osteosarcoma

Epidemiology
• around 15-19 year,
• Sequence No. 2 of malignant after multiple myeloma
• 21% from all tumor malignant bone

• event in African-Americans >> skin white

• Male > female

• At the age of older adults arise as a complication from Paget's disease (Osteoitis
deformans)

• Often appear The distal femur (32%), tibia proximal (16%), and humerus proximal (9%)
etiology
• idiopathic
• suspected :
• Substance carcinogenic : berylinnium oxyde
• shelf Radiation,
• Virus.
• Trauma.
• Paget's disease  especially adult
pathogenesis
• osteosarcoma be trusted originated from cell stem mesenchyme or
cell osteoprogenitor that experience disruption in lane differentiation
osteoblasts,
• Some studies prove that osteosarcoma have Cancer stem cells.
• Cause the most known related with disease this is radiation,
• Around 70% disease this have abnormality genetic as deviation
structure complex and total chromosome,
Manifestation Clinical
• patient generally complained bump that painful, limit not assertive
• painful be perceived continue constantly, increase in night day
• Skin in on tumor warm and veins look stand out, and shine (Shinny)
• Tumor swell with fast so that when not immediately addressed, will
happen necrosis on skin that shape ulcer,
Radiology
• Soft tissue swelling.
• Reaction bone : osteolytic /osteoblastic
• Perforation cortical bone
• elevation periosteum (Codman triangle)
• Sunrays appereance (heap osteoid in around vessel blood )
a. facet 3 Codman → soft tissue
b. MRI : extension transfisis →
involvement soft tissue
c. macroscopic → tumor
medullary : extension soft
tissue
pathologist
• picture from tissue bone or osteoid, and picture pleomorf tissue,
• Bone and osteoid will produce bone troubled, soft tissue, or miksoid
tissue.
• Maybe there is area tissue tumor with cells spindle.
Governance
• General : repair MY patient : nutrient, Blood etc
• Surgery  Wide excision
• Amputation,
• Limb salvage procedure
• Therapy Adjuvant.
• immunotherapy  BCG & Allogenik Sarcoma cell vaccine
• Radiotherapy  1000 - 1700 Rad.
• Chemoterapi  Stop replication DNA cell tumor so that growth stopped
prognosis
• Malam  5 years survival: 10-20%.
• Factor that influence prognosis
• locations and size of tumor
• grade tumor
• Level necrosis that rated after chemotherapy