TUMOR-TUMOR TULANG

Rachmat Saleh
Bagian Radiologi
Fak. Kedokteran Unhas

Klasifikasi histologis tumor-tumor tulang

berdasarkan :
Pemeriksaan sitologi
osteocyte/osteoblast
chondrocyte/chondroblast
osteoclast,etc
Bentuk (Arsitektur)
Tipe dari matriks yang dihasilkan oleh sel tumor

 Tumor Primer (primary bone tumor)

Tumor Jinak (Benign Tumor)

Giant cell tumor
Tumor Ganas (Malignant Tumor)
Osteosarcoma
Tumor sekunder / secondary bone tumor (metastase)
Lesi mirip tumor / Tumor like lesion
Aneurysmal bone cyst

Proliferasi sel stromal mononuklear Osteoclastik

multinucleated giant cell
Usia : 2045 th
Lokalisasi : Metafisis Epifisis Subartikuler
Predileksi :

Distal femur
proximal tibia
distal radius
sacrum

Metastasis ke paru 2%
Gejala klinis :
Nyeri istirahat
Local swelling
Pergerakan sendi sekitar terbatas
Fraktur patologis (10-12%)
Gejala neurologis (spine lesion)

Radiologis
Central/eksentrik, ekspansif
Lesi radiolusen (litik)
Batas tidak tegas
Bersepta-septa (foam like app.)
Zona transisi antara tulang normal dan
patologik (<1 cm)
Penipisan korteks dan + periosteal reaction

A. GCT of the distal femur in a 68-year-old woman. AP radiograph shows the lesion (arrows)
approaching the end of the bone. B. GCT of the distal radius in a 16-year-old girl. Radiograph shows
that the giant cell tumor originates in the metaphysis (asterisk), and in this patient with a partially
open physis, the tumor has crossed the physis (black arrow) and extends to the end of the bone

Malignant bone producing tumor

Pertumbuhan tak terkendali dari osteoblast dan osteoclast
Usia : 1030 th
Lokalisasi : >> metafisis tulang panjang
Predileksi :

Distal femur
Proximal tibia,
Hip
Shoulder

Metastasis ke paru , tulang, kel. limfe

Gejala klinis nonspesifik

Nyeri
Swelling
Riwayat trauma
Fraktur patologis (15-20%)

Radiologis
Bentuk

Batas tidak tegas

Periosteal new bone formation Codmans triangle
Kalsifikasi dan pembengkakan

Bentuk

osteolitik

osteoblastik/osteogenik

Batas irregular
Kalsifikasi jaringan lunak densitas
Reaksi periosteal Sunray/sunburst app.
Soft tissue swelling

DD/
Ewings

sarcoma Onion skin app.

Osteosarcoma of the distal femur with periosteal reaction and so tissue mass. a
Anteroposerior radiograph of the distal femur shows a small triangle of interrupted
periosteal reaction (arrow) at the superior margin or the tumor (Codman triangle). Note
that the lesion shows areas of sclerosis (large asterisk) and lysis (small asterisk). b Lateral
radiograph shows the associated so tissue mass (arrows) to better advantage

a.Osteosarcoma

of the distal fibula-predominantly osteoblastic. Amorphous calcification/ossification is present in the soft

tissues withcortical destruction and a little periosteal new bone formation.
b. Osteosarcoma

of the distal femur predominantly chondroblastic. Note the well-defined soft-tissue mass and radiating
spiculation of calcification within it. Sclerosis and lysis are present within the medullary cavity that is slightly expanded

Reactive vascular phenomenon or secondary to another

lesion or trauma
Klasifikasi :
Primary ABC

(70%)
Secondary ABC (30%)

Usia : 520 th
Lokalisasi : >> metafisis tulang panjang, short tubular
bones, pelvis, axial and craniofacial skeleton

Predileksi :
Femur
Tibia
Humerus
Vertebrae

Gejala klinis :
Nyeri

dan bengkak < 6 bulan pulsatile

Fraktur

patologis (15-20%) nyeri akut

Classification of morphological types of ABC. Type I, central with little expansion; type 2, central with
expansion and cortical thinning; type 3, eccentric with involvement of only one cortex; type 4,
subperiosteal extending outwards with intact or only superficially eroded cortex; and type 5,
subperiosteal with growth both outwards and centrally towards the medulla, with cortical destruction

Radiologis
Destruksi tulang radiolusen
Lesi ekspansif
Korteks menjadi sangat tipis dan
mengembung keluar

TERIMA KASIH