CASE REFLECTION

OSTEOSARCOMA
Pembimbing : dr. Nurhuda Hendra Setyawan, Sp.Rad.
Benny Yohanis Gae
Stase Radiologi RSUP Sardjito
 IDENTITAS
• Nama : An. DS
• Umur : 9 tahun
• Jenis kelamin : Perempuan
• Agama : Islam
• Alamat : Sumberdadi, Kebumen, Jawa Tengah
• No. Register : 018474xx
• Pemeriksaan : 24 April 2018, pukul 13.05 WIB
 DESKRIPSI KASUS
Os dengan keluhan utama nyeri di pergelangan kaki kiri yang dimulai ± 5
BSMRS, nyeri terus menerus, terasa kaku, benjolan (-), penurunan BB (-).
Sejak 2 bulan ini pasien mengeluh kesulitan berjalan dan hanya
menghabiskan waktu di tempat tidur. Kemudian pada Maret 2018 os berobat
ke RS di daerah kemudian oleh dokter didiagnosis Obs Primary Bone Tumor
ec Susp Osteosarcoma distal tibia fibula sinistra. HMRS keluhan menetap dan
mulai timbul batuk.
RPD : keluhan yang sama (-), tumor (-), riw. trauma (-).
RPK : keluhan yang sama (-), tumor (-).
Dari pemeriksaan fisik dalam batas normal.
Stt. Lokalis ankle sinistra : Lump (-), NT (+), NVD (-), Move limited due to pain.
GDS 77.

Kesan : Primary bone tumor mengarah
gambaran periosteal osteosarcoma os tibia (S)
pars tertia distal
Tampak foto ankle joint sinistra,
proyeksi AP dan lateral, kondisi
cukup, hasil :
• Tak Tampak soft tissue
swelling di regio cruris pars
tertia distal
• Tampak lesi osteoloitik yang
berasal dari metadiafisis os
tibia sinistra pars tertia distal
dengan periosteal reaction :
codman triangle (+), sunburst
appearence (+), dengan wide
zone transition (+)
• Tak tampak diskontinuitas
tulang
• Tak tampak osteofit maupun
subchondral sclerotic
• Joint space tidak menyempit
maupun melebar
 PROBLEM
• Hows about the insidence of OS?
• Is the periosteal reation is phatognomonis for
OS?
 DISCUSSION
Osteosarcoma • Benign tumours and tumour-like
• Tumor is characterised by production lesion of the foot and ankle are not
of osteoid by malignant uncommon but malignant tumours
and especially malignant bone
mesenchymal cells.
tumours of the foot are rare.
• Most common primary malignant bone
tumor (35%). • Most of the foot tumours are benign:
usually synovial cysts and lipomata
• Most common radiation induced sarcoma. arise on the dorsum of the foot.
• 10%-20% present with metastatic disease
at diagnosis. Spreads hematogenously, • Villonodular synovitis (or tenosynovial
giant cell tumours) are more frequent
with lung being the most common
and deepseated lesions and plantar
metastatic site. fibromatosis
• 5 year survival rate is 5% - 23%
7
• Sites:
Metaphysis: 90%
Diaphysis: 8-10%
Epiphysis: 1%

• Occurrence:
Long Bones: 70%-80%
Distal Femur (40%)
Proximal Tibia (20%)
Proximal Humerus (15%)
Axial Skeleton
Pelvis
Jaw
Tumor is located at the typical metaphyseal site
A. Tumor is largely restricted to bone
B. Tumor is accompanied by massive soft tissue extension.
 Etiology
• The exact cause of osteosarcoma is
unknown

Risk factors –
• Rapid bone growth
• Environmental
• Genetic
• Pre-existing benign /malignant lesions
Sub-types
– Intramedullary (80%) :
typically presents within
areas of rapidly
proliferating skeletal bone.
– Juxtacortical/Surface (7-
10%) : arise adjacent to
the outer surface of
cortical bone.
– Intracortical (2%)
X-Ray Appearance Radiologic features:

Metaphyseal lesion

Bone destruction and

sclerotic lesion

Eccentric extraosseous
mass

Periosteal reaction
“sunburst” appearance

Codman’s triangle

 Wide Lucent area

PERIOSTEAL REACTION A. Thick/solid
PATTERN B. Undulated
C. Laminated or onion
skin
D. Perpendicular or
sunburst, hair-on-
end
E. Amorph
 Codman’s
triangle

Extraosseous
mass
Sunburst
 OSTEOSARCOMA
OSTEOBLASTIC TYPE OSTEOLYTIC TYPE
Lace-like osteoid deposition is characteristic
Management

51
 CONCLUSION
• OS pada tibia pars distalis merupakan tumor yang
tergolong jarang
• Perlu dilakukan pemeriksaan histopatologi untuk
menentukan staging dan jenis OS
• Perlu dilakukan pemeriksaan foto polos thoraks
untuk melihat gambaran metastasis
• Tatalaksana hipoglikemi secara oral
 Referensi
• De Souza, AMG & Bispo Junior, RZ.
Osteochodroma : ignore or investigate?. Rev Bras
Ortop. 2014;49:555-564.
• Kumar, V, et al. Robbins basic pathology. 2013. 9th
ed. Elsevier, Philadelphia.
• Solomon, L, et al. Apley’s system orthopedic and
fracture. 2010. 9th ed. Taylor & Francis, USA.
• Radiopedia.org