OSTEOCHONDROMA

IDENTITAS PASIEN
Nama : An. FA
No RM : 01805965
Tgl lahir : 17/8/1999
Tgl periksa : 5 desember 2017
Pekerjaan : pelajar
ANAMNESIS
KU : benjolan pada tungkai kiri bagian atas
RPS
+ 8 bulan SMRS : timbul benjolan pada tungkai kiri bagian atas, nyeri (+), tidak ada
gejala/keluhan lain pada kaki kiri. Os periksa ke RSUD Panembahan Senopati Bantul
kemudian dirujuk ke RSS.
+7 bulan SMRS :Os mulai merasakan tungkai kanan sulit digerakkan saat kecapekan. Os
hanya mengonsumsi obat anti nyeri dari RSS. Os disarankan operasi saat saat pertumbuhan
tulang berhenti.
+ 1 bulan SMRS, os mulai merasakan yeri yang bertambah pada tungkai kiri bagian atas
kemudian HMRS os datang ke poli untuk rencana operasi
RPD : keluhan yang sama (-), tumor (-), riw. trauma (-)
RPK : keluhan yang sama (-), tumor (-)
 PEMERIKSAAN FISIK
KU : Baik, CM
Kepala : Konjungtiva pucat (-/-), sklera ikterik (-/-)
Leher : Lnn. tidak teraba, JVP tidak meningkat
Thorax
 Cor : S1-S2 reguler, bunyi tambahan (-), bising (-), cardiomegaly (-)
 Pulmo : simetris, sonor (+/+), SDV (+/+), wheezing (-/-) crackle (-/-)
Abdomen : BU (+), supel (+), hepar & lien tidak teraba.
STATUS LOKALIS
region cruris sinistra
L: swelling (-), lump (+) pada proximal cruris sinistra, venectasi (-),
F: NT (+), lump size diameter 4 cm pada posterolaeral proksimal criris S,
teraba keras, terfiksir, NVD (-)
M : Free ROM
28/11/2017
Foto cruris sinistra AP dan lateral view,
kondisi cukup, hasil:
-Tak tampak soft tissue swelling
-Tampak exostosis di metadiaphysis os
fibula sinistra pars tertia proksimal
aspek posteromedial, menjauhi sendi,
pedunculated, batas tegas, zona
transisi sempit, cauliflower appearance
(+) dengan ukuran lk 4,3 cm x 2,5 cm
-Trabekulasi tulang baik
-Tak tampak discontinuitas
-Facies articularis licin
-Joint space tak melebar maupun
menyempit
Kesan : menyokong gambaran
osteochondroma os fibula sinistra pars
tertia proksimal
DIAGNOSIS
Primary benign bone tumor the left fibular due to susp. Osteochondroma

Plan :
Pro tumor excision
Meloxicam tab 2x7,5 mg (k/p)
PEMBAHASAN
 DEFINISI
Osteochondroma adalah tumor jinak tulang dengan penampakan
adanya penonjolan tulang yang berbatas tegas sebagai eksostosis
yang muncul dari metafisis, penonjolan tulang ini ditutupi(diliputi)
oleh cartilago hialin.
Tumor ini berasal dari komponen tulang (osteosit) dan komponen
tulang rawan (chondrosit).
 EPIDEMIOLOGI
relatively common imaging finding, accounting for 10-15% of all bone tumours and ~35% of all benign
bone tumours.
They are frequently asymptomatic and have very low malignant potential if sporadic and solitary.
Osteochondromas develop during childhood (period of most rapid skeletal growth), but once formed
remain for the rest of the individual's life. They can present at any age and are most frequently found
incidentally.
They are usually sporadic, but can be part of:
hereditary multiple exostoses (HME)/diaphyseal aclasis
Trevor disease/ dysplasia epiphysealis hemimelica
Malignant transformation occurs in the cartilage cap, and is uncommon in sporadic solitary
osteochondromas (~1%), whereas in the setting of hereditary multiple exostosis the rate is much higher
(5-25%) 5
 SOLITARY OSTEOCHONDROMA
Osteochondromatous exostosis ; osteocartilaginous
exostosis
10% of all bone tumors ; 85% of individual with
osteochondroma
M:F = 3:1
Common during childhood or adolescence
Appendicular skeleton, mostly long bones of lower
limbs
Knee (40%), prox. portion of femur and humerus
Metaphysis, diaphysis (rare)
 MULTIPLE OSTEOCHONDROMAS
Hereditary Multiple Exostosis; Multiple cartilaginous
exostosis; hereditary osteochondromatosis
15% of patient with exostosis
Tends to be large and sessile
Predilection site, age, and sex similar to solitary
 SIGN AND SYMPTOM
Symptomatic presentation is either due to mechanical effects of the lesion,
fracture, or malignant transformation.
Mechanical symptoms include:
 impingement upon nearby structures:
nerve compression
vascular compression
reactive myositis
palpable lump
bursal formation and bursitis
Fractures occur typically through the neck of pedunculated lesions.
Ongoing growth and or pain after skeletal maturity has been reached is
suspicious for malignant degeneration.
LOKASI
Lokasi tersering osteochroma adalah appendicular skeleton terutama pada
daerah lutut.
lower limb: 50% kasus
 femur (terutama distal): paling sering: 30%
 tibia (terutama proximal): 15-20%
 less common locations: feet, pelvis

upper limb
 humerus: 10-20%
 less common locations: hands, scapula

spine: the posterior elements of the spine are uncommon

 X-RAY APPEARANCE
Well-defined exostosis emerging from metaphysis,
base co-extensive with parent bone
In metaphyseal region projecting away from epiphysis
Looks smaller than it feels -> cartilage is invisible
Terkadang tampak adanya kalsifikasi berupa bercak
opaq akibat komponen kondral yang mengalami
kalsifikasi.
Jika tumor semakin membesar maka akan tampak
sebagai benjolan menyerupai bunga kol (cauliflower)
Inhomogen: opaq pada tangkai (osteosit), lusen pada
bunganya (kondrosit)
Tanda malignant formation:
- Pembesaran kartilago cap pada pemeriksaan yang berturut-turut
- Cartilage cap yang menonjol dengan ketebalan >1 cm
- Bercak kalsifikasi ireguler dari dalam cartilage cap
- Penyebaran ke soft tissue disekitarnya
 SESSILE TYPE
Broad base
↑ risk of malignant
degeneration
Occur at the
metaphyseal-diaphyseal
region
 PEDUNCULATED TYPE
Narrow stalk
 PEMERIKSAAN PENUNJANG
CT demonstrates the same findings as on radiograph but is better able to
demonstrate medullary continuity and the cartilage cap.
USG is able to demonstrate the cartilage cap very accurately as a
hypoechoic region bounded by bone on its deep surface and muscle/fat
superficially.
MRI is the best imaging modality to assess cartilage thickness (and thus
assessing for malignant transformation), the presence of oedema in bone or
adjacent soft tissues, and visualising neurovascular structures in the vicinity. A
cartilage cap of over 1.5 cm in thickness issuspicious for malignant
degeneration.
TREATMENT
Observation (if the patient asymptomatic)
Excisional after skeletal maturity (usually done if there is the presence of pain,
cosmetic deformity or loss of range motion)
Differential diagnosis
Imaging differential considerations include:
hands: bizarre parosteal osteochondromatous proliferation (BPOP)
humerus: supracondylar spur: projects towards the elbow joint
malunited fracture