NEOPLASMA OBJECTIVES: To explain biocellular activity and pathology of bone tumor To understand the clinical and prevalence of bone tumor To assess bone tumor based on multidiciplin Should be able early detection of bone tumor To explain the principle and moran of bone tumor management Objektif pembelajaran neoplasma…………..

NEOPLASMA BENIGN BONE TUMOR MALIGNANT BONE TUMOR

NEOPLASMA ETIOLOGY GENETIC RADIATION CHEMISTRY TRAUMA CHRONIC LYMPHEDEMA INFECTION

BONE TUMOR BASED ON AGE OSTEOMIELITIS Simple bone cyst Ewing sarcoma Metastasis Metastatic neuro-blastoma Aneurysmal bone cyst Giant cell tumor Multiple myeloma Nonossifying fibroma Osteosarcoma Fibrosarcoma Eosinophilic granu-loma Malignant fibrous histiocytoma Osteomyelitis Chordoma Enchondroma Chondroblastoma Chondromyxoid-fibroma Osteoblastoma Fibrous dysplasia Osteofibrous dysplasia

BONE TUMOR Asal Jaringan Benign/Jinak Malignant/Ganas 1. Kartilago Khondroblastoma (umur 8 sampai maturitas, jarang, lokasi di epifisis) Khondromixoid fibroma (adolescent, eccentric, metafisis, tibia) Enkhondroma (dewasa muda, jari, dan metakarpal, speckled calcification) Osteokhondroma (Anak-anak atau teneeger, cartilaginous cap on bony stalk) Khondrosarcoma (>40, lokasi pusat metafisis, kalsifikasi Fibrosarcoma/ malignant fibrous histiocytoma (dewasa tua, metafisis,litik) Osteosarcoma (dekade kedua, metafisis, tulang panjang, mixed blastic dan lityc area) Osteosarcoma sekunder (asal peny. Paget atau irradiasi tulang) Catatan: asal tulang, kartilago, dan jaringan fibrosa

BONE TUMOR Asal Jaringan Benign/Jinak Malignant/Ganas 2. Tulang Osteoid osteoma (anank-anak-anak dan teneeger, nyeri di malam hari dan dengan dosis kecil NSAIDs) Osteoblastoma (anak-anak, dewasa muda, jarang, tulang belakang)

BONE TUMOR Asal Jaringan Benign/Jinak Malignant/Ganas 3. Elemen sumsum tulang/bone marrow Eosinophilic granuloma (anak-anak muda, “hole in bone”) Ewing sarcoma (dekade kedua, dapat distimulasi oleh OSTEOMIELITIS, litic) Leukemia (anak-anak muda, anggota gerak, tulang belakang) Multiple myeloma atau plasmacytoma (umur > 40, tulang belakang dan pelvis)

BONE TUMOR Asal Jaringan Benign/Jinak Malignant/Ganas 4. Jaringan fibrosa Nonossifying fibroma (anak-anak dan teneeger, metaphysis eccentric) Fibrous dysplasia (umur 6 sampai maturitas, diaphyseal, bony deformity, limb shortening)

BONE TUMOR Asal Jaringan Benign/Jinak Malignant/Ganas 5. Tissue of uncer-tain origin Aneurysmal bone cyst (anak-anak dan teneeger, metafisis, expansile) Giant cell tumor (dewasa muda, epifisis dan metafisis, eccentric dan lytic) Simple bone cyst (anak-anak dan teneeger, metafisis, lytic)

SYMPTOM AND SIGN OF BONE TUMOR IDENTIFICATION OF SYMPTOM AND SYMPTOM: Deep aching pain, pathologic fracture (osteoid osteoma) or keluhan benjolan. AGE PATIENT > 40: Metastasis tumor (paru-paru, payudara, prostat, tiroid, and kidney TUMOR IDENTIFICATION: Pain, location, mobilization, ROM decreasing, limping, body weight decreasing, and adenopathy. RADIOGRAPHS DESCRIPTION: Circumcribed/uncircumscribed, periostela elevation, Codman triangle, calcification/blastic or lytic, eccentric/central

HOW TO DIFFERENTIATE BENIGN AND MALIGNANT BONE TUMOR INTERMEDIATE SLOW SPEED UP LOCAL INVASSIVE CAPSULLATED INFILTRATIF A LITTLE BIT METASTASIS GOOD PROGNOSIS HEMATOGEN/LYMPHOGEN BASAL CELL CARCINOMA BAD PROGNOSIS

BONE TUMOR DIAGNOSIS BONE TUMOR COMPLAINT PHYSICAL EXAMINATION: LOOK, FEEL, AND MOVE INVESTIGATION: RADIOGRAPHS AND LABORATORIES DATA, FNAB (Fine Needle Aspiration Biaopsy)

EARLY DETECTION OF BONE TUMOR

BENIGN POPULASI HOSPITAL OBSEVATION RISK FACTOR EARLY DETECTION MALIGNANT BENIGN HOSPITAL OBSEVATION RISK FACTOR Armis - 2010

A B History Physic. Exam. Add. Exam: lab,& X-ray Tumor suspected Observation Surgery Non-surgery: Drugs Chemotherapy Terapi radiasi History Physic. Exam. Add. Exam: lab,& X-ray Tumor suspected Expert/Hosp. (oncologic team) BIOPSI ASPIRASI DIAGNOSIS BENIGNA MALIGNA Second. tumor THERAPY Primary tumor Additional Examination Refer History, physical exam., lab. & X-ray reevaluation Armis 2004 A B