malignancy in orthopaedic

7/25/2019 Malignancy in Orthopaedic

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Malignancy in orthopaedic


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Klasifkasi

A classifcation o bone tumours. Modifed ater Revised WHO Classifcation

Schajowic !"##$%


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Pemeriksaan Fisik

I there is a lump, where does it arise? Is it discreteor ill-defned? Is it sot or hard, or pulsatile? And is ittender?

Swelling is sometimes diuse, and the o!erlying

skin warm and in"amed# it can $e di%cult todistinguish a tumour rom inection or a haematoma

I the tumour is near a &oint there may $e anefusion and'or limitation o movement(

)pinal lesions, whether $enign or malignant, otencause muscle spasm and back stifness, or apainulscoliosis


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Pemeriksaan *adiologi

+-*ay

Plain -rays are still the most useul o allimaging techniues

.here may $e an o$!ious a$normality in the$one / cortical thickening, a discrete lump, a0cyst1 or ill-defned destruction(

2here is the lesion3 in the metaphysis or the

diaphysis?

Is it solitary or are there multiple lesions?Are the margins well-defned or ill-defned?


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*A4I56789I4: )8A66I6;

)canning with


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85MP7.:4 .5M5;*AP@

8. etends the range o -raydiagnosis# it shows more accurately$oth intraosseous and etraosseous

etension o the tumour and therelationship to surrounding structures(

It may also re!eal suspected lesions in

inaccessi$le sites, like the spine orpel!is# and it is a relia$le method odetecting pulmonary metastases(


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MA;6:.I8 *:)56A68: IMA;I6;

M*I pro!ides urther inormation( Itsgreatest !alue is in the assessment otumour spread3

within the $one, into a near$y &oint

into the sot tissues(

lood !essels and the relationship o the

tumour to the peri!ascular space are welldefned( M*I is also useul in assessing sot-tissue tumours and cartilaginous lesions(


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Pemeriksaan 9a$

lood tests are oten necessary to eclude otherconditions, e(g( inection or meta$olic $one disorders, ora 0$rown tumour1 in hyperparathyroidism(

Anaemia, increased ESR and ele!ated serum alkaline

phosphatase le!els are non-specifc fndings, $ut i othercauses are ecluded they may help in dierentiating$etween $enign and malignant $one lesions(

Serum protein electrophoresis may re!eal an a$normalglo$ulin raction and the urine may contain Bence Jones

protein in patients with myeloma( A raised serum acid phosphatase suggests prostatic

carcinoma(


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iopsi

Needle biops 6eedle $iopsy should $e perormedeither $y the surgeon planning defniti!e treatmentor $y an eperienced radiologist(

!pen biops.his is a more relia$le way oo$taining a representati!e sample, howe!er it isassociated with signifcant mor$idity(

For tumours that are almost certainly $enign, ane"cisional biops is permissi$le =the entire lesion is

remo!ed># with cysts that need operations,representati!e tissue can $e o$tained $y careulcurettage(


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4ierensial diagnosis

Sot#tissue haematoma

$ositis ossi%cans

Stress racture &endon avulsion in'uries

Bone inection

(out !ther bone lesions


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)taging o ones .umors

&able #.' Sta(in( o beni(n bone tumours as #described b) *nne+in(


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Aggressi!eness

.umor di$agi $ukan hanya$erdasarkan grade tapi &uga$erdasarkan maniestasi klinis enign lessions lowest grade

Malignant tumours low grade andhigh grade


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Metastasis

one sarcomas are $roadly di!idedas ollows3 Stage ) * All low-grade sarcomas(

Stage )) *istologically high-gradelesions(

Stage ))) * )arcomas which ha!e

metastasiBed( :ach category is urther su$di!ided

into &pe A =intracompartmental> and

&pe B =etracompartmental>


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Sur(ical sta(es as described b)*nne+in(

malignancy in orthopaedic

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