TUMOR TULANG JINAK.ppt

8/9/2019 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


2/23

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


3/23

$$T'($$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


4/23


5/23

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


6/23

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


7/23

-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


8/23

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


9/23

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


10/23

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+"


12/23


13/23

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/


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


15/23


16/23

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


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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18/23

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


19/23

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


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


20/23

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$n '$n"s! Rar" t$ +ra4tuL$n '$n"s! Rar" t$ +ra4tu$'s"r2"$'s"r2"

I+ r$-s it is 4$nsi%"r"% 4I+ r$-s it is 4$nsi%"r"% 4an% -$ul% r"4$**"n% san% -$ul% r"4$**"n% s

-rognosis-rognosis

R"4urr"n4" rat" +$ll$-in 4R"4urr"n4" rat" +$ll$-in 4


21/23

CHONDROBLASTOMACHONDROBLASTOMA

B"nin n"$&las* $+ i**atur"B"nin n"$&las* $+ i**atur"

4artila" 4"ll 04)$n%r$'last14artila" 4"ll 04)$n%r$'last1

&r$li+"rati$n&r$li+"rati$n

Rar" 7#8< all '$n" tu*$rsRar" 7#8< all '$n" tu*$rs


Mil% Pain lastin +r$* *$Mil% Pain lastin +r$* *$

s"2"ral /"arss"2"ral /"ars

99< $+ &ati"nts )a2" a ,$99< $+ &ati"nts )a2" a ,$

an% s-"llin -it) li*itati$an% s-"llin -it) li*itati$

$+ *$ti$n$+ *$ti$n

O+t"n 4$n+us"% -it) a s&$O+t"n 4$n+us"% -it) a s&$

S"= Pr"%il"4ti$n! Mal" S"= Pr"%il"4ti$n! Mal" F

$geRan" 9 # 8 /"ars< $+ 4as"s $44ur '"t-""n t)" a"s an%8M$st 4as"s $44ur in a%$l"s4"nts '"t-""n 7an% 8 /"ars $+ a"

*itesPr"%il"4ti$n +$r %istal +"*ur( &r$=i*al ti'ia )u*"rus< l$4at"% in "&i&)/sis( 9< in kn"" ar"aMa/ als$ $44ur in 4al4an"us( talus an%t"*&$ral '$n"


22/23

TreatmentTreatment

Intral"si$nal 4ur"tta" r"Intral"si$nal 4ur"tta" r"

'$n" ra+tin is t)" *$st'$n" ra+tin is t)" *$st

tr"at*"nt.tr"at*"nt.

-rognosis-rognosis

C)$n%r$'last$*as ar" '"C)$n%r$'last$*as ar" '"

ar"ssi2" tu*$rs t)at ar"ssi2" tu*$rs t)at

%"str$/ t)" '$n" an% ,$in%"str$/ t)" '$n" an% ,$in

T)"r" is a sini54ant risk T)"r" is a sini54ant risk

r"4urr"n4" 0u& t$ 9< -ir"4urr"n4" 0u& t$ 9< -iintral"si$nal 4ur"tta" alintral"si$nal 4ur"tta" al$

an a%%iti$nal l$4al a%,u2aan a%%iti$nal l$4al a%,u2a

4r/$sur"r/1.4r/$sur"r/1.


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TUMOR TULANG JINAK.ppt

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