OSTEOSARCOMAJ. Ritter & S. S. BielackOktober 2010

Group 2Intan Nararia P(1313010010)Almora Nur A(1313010011)Syarah Muria D(1313010012)Wahyu Syafiyati(1313010013)Dina Rahayu L P(1313010014)Zakky Rabbani M(1313010016)Andika Nugraha(1313010017)Nur Indah C(1313010018)Pravangesta Anggit A(1313010019)Rifki Ghifari A(1313010021)

Osteosarkoma adalah tumor ganas yang berasal dari sel spindel neoplastik yang menghasilkan tumor tulang osteoid dan/atau imatur. Ada tiga lokasi osteosarkoma yaitu;1. Osteosarkoma intraosseus/intrameduler jika lesi terdapat di dalam tulang (91-95% kasus) 2. osteosarkoma jukstakortikal/permukaan jika lesi terdapat pada permukaan tulang (5-8% kasus), dan 3. ekstraosseus/ekstraskeletal jika osteosarkoma terdapat di luar sistema tulang (1% kasus)

Before the introduction of polychemotherapy >90% of patients with osteosarcoma died from pulmonary metastasis. Sehingga, pasien osteosarcoma ini memerlukan pengobatan. The successful treatment of patients with osteosarcoma requires close cooperation within an experienced multidisciplinary team including pediatric or medical oncologists, surgeons, pathologists and radiologists

EtiologyThe etiology of osteosarcoma remains obscure. The predilection of osteosarcoma for the age of the pubertas growth spurt and the sites of maximum growth suggest a correlation with rapid bone proliferation. A minority of osteosarcomas are caused by radiation exposure. Exposure to alkylating agents may also contribute to osteosarcoma development. The incidence of osteosarcoma is increased in several well-dened hereditary disorders associated with germline alterations of tumor suppressor genes such as hereditary retinoblastoma and the LiFraumeni cancer

Osteosarkoma dibagi menjadi dua; Osteosarkoma primerOsteosarkoma sekunder (Osteosarkoma yang tidak diketahui penyebabnya merupakan osteosarkoma primer, sedangkan osteosarkoma sebagai akibat keadaan lainnya merupakan osteosarkoma sekunder. Osteosarkoma sekunder misalnya terjadi pada penderita penyakit Paget, displasia fibrosa, radiasi ionisasi eksternal atau adanya riwayat makan zat radioaktif) ini yang aku kurungan diapalin. Yang dapet bagian slide ini.

PatogenesisStem sel mesenkimal secara normal akan berdiferensiasi menjadi tulang, kartilago, otot, sumsum tulang, tendon, ligamen dan jaringan ikat. Pada osteosarkoma diferensiasi ini mengalami kegagalan, sehingga osteoprogenitor tidak berkembang menjadi proosteoblas dan berakhir menjadi osteosit sempurna. Sel imatur ini berkembang terus dan sel tumor akan menembus trabekula tulang, system Havers dan kanalis Volkmann. Bila tumor telah mencapai permukaan korteks paling luar, periosteum terputus dari tulang. Lapisan kambium lapisan dalam periosteum bereaksi agar terpisah dari korteks dengan membentuk tulang baru

DiagnosisThey often have a soft tissue component in which patchy calcications resulting from new bone formation or spiculae may be observed. A triangular area of periosteal calcication in the border region of tumor and healthy tissue is known as a Codman triangle

Minta tolong carikan gambar comman triangle pada osteosarcoma

StadiumMinta tolong masukin tabel tabel 2,

Recommended diagnostic work-up for osteosarcoma patientsMasukin tabel 1

treatmentSurgeryradioterapi, with Samarium-153-ethylendiame tetramethylene phosphonate systemic therapypolychemotherapy. Currently, doxorubicin , cisplatin , high-dose methotrexate with leukovorin-rescue and ifosfamide are considered the most active agents against osteosarcomaImmunomodulation. Addition of the immunomodulator liposomal muramyl tripeptide phosphatidyl ethanolamine (MTP) to postoperative chemotherapy

d. supportive careThe introduction of serotonin antagonists has dramatically reduced chemotherapy-induced emesis. (highly emetogenic chemotherapy, especially cisplatin)Other agents used in supportive care of osteosarcoma patients include opioids for tumor pain control and hematopoetic growth factors to decrease the incidence and duration of chemotherapy-induced severe granulocytopenia.

follow-up and late effects of treatmentFollow-up intervals recommended in most trials are every 6 weeks to 3 months in years 1 and 2 after diagnosis, every 24 months in years 3 and 4, every 6 months in years 510 and every 612 months thereafter. Each visit should include a history and physical examination, and a chest X-ray

Sama minta tolong tambahin gambar2 osteosarkoma