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Plenary Discussion Week 3: Group of 15-C
Plenary Discussion Week 3: Group of 15-C
Plenary Discussion Week 3: Group of 15-C
Group of 15-C
01 Terminology
02 Problem Identification
03 Problem Analysis
04 Scheme
05 Learning Objective
TERMINOLOGY
Terminology
Osteolytic
Increased osteoclast cells
or cells of bone destruction Onion Skin
caused by neoplasm Appearance
The description of an
Periosteal Reaction obscure bone destruction
The formation of new bone in the form of layers found
layer due to injuries that in the diafisis
stimulate the layer of the
periosteum Open Biopsy
in the form of retrieval and
examination to see
microscopic cell body by
incision or excision of
tissue yg will be taken.
PROBLEM IDENTIFICATION
Problem Identification
Growing pain--> muscle pain increased when doing activities on the damaged muscles
Pain can also be due to neoplasm bone-somatic pain quick and strong pains
Ewing sarcoma
Ewing sarcoma-> intermitten, progressive and symptoms occur in children and adoles
cents aged 10-20 years
Problem Analysis
2. What is the relationship of age and gender with
complaints suffered by Erwin?
The father was a laborer exposure to carcinogenic substances against the child
PAIN
QUALITY
RADIOTION
SEVERITY
TIME
The prognosis of the disease If treated early in a disease that is known, then the
prognosis is better
If left untreated the degree of severity is increasing handling the more difficult
prognosis gets worse with the survival rate decreases
Problem Analysis
7. Why does the doctor recommend Erwin
to immediately referred to?
Life expectancy :
Stadium 1 & 2 = 70%
Stadium 3 & 4 = 15-30%
SCHEME
LEARNING OBJECTIVE
Learning Objective
1. Ewing Sarcoma
2. Osteosarcoma
3. Giant Cell Tumor
4. Multiple Myeloma
5. Bone Cyst
6. Osteoid Osteoma
7. Osteocondroma
8. Osteoblast
9. Soft Tissues Benign
10. Soft Tissues Malignancy
Ewing’s Sarcoma
• Ewing’s sarcoma is a small round-cell tumor typically arising in the
bones, rarely in soft tissues, of children and adolescents.
• All are characterised by recurrent chromosomal
translocation involving 11 & 22 (85%) & 21 &22 (15%)
Epidemiology
Male : Female
1.3:1 < 10 yrs
1.6:1 > 10 yrs
CLINICAL MANIFESTATION
almostalwaysmetaphysealordiaphyseal
• Localised,painful, tendermas
• Systemicsymp.–fever,malaise,weight loss
• mistakenforOM
• disseminationoftumor
• Maymetastasizeto otherbones
• pathological fracture
RADIOGRAPH
• The lesion is poorly defined
• Permeative or moth-eaten
type of bonedestruction
• Aggressive periosteal
response
onion peel
codman triangle
sunburst appearance
Mortality Rate:
400 New Cases per year in the US
Kills 1470 people per year Worldwide.
Prognosis:
70% Survival Rate for those whose disease has not metastasized at
the time of diagnosis
30-50% Survival Rate for those people whose cancer has
metastasized
Surviving Patients can expect to live a long, healthy life in
remission
Giant Cell Tumor of Bone
introduction
• GCTs are benign tumors with potential for aggressive behavior and
capacity to metastasize.
• Amputation
– Severe disability
– Malignant tumor
– Recurrence after surgery
Multiple Myeloma
Introduction
Male Female
• Familial clustering
• African Americans
• Radiation
• Agriculture, Benzene, Radiation, Sheet metal work
• Chronic inflammatory disorders
Normal B cell Development
Pre B cell
IgM
B cell Follicles
Bone
Marrow Travel
Lymph Node
B cell finds “meaning”
“meaning”
B cell activation
Germinal Center
Formation
Plasma Cells travel
back to bone marrow
Memory B cell
“Activated B cell”
Plasma Cell
Properties of Plasma Cells
• Proliferate
• Secrete Immunoglobulins
• “Make space”
• Influence bone turnover
• Secrete Inflammatory mediators
Clinical Manifestations
• Symptoms • Signs
• Back Pain • Lytic lesions
• Fatigue • Anemia, pancytopenia
• Anorexia • Hypercalcemia
• Recurrent infection • Renal insufficiency
• Constipation • Monoclonal proteins
• Somulence • Organomegaly
• Fracture • Bone tumors
• Neuropathy • Hypogammaglobulins
Initial Diagnostic Workup
• Monoclonal gammopathy
• IgG > 3.5 g/dl and < 5 g/dl
• IgA > 2 g/dl and < 3 g/dl
• Urine light chains > 1 g/dl
• Bone Marrow Plasma cells
• Greater than 10% and less than 20%
• No anemia, renal insufficiency, hypercalcemia
• No lytic lesions or diffuse osteopenia
NCCN Treatment Guidelines
Treatment
• main treatment is still surgical, exciciary of tumor tissue
(stage 1-2 es internal excision) (stage 3 wide excision)
• Chemotherapy and radiation provide controversy
Soft Tissues Benign
LIPOMA
LIPOMA
Tumor jaringan lunak yang paling sering ditemuk
an, biasanya muncul antara usia 40 dan 60 tahun
Asimptomatik
Intestines Subkutis
nyeri benjolan
abdomen, teraba lunak,
perdarahan mobile
Saluran napas
Lipoma Tidak nyeri -
gagal
nyeri
napas
Esofagus
obstruksi, Sendi
disfagia, ROM terbatas
muntah
Diagnosis
Pemeriksaan Fisik
Anamnesis 1. Benjolan teraba lunak
2. Lobulasi Pemeriksaan Penunjang
1. Gejala klinis
3. Mobilitas bebas dari kulit 1. USG
2. Waktu pertumbuhan di atasnya (slippage sign)
lipoma lambat 2. CT-scan
4. Bentuk bulat atau
ireguler 3. MRI
5. Single atau multiple 4. Biopsi
6. Ukuran nodul ±2-10 cm
Diagnosis Banding
Eksisi Liposuction
Lipolisis
EKSISI
Liposuction
++ • Jaringan
lebih kecil
parut
• Jarum ukuran 16-gauge
dan jarum suntik ukuran
besar
• Anastesi dengan lidokain
dilusian
•
Lipoma lunak
Komponen
-- • Sulit eliminasi
sempurna
jaringan ikat • Sulit untuk
yang lebih kecil diagnosis
histopatologi
Lipolisis
• Injeksi
kortikosteroid
fosfatidilkolin
atau
Atrofi jaringan
adiposa
• Lipoma
berdiameter <2,5
cm
Fungsi otot
ROM terbatas Nyeri saraf
terganggu
Obstruksi
Perdarahan
lumen
Soft Tissues Malignancy
Introduction
• h/o Radiation therapy increases grade of tumors and risk for metastasis
• Chemical exposure
• Thorotrast, vinyl chloride, arsenic for hepatic angiosarcoma
• Genetic syndromes
• Neurofibromatosis – nerve sheath tumors
• Familial gastrointestinal stromal tumor syndrome – KIT mutation
• Skin hyperpigmentation, uticaria, cutaneous mast cell dx
Classification
• MRI
• For extremity masses
• Gives good delineation between muscle, tumor and blood vessels
• CT for abdominal and retroperitoneal
• PET
• May help determine high vs. low grade
• May be helpful in recurrences
Staging
Staging system predicts survival and risk of metastasis, but not local recurrence
**Does not take into account extremity vs. visceral
Relative risk for recurrence and survival
• Limb-sparing vs amputation
• Comparison study with post-op radiation in limb sparing showed no
difference in survival
• Amputation still may be indicated for neurovascular or bone involvement
Resection
• Small, low grade tumors resected with 2 cm margins may not require radiation
• Improves local control but not survival
• Whether improved local control leads to improved survival is controversial
Pre-op or post-op radiation?
• Some avoid pre-op use because of increased wound complications (although this
is debatable)
• RCT looking at wound complication rate pre-op vs post-op radiation showed
35% vs 17%
• Risk confined to lower extremity
• Conclusions: pre-op may be better for upper extremity and head & neck
because of equal wound complication risk and benefit of lower radiation
doses to more vital tissues
Pre-op vs post-op radiotherapy
Chemotherapy