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Bone Tumor - Dr. Andri R. Winoto, SpOT (K)
Bone Tumor - Dr. Andri R. Winoto, SpOT (K)
TISSUES
(bone)
ANDRI R. WINOTO
dr. SpOT(K) Hand and Microsurgery Reconstruction
Radiographic features
Scintigraphy (bone scan)
Computed tomograpphy
Arteriography (angiography)
MRI
Biopsy
Microscopic appearance
Primary Neoplasms and
Neoplasma-like Lesions
of Bone
Classifications:
World Health Organization,
Lichtenstein, Aegerter.
Primary neoplasms
1% of all age groups
Secondary neoplasms
Types of Specialists:
Orthopaedic surgeon
Radiologist
Patologist
Medical oncologist
General Considerations
incidence, pathogenesis, clinical features, diagnosis,
treatment
Incidence:
osteosarc-during childhood
GCT- during adult life
Site incidence
metaphyseal regions
A.Oteogenic
Osteoma
osteochondroma
osteochondroma
RATE OF GROWTH
(Lodwick)
Grade 1
1a. Sclerotic margin
without complete cortical
penetration
1b. Sharp margin, non-sclerotic
margin without total
cortical penetration
1c. Poorly defined margin,
totally penetrated the
cortex
Grade 2
geographic lesion + moth-eaten
and/or permeative destruction
Grade 3
motheaten and/or permeative
destruction only
PERIOSTEAL REACTIONS
Radiographic Features Osteosarcoma
Expansion
Codmans triangle
Onion skin
Sunburst appearance
Pathological fracture
chondrosarcoma
D. Myelogenic
Ewings tumor
SURGICAL STAGES
Stage I: (G1,T1,Mo)
Low-grade,
intracompartmental,
metastase (-)
Stage IB:(G1,T2,Mo)
low-grade, extracompartmental,
metastase (-)
Stage IIA:(G2,T1,Mo)
High-grade,intracompartement.
Metastase (-)
Stage IIB:(G2,T2,Mo)
High-grade,extracompartment.
Metastase (-)
Stage IIIA: (G1 or G2,T1,M1)
Intracompartment,
metastase (+)
Stage IIIB:(G1 or G2,T2,M2)
Extracompartment,
metastase(+)
Principles of Treatment
Accurate diagnosis
Benign neoplasms and non-malignant
lesion: surgically (excision,
curettement, bone grafting)
EARLY DETECTION
(VERY EXPENSIVE)
LATE must be AMPUTATION
(paliative treatmant)
SO
PREVENTION
HEREDITARY
SOSIAL PROBLEM