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    Patologi Tulang: Dr. Saukani Gumay, Sppa (K)

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    shevinesa
    This document provides information on normal bone structure and types of bones. It discusses the cortical and cancellous components of bone and describes the Haversian system. It also summarizes common bone tumors like osteosarcoma and chondrosarcoma, including their locations, incidence rates, radiographic appearances, and distinguishing characteristics. Diagnostic methods for bone lesions and tumors are mentioned as well as the grading and staging of bone tumors.

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    Patologi Tulang: Dr. Saukani Gumay, Sppa (K)

    Uploaded by

    shevinesa
    53 views26 pages
    This document provides information on normal bone structure and types of bones. It discusses the cortical and cancellous components of bone and describes the Haversian system. It also summarizes common bone tumors like osteosarcoma and chondrosarcoma, including their locations, incidence rates, radiographic appearances, and distinguishing characteristics. Diagnostic methods for bone lesions and tumors are mentioned as well as the grading and staging of bone tumors.

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    bone pathology

    Original Title

    Pathologi tulang

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    This document provides information on normal bone structure and types of bones. It discusses the cortical and cancellous components of bone and describes the Haversian system. It also summarizes common bone tumors like osteosarcoma and chondrosarcoma, including their locations, incidence rates, radiographic appearances, and distinguishing characteristics. Diagnostic methods for bone lesions and tumors are mentioned as well as the grading and staging of bone tumors.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    53 views26 pages

    Patologi Tulang: Dr. Saukani Gumay, Sppa (K)

    Uploaded by

    shevinesa
    This document provides information on normal bone structure and types of bones. It discusses the cortical and cancellous components of bone and describes the Haversian system. It also summarizes common bone tumors like osteosarcoma and chondrosarcoma, including their locations, incidence rates, radiographic appearances, and distinguishing characteristics. Diagnostic methods for bone lesions and tumors are mentioned as well as the grading and staging of bone tumors.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 26

    PATOLOGI TULANG

    Dr. Saukani Gumay, SpPA(K)


    Departemen Patologi Anatomik
    Fakultas Kedokteran Universitas Indonesia,
    Jakarta
    Structure of Normal Bone
    Functions :
    Supporting the body

    Providing attachment site for
    muscles & tendons
    provide motion
    Protects vital organs &
    houses of bone-marrows
    Mineral deposits, esp.
    calcium
    Type of Bones
    The flat bones
    Skull, scapula, clavicle, vertebra, jaw & pelvis
    The tubular bones
    Femur, tibia, fibula, humerus, etc
    Cortical (or compact) bone
    Both types consists of
    Cancellous (or spongy) bone

    In a typical long bone (Such as femur) :
    Diaphysis is composed of cortical bone surrounding medullary
    cavity
    Epiphyses mostly are cancellous bone & a thin rim of cortical
    bone
    Cancellous bone
    Made up of plates &
    bars form an
    interconnecting
    network
    Composed of
    contiguous thin
    layers (lamellae)
    The cortex of bone
    Consists of compact
    osseous tissue
    The medullary
    cavity
    Contains cancellous
    bone
    Normal Bones
    is the basic structural unit of
    cortical bone
    It consists of
    a central Haversian canal
    - blood vessels
    - surrounding by lamelae of bone
    anastomosing system of canals
    Lamelae of Bone
    Have a large number of
    lacunae contain osteocytes
    The Haversian System = Osteon
    Normal Bones
    Periosteum : a connective tissue layer
    (collagen), penetrate cortical bone
    a tight attachment
    together with large blood vessels & nerve

    Cortex Separated by endosteum
    Marrow space (a thin layer of connective tissue)
    Methods of Biopsy
    Open Biopsy
    The most common method for diagnosing
    bone tumors
    Needle Biopsy
    Effective & safe technique
    A larger amount of tissue compare to FNAB
    Fine Needle Aspiration Biopsy (FNAB)
    The accuracy about 80% in bone tumors
    Handling of Specimens
    Incisional Biopsy
    From the soft region of lesion
    In osteosarcoma usually involves the soft tissue
    extension
    Excisional Biopsy
    In bone tumors, usually by curettage
    Resection
    In patient of high grade sarcoma
    pre-operative chemotherapy
    the bone containing the tumor is resected for
    assessment of chemotherapy affect
    Diagnosis of Bone Lesions
    Clinical datas
    or
    diagnosis
    Histopathological
    diagnosis
    Radiological
    diagnosis
    Frozen section :
    - To check the tumor margins
    - for metastatic tumor
    - to check the adequacy of
    biopsy
    - Name
    - Sex
    - Age
    - History
    - Examination
    - Lab. Findings
    - etc
    - Location
    - Type of lesion
    - Extension
    - Periosteal -
    reaction
    - Calcification
    - etc
    Genetic of Bone Tumors
    Cancer Pathogenesis a multistep
    process
    Stemming from somatic mutations
    That impair the regulation of :
    Normal cell development
    Cell proliferation
    Fundamental cellular activities
    Basic Principles of Cancer Cytogenetics
    In 1960 : The Philadelphia (Ph)
    chromosome in CML was discovered
    In 1970 : Chromosomal Banding
    techniques. Each chromosome could be
    identified precisely

    Tissue must be fresh not frozen or fixed in
    formalin in sterile culture media :
    Buffer sol (Hanks buffered salt solution)
    Cytogenetic Analysis
    Bone Tumors
    Classification, based on :
    Cytologic features
    The matrix
    Benign tumors :
    Malignant tumors : rarely arise from
    benign ones
    Incidence : 0,2% of all cancers were Bone
    Sarcomas
    Bone Sarcoma
    The most frequent : Osteosarcoma
    Followed by :
    Chondrosarcoma
    Myeloma
    Lymphoma
    Ewing Sarcoma
    Chordoma
    Fibrosarcoma
    etc
    Grading of Bone Tumors
    Is an attempt to predict the biologic behaviour of a tumor on
    the basis of its histologic appearance

    Broders :
    Grade 1 : 0-25% of the cells are undiff
    Grade 2 : 25-50% of the cells are undiff
    Grade 3 : 50-75% of the cells are undiff
    Grade 4 : 50-100% of the cells are undiff

    Ewing sarcoma : cannot be graded
    Chordoma
    Adamantinoma Grading is not useful
    myeloma
    Staging of Bone Tumors
    Enneking et al :
    Histologic grade and
    Anatomic extent of the neoplasm
    Intra compartmental : confined to the Bone
    Extra compartmental : extend into soft tissues

    Stage 1A : low grade, intra compartmental
    Stage 1B : low grade, extra compartmental
    Stage 2A : high grade, intra compartmental
    Stage 2B : high grade, extra compartmental
    Stage 3 : distant metastasis. Regardless of other factors

    Low grade is Grade 1 and 2
    High grade is Grade 3 and 4
    Surgical Margins
    Radical
    The entire compartment involved by tumor is removed
    Wide
    The tumor is removed with surrounding normal tissue
    & the reactive zones (composed of the fibrovascular
    pseudocapsule) is removed intact
    Marginal
    The tumor is removed entirely but the incision goes
    through the reactive zone
    Intra lesional
    The tumor is not removed intact & margins are
    involved
    Entirely cartilage
    Malignant osteoid (-)
    Pelvic, shoulder girdles,
    upper ends of the femur
    & humerus
    More than 60% in the
    fourth-sixth decades
    Radiographic
    Usually large size
    75% calcification
    Mineralization shape, ring
    shaped, popcorn like, or
    comma shaped
    Expansion of bone &
    thickening of cortex
    Bone produced by the
    tumor cells
    Malignant osteoid (+)
    The metaphyseal region
    of long bones (region of
    the knee)
    The peak incidence is in
    the second decade of life
    Radiographic
    Lytic
    Sclerotic
    Codmans triangle
    Cloud like
    sunburst
    CHONDROSARCOMA OSTEOSARCOMA

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