TUMOR TULANG

3 Pertanyaan 1. Lesi : tumor >< infeksi 2. Benigna >< maligna 3. Primer >< sekunder ( metastase) Tumor jelas pada X-Ray : Osteochondroma Tumor ganas primer : - 1% - 15-20, > 40 tahun Tumor ganas sekunder >>
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Gambaran Ro : - Besar - Korteks - Bentuk - Spongiosa - Kontur - Reaksi periost - Densitas - Jaringan lunak

Tipe tulang yang diserang : 1. Tumor primer : semua tulang tapi terutama : pelvis, tulang panjang ( tulang sekitar hip dan knee joints) 2. Tumor sekunder ( metastase) : tulang axial

Umur : Osteosarkoma Ewingsarkoma

: 10-15, > 50 tahun : 5-15 thn

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Lesi - Soliter : primer kecuali multiple osteochondroma - Multiple : metastase

Bagian tulang yang diserang : - Korteks : Fibrous cortical defect Non ossifying fibroma - Epifisis : Chondroblastoma - Subartikular : Giant cell tumor - Metafisis : Osteosarkoma - Diafisis : Ewingsarkom
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Batas Lesi : - Jinak :tegas korteks tipis reaksi periost (-) - Maligna :tidak tegas korteks destruksi reaksi periost (+) - Transition zone : Bila lebar tumor agresif infeksi
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Metastase Letak lesi axial Jumlah > 1 Gambaran :osteolitik osteoblastik ( sklerotik) campuran Asal primer gambaran berbeda
1. Ca mama : campuran 2. Ca prostat : osteoblastik 3. Ca ginjal : soliter, osteolitik
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OSTEOSARCOMA - Paling sering : 10-25, > 50 thn - Lokasi : sekitar lutut humerus proksimal pelvis - Ro : - osteolitik, tidak tegas - korteks periost keluar - reaksi periost/Codman : Sunray Lamelar - Ukuran destruksi - DD : 1. Osteomielitis 2. Ewing sarcoma
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Anteroposterior radiograph of a typical mixed sclerotic and lytic osteosarcoma arising from the right proximal humerus in a 16-year-old girl. The tumor has penetrated the bone and formed a soft tissue mass (stage IIB; see Table 4). Note the ossifications in the surrounding soft tissue (arrows).

Lateral radiograph of a sclerotic osteosarcoma (arrow) arising in the proximal metaphyseal region of the right tibia in a 16-year-old boy.
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Osteosarcoma arising from the right proximal humerus in a 16-year-old girl. (Left) Anteroposterior radiograph of the tumor (arrow) obtained before the institution of induction chemotherapy. (Right) Anteroposterior radiograph of the same tumor after two cycles of induction chemotherapy. Extensive calcification of the lesion (arrow) indicates a good 11 response to treatment

EWING SARCOMA - Pada diafisis - 5-15 thn - Ro : - Osteolitik, cepat korteks - reaksi periost : onion peel appearance - DD : 1. Osteosarcoma 2. Osteomielitis
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Osteochondroma

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RHEUMATOID ARTHRITIS Stage I : periarticular osteoporosis - soft tissue swelling Stage II : Celah sendi Stage III: Destruksi cartilago + tulang Stage IV : Ankilose

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OSTEOARTHRITIS 1. Osteofit 2. Celah sendi 3. Subchondral osteosklerotik

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GOUTY ARTHRITIS 1. Celah sendi 2. Subchondral osteosklerotil 3. Lesi lusen ( punched out) 4. Hypertrophic bone reaction 5. Ankilose

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