TUMOR TULANG JINAK.ppt

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    NEOPLASMANEOPLASMA

    MUSCULOSKELETAMUSCULOSKELETA

    TUMOR JINAKTUMOR JINAK

    TULANGTULANG

    LUGINDOLUGINDO

    KEPANITRAAN KLINIK ILMU BEDAH FK UNSWKEPANITRAAN KLINIK ILMU BEDAH FK UNSW

    RSUD WALEDRSUD WALED

    CIREBONCIREBON

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    Tumor muskulosk

    0,2 % dari seluruh neoplasma yanmanusia

    65,8 % Tumor tulang primer 34,2% Tumor tulang primer g

    PENDAHULUANPENDAHULUANJaringan tulang &

    Jaringan lunak otot, pem!uluh darah, sara"

    lemak #

    JINAK

    GANAS

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    $$T'($$T'(& )(*(+(& )(*(+(

    TULANGORGAN VITAL

    -em!entuk t'enahan dan me

    tu!uh

    erak pas

    Tempat perleka

    -roteksi alat.alattu!uh

    'eta!olisme kalminera

    rgan hemop

    Matriks tulan !s"rat#s"rat k$la"n %an &r$t"inn$n#k$la"n

    s"l tulan !$st"$'las( $ist"$sit( %an$st"$klas

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    TUMOR TULANGTUMOR TULANG

    TumorTumor a%ala) &"rtu*'u)an s"l 'aru(a%ala) &"rtu*'u)an s"l 'aru(

    a'n$r*al( &r$r"si+( %i*ana s"l#s"la'n$r*al( &r$r"si+( %i*ana s"l#s"l

    t"rs"'ut ti%ak &"rna) *"n,a%i %"-asa.t"rs"'ut ti%ak &"rna) *"n,a%i %"-asa.

    Tumor TulangTumor Tulang /aitu &"rtu*'u)an/aitu &"rtu*'u)an

    a'n$r*al &a%a tulan /an 'isa ,inaka'n$r*al &a%a tulan /an 'isa ,inak

    atau anasatau anas

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    ETIOLOGIETIOLOGI

    P"n/"'a' &asti t"r,a%in/a tu*$rP"n/"'a' &asti t"r,a%in/a tu*$r

    tulan ti%ak %ik"ta)uitulan ti%ak %ik"ta)ui Ra%iasi sinar ra%i$ akti+ %Ra%iasi sinar ra%i$ akti+ %

    K"turunanK"turunan..

    B"'"ra&a k$n%isi tulanB"'"ra&a k$n%isi tulan

    s"'"lu*n/a s"&"rti &"s"'"lu*n/a s"&"rti &"

    0aki'at &a,anan ra%iasi0aki'at &a,anan ra%iasi1.1.

    P"n"litin %i%ua

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    -emer

    T"ra'a *assa tulan %an &kulit %iatas *assa s"rta a2"na.

    P"*'"nkakan &a%a 3 %i a&"rs"n%ian s"rta "rakan

    N/"ri t"kan atau n/"ri l$kasakit.

    N/"ri %an 3 atau

    &"*'"nkakan

    Fraktur &at$l$ik

    T"ra'a *assa tulan

    &"r"rakan /an t"r'atas

    G",ala#",ala &"n/akit

    *"tastatik

    'ani"estasi klinis

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    PEMERIKSAANA PENUNJANGPEMERIKSAANA PENUNJANG

    R$"nt"nR$"nt"n

    CT#S4anCT#S4an

    MRIMRI

    Skintira5 0ra%i$nu4li%" '$n" s4an1Skintira5 0ra%i$nu4li%" '$n" s4an1

    PET 0 P$sitr$n "*issi$n t$*$ra&)/1PET 0 P$sitr$n "*issi$n t$*$ra&)/1

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    KLASIFIKASI TUMOR TULANG MENURUT WHO TAHUN KLASIFIKASI TUMOR TULANG MENURUT WHO TAHUN

    J($

    Tu*$r asal ,arinan tulan 0Ost"$"nik1!

    Ost"$i% $st"$*a

    Ost"$'last$*a .

    Tu*$r asal ,arinan tulan ra-an

    0K$n%r$"nik1!

    Ost"$k$n%r$*a 0Enk$n%r$*a(

    $$*

    Tu*$r asal ,arinan tu

    0Ost"$"nik1!

    Ost"$sark$*a

    Tu*$r asal ,arinan tu

    0K$n%r$"nik1!

    K$n%r$sark$*a

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    TUMOR TULANG JINAKTUMOR TULANG JINAK

    S"rin %it"*ukan s"4ara

    k"'"tulan &a%a +$t$ R$"t"n

    /an %i*aksu%kan untuk

    &"n/akit lain.

    Jaran *"ni*'ulkan k"lu)an.

    Lanka) untuk *"n"ntukLanka) untuk *"n"ntuk

    tu*$r !tu*$r !

    7.7.L$kasi &r"%il"ksiL$kasi &r"%il"ksi

    8.8.Ar"si2itas tu*$r %"nanAr"si2itas tu*$r %"nan

    tu*$r %"nan tulan %")tu*$r %"nan tulan %")

    9.9.R"aksi tu'u) t"r)a%a& tuR"aksi tu'u) t"r)a%a& tu

    transisi1transisi1

    ;.;.Min"ralisasiMin"ralisasi

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    *T1(*T1(*T1'$*T1'$

    *igns*ymptoms*igns*ymptoms

    Pr$r"ssi2" &ain t)at isPr$r"ssi2" &ain t)at is

    r"li"2"% '/ as&irin $r anr"li"2"% '/ as&irin $r an

    rar"l/( l"ss t)an 7usi$n an% 4lini4al &i4t

    r)"u*at$i% art)ritisr)"u*at$i% art)ritis

    ?"rt"'ral l"si$ns *a/ 4au?"rt"'ral l"si$ns *a/ 4au

    %u" t$ *us4l" s&as*%u" t$ *us4l" s&as*

    Pr"2al"n4"! Mal"s *$rPr"2al"n4"! Mal"s *$r

    a>"4t"% t)an +"*al"s @ 9!a>"4t"% t)an +"*al"s @ 9!

    Ost"$i% Ost"$*a is a '"nin $st"$'lasti4Ost"$i% Ost"$*a is a '"nin $st"$'lasti4

    0'$n" +$r*in1 tu*$r t)at is usuall/ l"ss0'$n" +$r*in1 tu*$r t)at is usuall/ l"ss

    t)an 84* in si:"t)an 84* in si:"

    $geOst"$i% Ost"$*a is *$st 4$**$n in s"4$n%%"4a%" $+ li+"

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    TreatmentTreatment

    T$%a/( *$st $st"$i% $st"$T$%a/( *$st $st"$i% $st"$*a*"na'l" t$ CT ui%"% &"a*"na'l" t$ CT ui%"% &"

    ra%i$+r"u"n4/ a'lati$n 0Rra%i$+r"u"n4/ a'lati$n 0R

    S$*" &ati"nts *a/ r"uir"S$*" &ati"nts *a/ r"uir"

    "=4isi$n $r Burr D$-n R"s"=4isi$n $r Burr D$-n R"s

    $st"$i% $st"$*a.$st"$i% $st"$*a.

    -rognosis-rognosis

    T)is is a '"nin tu*$r an%T)is is a '"nin tu*$r an%

    risk $+ *"tastasisrisk $+ *"tastasis

    RF A'lati$n is ">"4ti2" $2"RF A'lati$n is ">"4ti2" $2"

    ti*"ti*"

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    OSTEOBLASTOMAOSTEOBLASTOMA

    B"nin $st"$'lasti4 n"$&las* -it)B"nin $st"$'lasti4 n"$&las* -it)

    ar"ssi2" r$-t) &att"rn 04$nsi%"r"%ar"ssi2" r$-t) &att"rn 04$nsi%"r"%

    a '"nin ar"ssi2" tu*$r1a '"nin ar"ssi2" tu*$r1

    Hist$l$i4all/ it is si*ilar t$ $st"$i%Hist$l$i4all/ it is si*ilar t$ $st"$i%

    $st"$*a 'ut is a lar"r si:" an% r$-s$st"$*a 'ut is a lar"r si:" an% r$-s

    &r$r"ssi2"l/&r$r"ssi2"l/

    *igns*ymptoms*igns*ymptoms

    Pain is t)" *$st 4$**$Pain is t)" *$st 4$**$

    s/*&t$*s/*&t$*

    Pain is usuall/ l"ss s"2Pain is usuall/ l"ss s"2

    &r$n$un4"% at ni)t an%&r$n$un4"% at ni)t an%

    n$t '" r"li"2"% '/ as&irinn$t '" r"li"2"% '/ as&irin

    an $st"$i% $st"$*a in -)an $st"$i% $st"$*a in -)

    is &arti4ularl/ s"2"r" anis &arti4ularl/ s"2"r" an

    usuall/ r"lia'l" r"li"2"% -usuall/ r"lia'l" r"li"2"% -$r NSAID$r NSAID

    S&inal l"si$ns *a/ '" a4S&inal l"si$ns *a/ '" a4

    *us4l" s&as*s( s4*us4l" s&as*s( s4

    n"ur$l$i4al *ani+"stati$nn"ur$l$i4al *ani+"stati$n

    Mal"s! F"*al"s 8#9!7Mal"s! F"*al"s 8#9!7

    $ge Pati"nts ar" /$un( M"%ian a" 7 < $+ &ati"nts ar" '"t-""n 7 an% 9 /"ars$l%

    *ites S&in" 0;< $+ 4as"s usuall/ &$st"ri$r"l"*"nts1L$n B$n"s 09

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    OSTEOCHONDROMAOSTEOCHONDROMA

    Ost"$4)$n%r$*a is an $utr$-t) $+Ost"$4)$n%r$*a is an $utr$-t) $+

    *"%ullar/ an% 4$rti4al '$n"*"%ullar/ an% 4$rti4al '$n"

    P"%un4ulat"% 0-it) a stalk1P"%un4ulat"% 0-it) a stalk1

    S"ssil" 0at -it)$ut a stalk1S"ssil" 0at -it)$ut a stalk1

    *igns*ymptoms*igns*ymptoms

    Har% s-"llin +$r *an/ /Har% s-"llin +$r *an/ /"

    S/*&t$*s %"&"n%"nt $nS/*&t$*s %"&"n%"nt $n Ma/ 4aus" *"4)ani4al s/Ma/ 4aus" *"4)ani4al s/

    +r$* 4$*&r"ssi$n $+ a%,a+r$* 4$*&r"ssi$n $+ a%,a

    stru4tur"s su4) as t"n%$nstru4tur"s su4) as t"n%$n

    'l$$% 2"ss"ls'l$$% 2"ss"ls

    Malinant Trans+$r*ati$nMalinant Trans+$r*ati$n

    $st"$4)$n%r$*a 7

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    TreatmentTreatment

    *imple eision*imple eision

    C$s*"ti4 r"as$nsC$s*"ti4 r"as$ns

    I*&in"*"nt $n t"n%$ns( n"r2I*&in"*"nt $n t"n%$ns( n"r22"ss"ls2"ss"ls

    Pain an% li*itati$n $+ *$ti$nPain an% li*itati$n $+ *$ti$n

    F$r *ulti&l" "=$st$s"s( 4$rr"4tF$r *ulti&l" "=$st$s"s( 4$rr"4t*a/ '" n"4"ssar/ %u" t$ s"4$*a/ '" n"4"ssar/ %u" t$ s"4$n%"+$r*iti"s%"+$r*iti"s

    -rognosis-rognosis

    R"4urr"n4" a+t"r "=4isi$n is rarR"4urr"n4" a+t"r "=4isi$n is rar

    Rar"l/( $st"$4)$n%r$*as *a/ Rar"l/( $st"$4)$n%r$*as *a/ *alinant 4)$n%r$sar4$*a*alinant 4)$n%r$sar4$*a

    S$litar/ $st"$4)$n%r$*as 7

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    ENCHONDROMAENCHONDROMA

    En4)$n%r$*a is a '"nin in%$l"ntEn4)$n%r$*a is a '"nin in%$l"nt

    intra*"%ullar/ )/alin" 4artila" n"$&las*intra*"%ullar/ )/alin" 4artila" n"$&las*

    Li*it"% r$-t)( *$st l"si$ns ar" l"ss t)anLi*it"% r$-t)( *$st l"si$ns ar" l"ss t)an

    4* in *a=i*al %i*"nsi$n 4* in *a=i*al %i*"nsi$n

    *igns*ymptoms*igns*ymptoms

    D"&"n%s $n l$4ati$nD"&"n%s $n l$4ati$n

    M$st l$n '$n" "n4)$n%rM$st l$n '$n" "n4)$n%r

    as/*&t$*ati4 an% +$un% as/*&t$*ati4 an% +$un%

    P)alan"al tu*$rs *a/ 'P)alan"al tu*$rs *a/ '

    t$ str"ss +ra4tur"st$ str"ss +ra4tur"s

    Pr"2al"n4"!Pr"2al"n4"!

    N$ 4l"ar s"= &r"%il"4ti$nN$ 4l"ar s"= &r"%il"4ti$n

    $geRan"! Wi%" %istri'uti$n # /"ars< $+ "n4)$n%r$*as ar" %is4$2"r"% in&ati"nts '"t-""n 7 t$ ; /"ars $+ a"

    *ites< in2$l2" )an%s an% +""t 0*$stl/&)alan"s1Pr$=i*al Hu*"rus( F"*ur *$st 4$**$nl$n '$n"sEn4)$n%r$*as $+ t)" &"l2is( 2"rt"'ra" an%ri's ar" un4$**$n

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    TreatmentTreatment

    En4)$n%r$*as ar" '"nin(En4)$n%r$*as ar" '"nin( r$-in1 tu*$rsr$-in1 tu*$rs

    In%i4ati$ns +$r sur"r/!In%i4ati$ns +$r sur"r/!

    Diits! I*&"n%in $r a4tuaDiits! I*&"n%in $r a4tua+ra4tur"+ra4tur"

    Intral"si$nal 4ur"tta" aIntral"si$nal 4ur"tta" a4"*"nt4"*"nt

    L$n '$