tumor tulang pp
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crohn's disease referatTRANSCRIPT
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TUMOR-TUMOR TULANG
Rachmat SalehBagian Radiologi
Fak. Kedokteran Unhas
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Klasifikasi histologis tumor-tumor tulang berdasarkan : Pemeriksaan sitologi
osteocyte/osteoblastchondrocyte/chondroblastosteoclast,etc
Bentuk (Arsitektur) Tipe dari matriks yang dihasilkan oleh sel tumor
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Tumor Primer (primary bone tumor) Tumor Jinak (Benign Tumor)
Giant cell tumor Tumor Ganas (Malignant Tumor)
Osteosarcoma Tumor sekunder / secondary bone tumor (metastase) Lesi mirip tumor / Tumor like lesion
Aneurysmal bone cyst
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Proliferasi sel stromal mononuklear Osteoclastik multinucleated giant cell
Usia : 20–45 th Lokalisasi : Metafisis Epifisis Subartikuler Predileksi :
Distal femur proximal tibia distal radius sacrum
Metastasis ke paru 2% Gejala klinis :
Nyeri istirahat Local swelling Pergerakan sendi sekitar terbatas Fraktur patologis (10-12%) Gejala neurologis (spine lesion)
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Radiologis Central/eksentrik, ekspansif Lesi radiolusen (litik) Batas tidak tegas Bersepta-septa (foam like app.) Zona transisi antara tulang normal dan patologik (<1 cm) Penipisan korteks dan + periosteal reaction
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A. GCT of the distal femur in a 68-year-old woman. AP radiograph shows the lesion (arrows) approaching the end of the bone. B. GCT of the distal radius in a 16-year-old girl. Radiograph shows that the giant cell tumor originates in the metaphysis (asterisk), and in this patient with a partially open physis, the tumor has crossed the physis (black arrow) and extends to the end of the bone
A B
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Malignant bone producing tumor Pertumbuhan tak terkendali dari osteoblast dan
osteoclast Usia : 10–30 th Lokalisasi : >> metafisis tulang panjang Predileksi :
Distal femur Proximal tibia, Hip Shoulder
Metastasis ke paru , tulang, kel. limfe Gejala klinis nonspesifik
Nyeri Swelling Riwayat trauma Fraktur patologis (15-20%)
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RadiologisBentuk osteolitik
Batas tidak tegas Periosteal new bone formation Codman’s
triangle Kalsifikasi dan pembengkakan
Bentuk osteoblastik/osteogenik Batas irregular Kalsifikasi jaringan lunak densitas Reaksi periosteal Sunray/sunburst app. Soft tissue swelling
DD/Ewing’s sarcoma Onion skin app.
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Osteosarcoma of the distal femur with periosteal reaction and so tissue mass. a Anteroposerior radiograph of the distal femur shows a small triangle of interrupted periosteal reaction (arrow) at the superior margin or the tumor (Codman triangle). Note that the lesion shows areas of sclerosis (large asterisk) and lysis (small asterisk). b Lateral radiograph shows the associated so tissue mass (arrows) to better advantage
a b
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a.Osteosarcoma of the distal fibula-predominantly osteoblastic. Amorphous calcification/ossification is present in the soft tissues withcortical destruction and a little periosteal new bone formation.b. Osteosarcoma of the distal femur predominantly chondroblastic. Note the well-defined soft-tissue mass and radiating spiculation of calcification within it. Sclerosis and lysis are present within the medullary cavity that is slightly expanded
a b
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Reactive vascular phenomenon or secondary to another lesion or trauma
Klasifikasi : Primary ABC (70%) Secondary ABC (30%)
Usia : 5–20 th Lokalisasi : >> metafisis tulang panjang, short tubular
bones, pelvis, axial and craniofacial skeleton
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Predileksi : Femur Tibia Humerus Vertebrae
Gejala klinis : Nyeri dan bengkak < 6 bulan pulsatile Fraktur patologis (15-20%) nyeri akut
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Classification of morphological types of ABC. Type I, central with little expansion; type 2, central with expansion and cortical thinning; type 3, eccentric with involvement of only one cortex; type 4, subperiosteal extending ‘outwards’ with intact or only superficially eroded cortex; and type 5, subperiosteal with growth both outwards and centrally towards the medulla, with cortical destruction
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Radiologis Destruksi tulang radiolusen Lesi ekspansif Korteks menjadi sangat tipis dan mengembung keluar
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TERIMA KASIH