tri ariyani (03010270) osteosarcoma
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OSTEOSARCOMA
Pembimbing : dr. Radi Sp.OT
Disusun oleh : Tri Ariyani Astuti (!"#$%
&a'ultas 'edo'teran ni)ersitas Trisa'ti
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Anatomi tulang
Tulang terdiridari
". *one
matri+#. *one ,ell
Osteoblast
Osteosit
Osteo'last
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Defnisi
-eganasan yang
berasal dari selprimiti padabagian meta/sedari tulangpan0ang padaorang muda.
Pembentu'annya
dari seriosteoblast dari selmesen'im primiti
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Epidemiologi
1#2 dari seluruh neoplasma
sia "3#3an1 dan diatas 4 tahun
5o'asi yang paling sering ter'enaadalah tulang pan0ang dimana
lempeng pertumbuhannya yangsangat a'ti. Distal emur1pro'simal tibia dan /bula1
pro'simal humerus dan pel)is.
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Faktor resiko
". mur
#. Tinggi badan
!. 6enis 'elamin
7. Radiasi
4. Predisposisi geneti' : dysplasiatulang1 termasu' penya'it Paget1/brous dysplasia1 e,hondromatosis1dan hereditary multiple e+ostoses.
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-lasi/'asi tumor tulang
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Lokasipredileksi
Neoplasma ganastulang
Rahang Osteosar'oma1mieloma
Tulang tubularpan0ang
Osteosar'oma semua)arian1adammantinoma1histiositoma /brosa
maligna1/brosar'oma1limoma primer1'ondrosar'oma1angiosar'oma.
Predile'si
'husus&emur distal('orte'sposterior%
Tibia
Osteosar'omaperosteal
Osteosar'omaperiosteal
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8ela0a 'linis
". 9yeri#. Pembeng'a'an
pada atau diatas
tulang ataupersendian
!. -eterbatasan
pergera'an7. Massa
4. &ra'tur patologis
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Pemeriksaan penunjang
". 3ray lo'asi tumor tulang dan lo'asidestru'sinya
Cadman triangles danmasa 0aringan luna'
yang luas
Sunburst
appearan,e
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#.Ct S,an melihat gambaran'erusa'an 'orte+ dan trabe'ula tulang
!. MR;
melihat e+pansi tumor 'e 0aringan
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7.S'intigra/ (radionuclide bone scan) melihat si'lus pergantian tulang yang
men,ermin'an a'ti/tas osteoblast4.PET (positron emission tomography) mendete'si tumor primer ataumetastasi pada tulang
<. Patologi anatomi didapat'anstroma sar'oma denganpembentu'an osteoid neoplasti' dari
tulang disertai gambaran anaplasiayang men,olo'
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Diagnosis banding
". Sot tisue hematoma
#. Stess ra,ture
!. Tendon a)ulsion in0uries
7. *one ine,tion
4. E=ing>s sar,oma
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Penatala'sanaan
". Operasi
Intracapsular tumor 0ina' ? resi'o 'ambuhrendah1 menghilang'antumor yang td' dapatdisembuh'an sehingga
menghilang'an ge0alalo'al
Marginal tumor 0ina'
Wide grade "A1
'e'ambuhan "2Radical grade
""A@""*
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RADICAL REEC!I"N
LIM# PARIN$ %LIM# AL&A$E'PR"ED(R-)riteria *
+, tidak -ole. ada skip lesion/, Neoplasma di tulang dan
jaringan lunak di angkat tanpamem-a.a0akan 1ungsi aggotalengan
2, Rekonstruksi ter.adap residual
de1ect muda. ditangani-. !indakan*+, 3ide e4cision/, .ort diap.0seal segment
5ascularised or non5asculari6ed -one gra1t
2, Longer gaps
custom madeimplant
7, "steo8articular segment large allogra1t9allogra1t8prot.etic9endoprot.esis
AMP(!AI 9 DIAR!IC(LA!I"N
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#. -emoterapi
Mengurangi u'uran tumor
Men,egah metastasis Mening'at'an harapan hidup
:ika -ersama dengan operasi;angka .arapan .idup sekitar
<=>
"-at 0ang digunakan*Met.otre4ateDo4oru-icin
c0clo1os1amid
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!. Radioteraphy
Menghan,ur'an radiosensiti)e tumor
Terapi adu)an sebelum operasi
Radioterapy ? 'emoterapi
Tumor sensiti)e radiasi
Tumor yang tida' dapat di,apai1dioperasi
Tumor yang de'at dengan pembulu
darah besar
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Prognosis
Pening'atan harapan hidupdengan terapi =iderese,tion?'emoterapi
(42<2% Tumor3repla,ement implant dapat
berungsi dengan bai'.
-ompli'asi tersering adalahine'si
Asepti' loosening lebih umum
ter0adi pada pasien muda
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TER;MA-AS;