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8/11/2019 Ringkasan PA

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1.ENCHONDROMA

Age : 10 60 y.oLocation :

- diaphyseal and or metaphyseal portion of the bone,metacarpal, proximal

and middle phalanx,rare in the distal phalanx.

X-Ray :- Radiolucent

- Often well defined round or ovoid

- Expanding and slightly thinning the cortexMicroscopic :

- Relative hypocelluler,Abundant hyaline cartilage matrix

- formed multiple nodule of cartilage,separated one another by bone marrow

Treatment : Curetage and bone grafting

2.CHONDROSARCOMA

Age : 30 60 Y.O Rare < 20 yo

Location : pelvis, femur, ribs,shoulder girdle,and humerusX-Ray :

- Fusiform,lucent defect with scalloping of the inner cortex

- Periosteal reaction- Extentsion into soft tissue

- Punctata or stippled calcification

Microscopic :

- Abundant blue gray cartilage matix

Gazali/ketut suyasa/suluh/jaya/arman/albert juli05


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Treatment : Enbloc excision

4.CONVENTIONAL OSTEOSARCOMAAge : 10 25 y.o (75%)

Location : Distal femur,proximal tibia and humerus

X-ray :- Destructive lesion of metaphyseal

- Typically mixture of lytic and blastic

- White zone of transition

- Triangular shaped area of periosteal new bone formation (codman triangle)Microscopic :

- Composed of highly pleomorphic tumour in which the tumour cells maybe

: Osteoclast,chondroblast,or spindle cells (fibroblast)- that produced osteoid matrix



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Telangiectatic Osteosarcoma characterized by numerous large spaces filled with bloodand separated by fibrous septa.

Intrraosseus well differentiated low grade osteosarcoma, composed mainly of fibrous and

osseus tissue with cellular atypia or mitotic activity

Round cell osteosarcoma with histological features of both ewing sarcoma andosteosarcoma

SURFACE OSTEOSARCOMAParosteal osteosarcoma consists of mass of bone trabeculae often mature and lamellar.

Trabeculae are separated by fibrous tissue composed of spindle cells minimally

pleomorphic and few mitotic.Fibroblast predominanlyPeriosteal Osteosarcoma containts predominantly low or medium grade malignant

cartilage. (Chondroblast).Tumour produced fine lace like osteoid



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High grade surface osteosarcoma : Highly malignant histological features

Treatment :-

Wide excision

- Multi agent chemotherapy neo adjuvant and adjuvant

5.FIBROSARCOMA

Age : 30 60 y.oLocation : Commonly around the knee

X-ray :

- Osteolytic lesion with margine well defined to ragged and mouth eaten- Periosteal reaction with cortical destruction

- Extension into soft tissue

Microscopic :

- Pleomorphic spindle sheet fibroblast, abundant mitosis and hyperchromaticnuclei.

- The herring bone pattern of fascicles of cells

Treatment :

- Radical excision and adjuvant radiation therapy



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6.MFH

Age :> 40 y.o male > femaleLocation : Long bones of lower extremity

X-ray : Not specific , Aggressive permiative lesion

Microscopic :

-

Consist mainly of mixed population of spindle cells,histiocytoid andpleomorphic cells

- Nucleous quite atypical

- Varying amount of multinucleated giant cell- Characteristic storiform pattern commonly seen in the fibroblastic area

Treatment :- Depend on grade

- Neo adjuvant chemotherapy may reduce the tumor and increase the

chances of limb sparing procedure- Local recurrent are common,metastatic to the lung lymphonodus,liver, and

bone

7.GIANT CELL TUMOUR (GCT)Age : 20 40 y.o

Location : Ephypisis of long bone :

- Lower end of the femur- upper end of the tibia

- Distal radius

X-ray :- Osteolytic destructive lesion in the metaphyseal extend to the epiphysis

- Often border the subchondral bone

Microscopic :

- Spindle shaped cells or ovoid cells- Numerous multinucleated giant cell with nucleus 20-100

- The nucleus of giant cell is the same with the mono nucleus cell within the

matrix.



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Primary malignant GCT- Spindle shaped cells or ovoid cells

- Numerous multinucleated giant cell with nucleus 20-100

- Variation of mononucleus cells

Treatment :

- Curetage and Cementation- For distal radius stage 2 : Resection and Reconstruction

8.EWING SARCOMAAge :5-15 y.o

Location : Diaphysis femoral,ileum,tibia,humerus,fibula,ribs.

X-ray :

- Osteolyitc lesion- Bone destruction is often with patchy reactive bone formation.

-

Periosteal bone formation with onion skin appearance.Microscopic :- Small, round, neoplastic cell with large hyperchromatic nuclei in lobulated

pattern separated by fibrous tissue

- Mytotic are common- Pseudorosette pattern are typical

- Ghost cells

- Cytoplasma less



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Treatment :

- Chemotherapy- Radiotherapy

- Wide surgical resection

9. MYELOMA

Age :50 80 y.oLocation : Spine,Ribs,Skull,Pelvic,sternum,metaphysis of the long bone

X-ray :

- Punched out lytic

lesions,expansion and ballooned

Bone Scan (Failed)

appearance,osteopenia

-

Microscopegate immature plasma

-

romatic neoplastic

- tric nucleus

plasmacys

reatment :herapy

ic :- Aggr

cells with little intervening

stroma

Hyperchplasma cell

Round eccen

- Prominent nucleolus- Abundant binucleated

T- Radiot



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- Surgical stabilization for impending fracture

Prognosis

10. LYMP

ge :Adult,Male predominance

- Non specific,in long bone diaphysis preferentially

- f lytic and scleroticrea transition

one scan almost always positive

- Disseminated disease --chemotherapy: 5 year survival rate under 30 %

HOMA MALIGNUM

A

Location : Bone with red marrow ; femur,spine,pelvis

X-ray :

involved

Mixture o- Poorly demarcated with wide a

- Periosteal new bone formation is unusual

B

Microscopic :

- Characteristic growth pattern tends to leave behind normal structures (suchas medullary bone and marrow fat cells)

- Large cell,with nuclei large,cleavaged appearance

- Associated with infiltrate of lymphocytes

Treatment : Radiation and chemotherapy

11. CHORDOMA

Age :More than 40 y.o,men are more common

Location : The Sacral region , spino occipital regions

X-ray :- Bone destruction at the sacral cortical margins,and neural foraminal



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- CT scan mid line bone destruction and a soft tissue mass with irregular

mineralizationMicroscopic :

- Lobular tissue with physaliporous cell (cord and sheets of highly

vacuolated cell

-

Mucoid intercellular material

Treatment :

- Resection wide surgical margin- Radiotheraphy added if wide margin is not achieved

12.Rhabdomyosarcoma

Age : < 20 y.o

Location :

- Lower limb (Adult rhabdomyosarcoma)- Head and neck (Embrional rhabdomyosarcoma)

X-ray :not specific

Microscopic :

- Spindle shaped cells in parallel bundles

- Multinucleatid giant cells- Racquet shaped cells (tade pole)

- Cross strations within the tumor cells (Rhabdomyoblast)



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