femur - 2 cazuri.ppt
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M.T. 16 ani
● nov.2005 - Durere genunchi stang,
- traumatism antecedent
- disparitia durerii dupa tratament AINS
● feb.2006- reapare durerea,
+ tumefactie locala
+ impotenta functionala
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Osteosarcom femur
RMN:• Proces inlocuitor de spatiu dezvoltat in metafiza si diafiza femurala stanga • Nodul tisular satelit (sau meta-skip) in dreptul fostei linii de crestere a cartilajului articular•Distructia corticalei osoase posterolaterale la nivel metafizar, cu invazia partilor moi pe aprox.2 cm
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• Martie 2006-biopsie osoasaEx. HP: osteosarcom osteoblastic de
malignitate inalta
• Bilantul gradului de extensie al bolii :Scintigrafie osoasaCT pulmonar
Fara metastaze la distanta
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M.T. 16 ani Tratament/ Evolutie
Protocol COSS 1996:• Chimioterapie policitostatica
- 5 serii preoperator
- 13 serii postoperator• Chirurgie radicala conservatoare
(necroza post- PCTstadiul IIB Rosen
(tumora vitala reziduala <50%).
Tratament finalizat in decembrie 2006
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M.T. 16 ani : Osteosarcom femur stg.Status postoperator
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Status postoperator
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M.T. 16 ani : Osteosarcom femur stg.
(+ 10 luni de la finalizarea tratamentului)• Oct.2007: control trimestrial
Clinic: junghi toracic
• Rgr pulmonara, CT pulmonar:
Suspiciune metastaza pulmonara unica lob superior stg.
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M.T. 16 ani : Osteosarcom femur stg.
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M.T. 16 ani : Osteosarcom femur stg.
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M.T. 16 ani : Osteosarcom femur stg.
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M.T. 16 ani : Osteosarcom femur stg.
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Evolutie :
• Excizia metastazei pulmonare: lobectomie• PCT postoperator : 3 cicluri
→ fara semne de evolutie 10 luni
• + 1 an (Nov. 2008): metastaza pulmonara unica → excizie chirurgicala
• + 1 an (Nov 2009): pleurezie de mare cavitate dr, hemoragica…..tratata cu antibiotice si evacuari repetate (!!!) 2 luni
- ex. Citologic negativ (!!!!)……Pleurezie metatstatica cu T. pulmonara inoperabila
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Interventie conservatoare cu grefon fixat cu tija ( genunchi imobilizat in extensie)
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Interventie conservatoare cu grefon fixat cu tija ( genunchi imobilizat in extensie)
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Interventie conservatoare cu grefon fixat cu tija ( genunchi imobilizat in extensie)
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Recidiva tumorala cu invazia tesuturilor moi dupa interventie conservatoare cu grefon fixat cu tijaMargini de excizie
neverificate intraoperator !!!
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Cu toate incertitudinile, viata poate fi frumoasa dupa un cancer