TUMOR TULANG

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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

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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 : 10-15, > 50 tahun
- Ewingsarkoma : 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
response to treatment 11
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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