Sei sulla pagina 1di 21

OSTEOCHONDROMA

CASE REFLECTION

OF

PEMBIMBING : DR. YANA SUPRIYATNA , PHD, SP. RAD (K) BENNY YOHANIS GAE

STASE RADIOLOGI RSUP SARDJITO

IDENTITAS

   
 

Nama

: Tn. BS

 

Usia

: 18 th

Alamat

: Imogiri, Bantul

Pekerjaan

: Mahasiswa

No RM

: 01.46.4X.XX

Tanggal masuk

: 25/4/2018

   
ANAMNESIS Keluhan Utama : Benjolan di lutut kanan yang mulai dirasakan ± 1,5 TSMRS, teraba keras,
ANAMNESIS
Keluhan Utama : Benjolan di lutut kanan yang mulai dirasakan ±
1,5 TSMRS, teraba keras, tidak bergerak, nyeri (-), penurunan BB
(-), batuk (-). HMRS keluhan menetap.
RPD : keluhan yang sama (-), tumor (-), riw. trauma (-)
RPK : keluhan yang sama (-), tumor (-).
Pemeriksaan fisik dalam batas normal. Status lokalis genu dextra :
◦ Look : Lump (+) di posterior knee Dextra Ø 5 cm
◦ Feel : Terfiksir, NT (+), NVD (-)
◦Move : Limited due to pain
Pemeriksaan laboratorium dalam batas normal

Tampak foto genu dextra, proyeksi AP dan lateral, kondisi cukup, hasil :

Tampak soft tissue swelling di aspek posterior articulatio genu D & os femur D

Trabekulasi tulang baik

Tampak eksostosis di margo posterior os femur D pars tertia distal bentuk pedunculated, dengan arah menjauhi sendi, cartilago cap (+),

densitas sama dengan os femur

Tak tampak diskontinuitas pada sistema tulang yang tervisualisasi

Tampak facies articularis licin

Tak tampak osteofit maupun subchondral sclerotic

Kesan :

Osteochondroma margo posterior os

femur dextra pars tertia distal tipe

pedunculated

Tampak eminantia intercondilar bilateral tak meruncing

Tak tampak penyempitan maupun pelebaran joint space

PRO EKSISI
PRO EKSISI

DISCUSSION

Introduction Osteochondroma is a bony exostosis projecting from the external surface of a bone. Tend to

Introduction

Introduction Osteochondroma is a bony exostosis projecting from the external surface of a bone. Tend to

Osteochondroma is a bony exostosis

projecting from the external surface of

a bone.

Tend to stop growing when normal

growth finished

Occas. pelvis, scapula, ribs -> mostly

sessile

Short tubular bones -> rare

INCIDENCE 45 % of benign bony tumours 12 % of all bony tumours Become evident <

INCIDENCE

45 % of benign bony tumours

12 % of all bony tumours

Become evident < 20 yrs

Solitary or multiple

Any enchondral ossification bone

Solitary Osteochondroma  Osteochondromatous exostosis ; osteocartilaginous exostosis  10% of all bone tumors ; 85%

Solitary Osteochondroma

Osteochondromatous exostosis ; osteocartilaginous exostosis 10% of all bone tumors ; 85% of individual with osteochondroma M:F = 3:1 Common during childhood or adolescence Appendicular skeleton, mostly long bones of lower limbs Knee (40%), prox. portion of femur and humerus Metaphysis, diaphysis (rare)

Multiple Osteochondromas  Hereditary Multiple Exostosis; Multiple cartilaginous exostosis; hereditary osteochondromatosis  15% of patient with

Multiple Osteochondromas

Hereditary Multiple Exostosis; Multiple cartilaginous exostosis; hereditary osteochondromatosis 15% of patient with exostosis Tends to be large and sessile Predilection site, age, and sex similar to solitary

Pathogenesis-Etiology Herniation of peripheral portion of the physis -> causes idiopathic, trauma Mutation on EXT1 &

Pathogenesis-Etiology

Herniation of peripheral portion of the physis -> causes idiopathic,

trauma

Mutation on EXT1 & EXT2 gene

Pathogenesis-Etiology Herniation of peripheral portion of the physis -> causes idiopathic, trauma Mutation on EXT1 &
Clinical Manifestation Around the knee Mostly asymptomatic Mass ; pain optional ◦ Mechanical mass effect ◦

Clinical Manifestation

Around the knee

Mostly asymptomatic

Mass ; pain optional

Mechanical mass effect Fracture of the stalk

Continue to grow until skeletal maturity

Slowly increasing bulging with hard

consistency

TYPES

TYPE

SESSILE

PEDUNCULATED

Incidence

Uncommon

Common

Location

Proximal humerus

Knee , hip and ankle

and scapula

Appearance

Flat plateau like stalk producing a broad based protuberance

Elongated bony stalk merging with the host bone .The hyaline cap is lobulated giving its appearance

  • Grows out from the medullary canal

  • Cortex of the bone becomes cortex of the lesion

  • Never sits on an intact cortex

  • Increase of Malignant if cartilage cap is thicker than 2.5 cm in aduts

X-Ray Appearance Well-defined exostosis emerging from metaphysis, base co-extensive with parent bone In metaphyseal region projecting
X-Ray Appearance Well-defined exostosis emerging from metaphysis, base co-extensive with parent bone In metaphyseal region projecting

X-Ray Appearance

Well-defined exostosis emerging from metaphysis, base co-extensive with parent bone

In metaphyseal region projecting

away from epiphysis

Looks smaller than it feels -> cartilage

is invisible

Cartilage degeneration and

calcification -> bony exostosis surrounded by clouds of calcified

material -> cauliflower appearance

Sessile Type Broad base ↑ risk of malignant degeneration

Sessile Type

Sessile Type Broad base ↑ risk of malignant degeneration
Sessile Type Broad base ↑ risk of malignant degeneration

Broad base

↑ risk of malignant

degeneration

Pedunculated Type Narrow stalk

Pedunculated Type

Pedunculated Type Narrow stalk
Pedunculated Type Narrow stalk

Narrow stalk

Complications Malignant transformation mostly occurred for HME (6%) rather than solitary (1%) Features suggestive : ◦

Complications

Malignant transformation mostly occurred for HME (6%) rather

than solitary (1%) Features suggestive :

Enlargement of the cartilage cap in successive examinations A bulky cartilage cap (more than 1 cm in thickness) Irregularly scattered flecks of calcification with the cartilage cap Spread into the surrounding soft tissues

Management Asymptomatic lesions require no treatment For symptomatic lesions -> excision ◦ Neurovascular compression ◦ Limitation

Management

Asymptomatic lesions require no treatment

For symptomatic lesions -> excision

Neurovascular compression Limitation of joint movement Fracture of the base

Referensi

De Souza, AMG & Bispo Junior, RZ. Osteochodroma : ignore or investigate?. Rev Bras Ortop. 2014;49:555-

564.

Kumar, V, et al. Robbins basic pathology. 2013. 9 th ed. Elsevier, Philadelphia. Solomon, L, et al. Apley’s system orthopedic and fracture. 2010. 9 th ed. Taylor & Francis, USA. Radiopedia.org

Orthobullets.com