TUMOR TULANG

Oleh:
Heriyanti Hanna Tamara
FAA 112 030

KEPANITERAAN KLINIK
SMF BEDAH
FAKULTAS KEDOKTERAN UNIVERSITAS PALANGKA RAYA
RSUD dr.DORIS SYLVANUS
PALANGKA RAYA
2017
 Giant Cell Tumor
Giant cell tumor of bone is a type of benign
(noncancerous) tumor that grows at the ends
of the body's long bones. Most often, the
tumors develop at the lower end of the femur
(thighbone) or upper end of the tibia
(shinbone), close to the knee joint.
 Giant Cell Tumor

Illustration shows a giant cell tumor at Formed by the fusion of

the lower end of the thighbone. This is several cells, giant cells show
a common location for the tumors to multiple nuclei when viewed
occur. under a microscope.
 Giant Cell Tumor

Other common locations include the:

Wrist (lower end of the lower arm bone)
Hip (upper end of the thighbone)
Shoulder (upper end of the upper arm bone)
Lower back (connection of the spine and
pelvis)
Most giant cell tumors occur in patients between 20
and 40 years of age. Only rarely do they occur in
children or in adults older than 65 years of age.
They occur slightly more often in females.

While giant cell tumors are typically benign

(noncancerous), they can grow quickly and destroy
bone close to a joint. In rare cases, a giant cell
tumor may spread, or metastasize, to the lungs.
 The most common symptom of a giant cell
tumor is pain in the area of the tumor. The
patient may also have pain with movement of
the nearby joint. This pain usually increases
with activity and decreases with rest.
 X-Ray

X-rays from the front (left) and side (right)

X-ray shows a giant cell
show a giant cell tumor in the lower end of
tumor in the lower end of
the thighbone.
the radius bone in the wrist
 MRI

MRI scan shows a giant cell

tumor at the upper end of
the shinbone.
 Aneurisme Bone Cyst
Non-neoplastic expansile lesion consisting of blood filled spaces separated by
connective tissue septa containing bone or osteoid and osteoclast giant cells
etiology unknown
may be primary or secondary;
an uncommon expansile osteolytic lesion of bone consisting of a proliferation
of vascular tissue that forms a lining around blood filled cystic lesion;
it develops in metaphyseal region of long bones, pelvis, vertebral posterior
elements;
it commonly involves the proximal humerus, femur, tibia, and pelvis;
can cause paraplegia when it involves the vertebral posterior elements;
 Aneurisme Bone Cyst
epidemiology:
peak incidence in 2nd decade
80% by age 20
male : female is 1:1.3
incidence is 0.14 / 100,000
1% of bone tumors
 Aneurisme Bone Cyst
In a published review of 897 cases of ABC, the following rates of
occurrence were reported [16] :
Tibia 17.5%
Femur 15.9%
Vertebra 11.2%
Pelvis 11.6%
Humerus 9.1%
Fibula 7.3%
Foot 6.3%
Hand 4.7%
Ulna 3.8%
Radius 3.1%
Other 9.2%
 Aneurisme Bone Cyst
Radiographs:
radiolucent lesion w/ expanded
cortex arising in medullary canal of
metaphysis;
aneurysmal expanded appearance
of cortex is contained by periosteum
& thin shell of bone;
marked cortical thinning and erosion
and periosteal elevation;
this lesion rarely penetrates the
articular surface or growth plate;
Aneurisme Bone Cyst

Radiograph shows an eccentric

diaphyseal tumor of the ulna
extending into the soft tissues
that is demarcated by a rim of
bone.
Aneurisme Bone Cyst
Aneurisme Bone Cyst

ABC in the proximal phalanx

 Osteosarcoma
Osteosarcoma (OS) is a malignant spindle cell
sarcoma in which the malignant cells produce
osteoid or bone in the background of a
sarcomatous stroma.
Osteosarcoma
X-ray of knee joint
anteroposterior views
showing surface
osteosarcoma: (a) parosteal
(b) periosteal. See the under
lying cortex is visibly intact in
'a' and lifting of periosteum
in 'b' (red arrow). However,
both are on the surface of
the bone
Osteosarcoma
 Osteosarcoma

(a) X-ray anteroposterior and lateral views of proximal tibia and knee joint showing
diaphyseal osteosarcoma of tibia with sclerosis (arrow), cortical destruction on
posteromedial side (arrow heads) and new bone formation in the soft tissues (b) x-
ray distal end of femur (anteroposterior and lateral views) showing sclerosis/radio-
opacity in sclerosing osteosarcoma
 Osteosarcoma

X-ray of humerus anteroposterior

view showing osteosarcoma of the
proximal humerus- typical sun burst
or sun ray appearance, new bone
formation in soft tissues, and
Codman's triangles (arrows)
 Multiple Myeloma

Most common primary

malignant bone tumor
Older adults
Imaging: sharply
circumscribed lytic
lesions or diffuse
demineralization.
Isolated myeloma lesion
without systemic
marrow involvement is
called a plasmacytoma.
 Multiple Myeloma

Multiple punched-out lesions in the skull.

This pattern is very characteristic fot multiple myeloma.
Also known as Swiss cheese-pattern.
 Multiple Myeloma

Multiple small osteolytic

lesions in a patient with
multiple myeloma.
 Ewing sarcoma
Ewing sarcoma is a malignant bone tumor that
forms in the bone or soft tissue. It affects
mostly teens and young adults.
Ewing sarcoma
 Ewing sarcoma
Ewing's sarcoma in diaphysis of the femur. Notice ill-
defined zone of transition (blue arrow) and aggressive
type of periosteal reaction (red arrows)
 Ewing sarcoma
Here a young patient with an ill-defined lytic lesion of the distal humerus.
There is irregular cortical destruction and partially interrupted periosteal reaction.
Final diagnosis: Ewing's sarcoma.
Diff. diagnosis: osteosarcoma.
TERIMA KASIH