas tulang primer dari unsur unsur tulang sendiri

Tumor ganas tulang sekunder metastasis dari organ lain Insidens Tumor tulang primer (Makassar):65,8% jinak34,2% ganasTumor ganas tulang 1,5% dari seluruh keganasanInsidens pria = wanita Insiden tumor jinak primer (Makassar): Osteoma (39,3%) Osteokondroma (32,5%)

Insiden tumor ganas primer (Makassar): Osteosarkoma (48,8%) Perbedaan insidens tumor jinak dan tumor ganas pada tulangTUMOR JINAKTUMOR GANASJenisInsidensJenisInsidensOsteoma39,3%Osteogenik sarkoma48,8%Osteokondroma32,5%Giant cell tumor17,5%Kondroma9,8%Kondrosarkoma10%Tumor jinak lain18,4%Tumor ganas lain23,7%KlasifikasiBerdasarkan asal seltrue neoplasmneoplasm-like lesiondibagi menjadi :osteogenik, kondrogenik, fibrogenik, angiogenik, mielogenikClassification of True Primary Neoplasms of Bone OsteogenikKondrogenikFibrogenikAngiogenikMielogenikAsal tidak diketahui (Uncertain origin)ASAL SELTUMOROsteogenikOsteosarkoma (sarkoma osteogenik)Surface osteosarkoma(sarkoma parosteal, sarkoma periosteal)ASAL SELTUMORKondrogenikKondroblastoma jinakFibroma kondromiksoidKondrosarkoma ASAL SELTUMORFibrogenikFibrosarkoma tulang Malignant fibrous histiocytoma of boneASAL SELTUMORAngiogenikAngiosarkoma tulangASAL SELTUMORMielogenikMieloma pada tulang (mieloma multipel)Sarkoma EwingLimfoma Hodgkin pada tulangLimfoma non-Hodgkin (sarkoma sel retikulum)Retikulosis skeletal (histiositosis sel Lagerhans) Leukemia ASAL SELTUMORUncertain originGiant cell tumor of bone (osteoklastoma)Classification of Neoplasm-Like Lesion of BoneOsteogenikKondrogenikFibrogenikAngiogenikUncertain originASAL SEL TUMOROsteogenikOsteoma (ivory exostosis)Osteokondroma (osteocartilagineous exostosis)Osteokondromata multipel (exostosis multipel herediter)Osteoid osteomaOsteoblastoma jinak (giant osteoid osteoma)ASAL SELTUMORKondrogenikEnkondromaEnkondromata multipel (Olliers dyschondroplasia)ASAL SELTUMORFibrogenikSubperiosteal cortical defect(metaphyseal fibrous defect)Fibroma nonosteogenik (nonossifying fibroma)Displasia fibrosa monostotikDisplasia fibrosa poliostotikDisplasia osteofibrosa(simdroma Campanacci)Tumor Brown pada hiperparatiroidismeASAL SELTUMORAngiogenikAngioma pada tulang (hemangioma dan limfangioma)Aneurysmal bone cystASAL SELTUMORUncertain originSimple bone cyst (unicameral bone cyst)Klasifikasi WHO (1972)Berdasarkan kriteria: histologis, jenis diferensiasi, jenis matriks interseluler yang diproduksiKlasifikasi WHO (1972)ASAL SELOsteogenikKondrogenikGiant cell tumorMielogenikVaskulerJaringan lunak Tumor lainTumor tanpa klasifikasiASAL SELJINAKGANASOsteogenik OsteomaOsteosarkomaOsteoid osteoma Osteosarkoma parostealOsteoblastoma jinakASAL SELJINAK GANASKondrogenik

KondromaKondrosarkomaOsteokondromaKondrosarkoma juksta kortikalkondroblastomaMesenkim kondrosarkomaFibroma kondromiksoidASAL SELGANASGiant cell tumorOsteoklastoma ASAL SELGANASMielogenikSarkoma EwingSarkoma retikulumLimfosarkomaMieloma ASAL SELJINAKINTERMEDIATEGANASVaskulerHemangiomaHemangioen-doteliomaAngiosarkoma LimfangiomaHemangiope-risitomaTumor glomusASAL SELJINAKGANASJaringan lunakFibroma desmoplastikFibrosarkomaLiposarkomaLipomaMesenkimoma ganasSarkoma tidak berdiferensiasiASAL SELJINAKGANASTumor lainNeurinomaKordomaNeurofibromaAdamantinoma ASAL SELJINAKTumor tanpa klasifikasiKista soliterKista aneurismaKista juksta artikulerDefek metafisisGranuloma eosinofilDisplasia fibrosaMiositis osifikansTumor Brown hiperparatiroidismeDiagnosis Diagnosis ditegakkan berdasarkan:AnamnesisPemeriksaan fisikPemeriksaan neurologisPemeriksaan radiologisPemeriksaan laboratoriumPemeriksaan biopsi Anamnesis Tanyakan riwayat: kelainan yang diderita, trauma, penyakit sejenis dalam keluargaPerhatikan:Umur Progresifitas penyakitNyeri Pembengkakan Pemeriksaan FisikPerhatikan:LokasiBesar, bentuk, batas dan sifat tumorGangguan pada pergerakan sendiSpasme otot dan kekakuan tulang belakangAdanya fraktur patologis Pemeriksaan NeurologisLakukan secara cermatTentukan gangguan neurologis akibat penekanan jaringan saraf oleh tumor Pemeriksaan RadiologisFoto polosRadionuclide scanningCT-scanMRIFoto PolosFoto polos lokal pada lesiFoto seluruh tulang (bone survey) bila tulang yang terlibat lebih dari satu, atau curiga metastasisFoto PolosMemberi gambaran:Lokasi lesiSoliter atau multipelJenis tulang yang terkenaMemberi gambaran sifat sifat tumorBatas; tegas atau tidak, mengandung kalsifikasi atau tidakSifat sifat tumor; uniform atau bervariasi, reaksi pada periosteum, infiltrasi jaringan lunak sekitarnyaSifat lesi; berbentuk kistik atau seperti gelembung sabun

Clues by Appearance of LesionPatterns of Bone DestructionGeographicMoth-eatenPermeativeGeographic Bone DestructionDestructive lesion with sharply defined borderImplies a less-aggressive, more slow-growing, benign processNarrow transition zone

Non-ossifying fibromaGeographicMoth-eatenPermeativePatterns of Bone Destruction R3, 2000Geographic LesionsExamplesNon-ossifying fibromaChondromyxoid fibromaEosinophilic granulomaMoth-eaten AppearanceAreas of destruction with ragged bordersImplies more rapid growthProbably a malignancy

Multiple MyelomaPatterns of Bone DestructionGeographicMoth-eatenPermeative R3, 2000Moth-eaten AppearanceExamplesMyelomaMetastasesLymphomaEwings sarcomaPermeative PatternIll-defined lesion with multiple worm-holesSpreads through marrow spaceWide transition zoneImplies an aggressive malignancyRound-cell lesions

LeukemiaPatterns of Bone DestructionGeographicMoth-eatenPermeativePatterns of Destruction

GeographicMoth-eatenPermeative

Less malignantMore malignantPeriosteal ReactionsBenignNoneSolidMore aggressive or malignantLamellated or onion-skinningSunburstCodmans triangleNon-ossifying fibromaBenignNoneSolidAggressive/malignantOnion-skinningSunburstCodmans trianglePeriosteal Reactions

R3, 2000Chronic osteomyelitisBenignNoneSolidAggressive/malignantOnion-skinningSunburstCodmans trianglePeriosteal Reactions

R3, 2000BenignNoneSolidAggressive/malignantOnion-skinningSunburstCodmans trianglePeriosteal Reactions

Ewings sarcoma Greenspan, 2000OsteosarcomaBenignNoneSolidAggressive/malignantOnion-skinningSunburstCodmans trianglePeriosteal Reactions

Greenspan, 2000

Ewings-CodmanstriangleBenignNoneSolidAggressive/malignantOnion-skinningSunburstCodmans trianglePeriosteal Reactions R3, 2000Periosteal Reactions

SolidLamellatedCodmansSunburstLess malignantMore malignantTumor MatrixOsteoblasticFluffy, cotton-like or cloud-like densitiesOsteosarcomaCartilaginousComma-shaped, punctate, annular, popcorn-like Enchondroma, chondrosarcoma, chondromyxoid fibromaOsteoblasticCartilaginous

Tumor matrix

Osteosarcoma R3, 2000OsteoblasticCartilaginous

Tumor matrixChondrosarcoma

R3, 2000Expansile Lesions of Bone Multiple myeloma Brown tumor Mets Enchondroma Aneurysmal bone cyst Lymphoma Fibrous dysplasiaMultiple MyelomaExpansile lesions Multiple myeloma Mets Aneurysmal bone cyst Fibrous dysplasia Brown tumor Enchondroma Lymphoma

Renal Cell CarcinomaExpansile lesions Multiple myeloma Mets Aneurysmal bone cyst Fibrous dysplasia Brown tumor Enchondroma Lymphoma

Aneurysmal Bone CystExpansile lesions Multiple myeloma Mets Aneurysmal bone cyst Fibrous dysplasia Brown tumor Enchondroma Lymphoma

Fibrous DysplasiaExpansile lesions Multiple myeloma Mets Aneurysmal bone cyst Fibrous dysplasia Brown tumor Enchondroma Lymphoma

Brown TumorExpansile lesions Multiple myeloma Mets Aneurysmal bone cyst Fibrous dysplasia Brown tumor Enchondroma Lymphoma

R3, 2000EnchondromaExpansile lesions Multiple myeloma Mets Aneurysmal bone cyst Fibrous dysplasia Brown tumor Enchondroma Lymphoma

R3, 2000LymphomaExpansile lesions Multiple myeloma Mets Aneurysmal bone cyst Fibrous dysplasia Brown tumor Enchondroma Lymphoma

R3, 2000Clues by Locationof LesionIn the Transverse PlaneCentralEnchondromaEccentricGCT, osteosarcoma, chondromyxoid fibromaCorticalNon-ossifying fibroma, osteoid osteomaParostealParosteal osteosarcoma, osteochondroma

Parosteal sarcomaOsteochondromaOsteosarcomaIn The Transverse Plane Greenspan, Lippincott, 2000In the Longitudinal PlaneEpiphysealGCT, chondroblastomaMetaphysealOsteomyelitis, osteo- and chondrosarcomaDiaphysealRound cell lesions, ABC, enchondromaTumor TypesCharacteristic Locations Simple bone cystProximal humerusChondroblastomaEpiphysesGiant Cell tumorEpiphysesSimple bone cystProximal humerusChondroblastomaEpiphysesGiant Cell tumorEpiphysesCharacteristic locations

R3, 2000

ChondroblastomaSimple bone cystProximal humerusChondroblastomaEpiphysesGiant Cell tumorEpiphysesCharacteristic locations R3, 2000

Giant Cell TumorSimple bone cystProximal humerusChondroblastomaEpiphysesGiant Cell tumorEpiphysesCharacteristic locations R3, 2000Tumor TypesCharacteristic Locations AdamantinomaTibiaChordomaSacrum, clivusOsteoblastomaSpine, posteriorAdamantinomaTibiaChordomaSacrum, clivusOsteoblastomaSpine, posteriorCharacteristic locations

Adamantinoma R3, 2000AdamantinomaTibiaChordomaSacrum, clivusOsteoblastomaSpine, posterior

ChordomaCharacteristic locations R3, 2000

OsteoblastomaAdamantinomaTibiaChordomaSacrum, clivusOsteoblastomaSpine, posteriorCharacteristic locations R3, 2000Tumor TypesCharacteristic Locations Parosteal sarcomaDistal femurPeriosteal sarcomaTibiaCharacteristic locationsParosteal sarcomaDistal femurPeriosteal sarcomaTibia

Parosteal sarcoma

Characteristic locationsParosteal sarcomaDistal femurPeriosteal sarcomaTi