MUSCULOSCELETAL

Dr. Dyah Marianingrum,M.Kes,Sp.PA

 Chapter 26 - Bones, Joints, and Soft-Tissue Tumors

OUTLINES
BONES Osteonecrosis (Avascular Necrosis)
Bone Modeling, Remodeling, and Peak Bone Mass InfectionsOsteomyelitis
Bone Growth and Development PYOGENIC OSTEOMYELITIS
Developmental Abnormalities in Bone Cells, Matrix, and Structure TUBERCULOUS OSTEOMYELITIS
MALFORMATIONS AND DISEASES CAUSED BY DEFECTS IN SKELETAL SYPHILIS
NUCLEAR PROTEINS AND TRANSCRIPTION FACTORS
Bone Tumors and Tumor-Like Lesions
DISEASES CAUSED BY DEFECTS IN HORMONES AND SIGNAL
BONE-FORMING TUMORS
TRANSDUCTION MECHANISMS
Osteoma
DISEASES ASSOCIATED WITH DEFECTS IN EXTRACELLULAR
STRUCTURAL PROTEINS Osteoid Osteoma and Osteoblastoma
Type 1 Collagen Diseases (Osteogenesis Imperfecta) Osteosarcoma
Diseases Associated with Mutations of Types 2, 9, 10, and 11 CARTILAGE-FORMING TUMORS
Collagen Osteochondroma
DISEASES ASSOCIATED WITH DEFECTS IN FOLDING AND Chondromas
DEGRADATION OF MACROMOLECULES Chondroblastoma
Mucopolysaccharidoses Chondromyxoid Fibroma
DISEASES ASSOCIATED WITH DEFECTS IN METABOLIC PATHWAYS Chondrosarcoma
(ENZYMES, ION CHANNELS, AND TRANSPORTERS) FIBROUS AND FIBRO-OSSEOUS TUMORS
Osteopetrosis Fibrous Cortical Defect and Non-Ossifying Fibroma
DISEASES ASSOCIATED WITH DECREASED BONE MASS Fibrous Dysplasia
Osteoporosis Fibrosarcoma Variants
DISEASES CAUSED BY OSTEOCLAST DYSFUNCTION Miscellaneous Tumors
Paget Disease (Osteitis Deformans) EWING SARCOMA/PRIMITIVE NEUROECTODERMAL TUMOR
DISEASES ASSOCIATED WITH ABNORMAL MINERAL GIANT-CELL TUMOR
HOMEOSTASIS
ANEURYSMAL BONE CYST
Rickets and Osteomalacia
METASTATIC DISEASE
Hyperparathyroidism
JOINTS
Renal Osteodystrophy
Fractures SOFT-TISSUE TUMORS AND TUMOR-LIKE LESIONS
Chapter 26 - Bones, Joints, and Soft-Tissue Tumors

BONES

Tulang (sistem skeletal) memiliki

fungsi yang vital dalam kehidupan:
homeostasis mineral
tempat elemen2 hematopoietik
penunjang mekanis utk
pergerakan
melindungi visera
menentukan ukuran dan bentuk
tubuh
Chapter 26 - Bones, Joints, and Soft-Tissue Tumors

BONES
Anatomi & Histologi

Tulang merupakan:
Organ :
t.d. jar. tulang, tulang
rawan, lemak,
sumsum tulang,
pemb.darah, saraf
dan jar. ikat fibrous
Jaringan :
secara mikroskopik
t.d. sel2 tulang.
 Chapter 26 - Bones, Joints, and Soft-Tissue Tumors

BONES
Anatomi & Histologi

Tulang (sistem skeletal) :

struktural
proteksi
metabolik
Disusun oleh 206 buah tulang:
Axial : cranium, columna
vertebralis, thoraks
Appendicular : ekstremitas
Berdasarkan bentuknya:
Tulang panjang
Tulang pipih
Tulang pendek
Ireguler
Sesamoid
Berdasarkan embriologik:
Membranous
Endokondral
Chapter 26 - Bones, Joints, and Soft-Tissue Tumors

BONES
Anatomi & Histologi
 Chapter 26 - Bones, Joints, and Soft-Tissue Tumors

BONES
Anatomi & Histologi

Secara makroskopik t.d. :

Substantia compacta : padat,
lapisan luar tulang, meliputi 80%
sistem skeletal. Fungsi utama
biomekanik.
Substantia spongiosa (trabecular,
medullary bone) : berongga,
terdapat pd ujung2 tulang panjang.

Anatomy of bone. A schematic representation of cortical and trabecular bone. The longitudinal section (left) shows the
vasculature entering the periosteum via the periosteal perforating arteries and coursing through the bone perpendicular to the
long axis in Volkmann canals. The vessels that proceed longitudinally, or parallel to the long axis, are located in haversian
canals. Each artery is accompanied by a vein. Within the cortex, osteocytes reside in lacunae, and their cell processes extend into
the canaliculi. The cross-sectional view (right) illustrates the various types of lamellar bone in the cortex. Circumferential lamellar
bone is located adjacent to the periosteum and borders the marrow space. Concentric lamellar bone surrounds the central
haversian canals to form an osteon. Each layer of the concentric lamellar bone displays a change in the pitch of the collagen
fibers, such that each layer has a different arrangement of collagen. The interstitial lamellar bone occupies the space between
osteons. The marrow space is filled with fat, and its trabecular bone is contiguous with the cortex. Multinucleated osteoclasts
are present, and palisaded osteoblasts surround the bone surfaces. The perforating arteries from the periosteum and the
nutrient artery from the marrow space communicate within the cortex via haversian and Volkmann canals.
Chapter 26 - Bones, Joints, and Soft-Tissue Tumors

BONES
Anatomi & Histologi
Chapter 26 - Bones, Joints, and Soft-Tissue Tumors

BONES
Anatomi & Histologi
Chapter 26 - Bones, Joints, and Soft-Tissue Tumors

BONES
Anatomi & Histologi
Chapter 26 - Bones, Joints, and Soft-Tissue Tumors

BONES
Anatomi & Histologi
 Chapter 26 - Bones, Joints, and Soft-Tissue Tumors

BONES
Sebagian besar terdiri dari matriks organik (osteoid) dan
mineral calcium hydroxyapatite memberi kekuatan dan
sifat keras pada tulang.

Tulang merupakan jaringan yg bersifat dinamis

continuously resorbed, renewed, and remodeled : proses ini
dilakukan sel2 tulang yg diatur oleh sejumlah faktor
transkripsi, sitokin, dan faktor pertumbuhan.
 Chapter 26 - Bones, Joints, and Soft-Tissue Tumors

BONES
Jenis sel2 tulang :
Sel osteoprogenitor : sel tunas mesenkim pluripoten
yang terletak di sekitar permukaan tulang
Osteoblas dan sel pelapis permukaan terletak di
permukaan tulang : untuk sintesis, transport dan
menyusun banyak protein matriks, serta memulai proses
mineralisasi.
Osteosit merupakan transformasi dari osteoblas yg telah
dikelilingi deposit matriks organik.
Osteoklas : sel yg berperan meresorpsi tulang.
 Chapter 26 - Bones, Joints, and Soft-Tissue Tumors

BONES

Figure 26-1 Bone cells and their interrelated activities. Hormones, cytokines, growth factors, and signal-transducing molecules are key
in their formation and maturation, and allow communication between osteoblasts and osteoclasts. Bone resorption and formation in
remodeling are coupled processes that are controlled by systemic factors and local cytokines, some of which are deposited in the
bone matrix. BMP, bone morphogenic protein; LRP5/6, LDL receptor related proteins 5 and 6.
 Chapter 26 - Bones, Joints, and Soft-Tissue Tumors

BONES

Figure 26-2 A, Active osteoblasts synthesizing bone matrix. The surrounding spindle cells represent osteoprogenitor cells. B, Two
osteoclasts resorbing bone.
 Chapter 26 - Bones, Joints, and Soft-Tissue Tumors

Bone Modeling, Remodeling, & Peak Bone Mass

Sekumpulan osteosit, osteoblas dan osteoklas bekerja secara terpadu
mengontrol pembentukan dan resorpsi tulang unit fungsional :
basic multicellular unit (BMU).

Pada awal kehidupan, saat tulang tumbuh dan membesar (modeling)

pembentukan tulang predominan.

Saat tulang telah mencapai maturitas, penguraian dan pembaruan

tulang yg berperan utk maintenance : remodeling
kemungkinan dimulai di tempat2 yg mengalami fatigue dan
microdamage
pada orang dewasa, sekitar 1 juta BMU aktif setiap saat melakukan
remodeling atau mengganti 10% tulang setiap tahun.

Peak bone mass tercapai pada usia dewasa muda setelah berhentinya
pertumbuhan tulang
 Chapter 26 - Bones, Joints, and Soft-Tissue Tumors

Bone Modeling, Remodeling, & Peak Bone Mass

Peak bone mass tercapai pada usia dewasa muda setelah berhentinya
pertumbuhan tulang
ditentukan oleh berbagai faktor :
polimorfisme reseptor vitamin D dan LRP5/6
nutrisi
aktifitas fisik
usia
status hormonal
sejak awal dekade keempat : resorpsi > formasi penurunan massa
tulang terus-menerus.
 Chapter 26 - Bones, Joints, and Soft-Tissue Tumors

Bone Growth & Development

 Chapter 26 - Bones, Joints, and Soft-Tissue Tumors

Bone Growth & Development

Figure 26-5

Active growth plate with ongoing enchondral

ossification.

1, Reserve zone.

2, Zone of proliferation.

3, Zone of hypertrophy.

4, Zone of mineralization.

5, Primary spongiosa.
SOFT TISSUE
Diagnosa
Soft tissue tumor
Lymphangioma