PATOFISIOLOGI SISTEM

MUSKULOSKELETAL
Nursiswati

TULANG
Tulang mbntuk rangka penunjang
dan pelindung bagi tbh dan tempat
u/ mlekatkn otot-otot yg mgerakkan
kerangka tbh.
Ruang di tengah-tengah tulang ttt
berisi jaringan hematopoetik.
Mrp tempat primer u/ mnyimpan &
matur kalsium & fosfat.

Mrp jar dinamis tdiri dr 3 sel :

Osteoblas: mbangun tlg dg mbtk
kolagen tipe 1 & proteoglikan sbg
matriks tlg atau jar osteoid mel
proses osifikasi.
Ketika sdg aktif mbtk osteoid,
osteoblas msekresi sejml besar
fosfatase Alkali yg bperan dl
mengendapkan calsium & fosfat ke dl
matriks tlg.

Osteosit : adl sel2 tlg dewasa yg

btindak sbg suatu lintasan u/
ptukaran kimiawi mel tlg yg padat.
Osteoklas : adl sel2 besar berinti
banyak yg memungkinkn mineral &
matriks tlg dpt diabsorbsi.
Mengikis tlg dg mhslkn enzim2
proteolitik yg memrcahkn matriks
& bbrp asam yg mlarutkn mineral
tlg, shg kalsium & fosfat tlepas ke
dl aliran drh.

KEGANASAN ST MUSKULOSKELETAL

OSTEOSARCOMA

In the United States, the incidence

of osteosarcoma is 400 cases per
year (4.8 per million population <20
y).15 The overall 5-year survival
rate for patients diagnosed
between 1974 and 1994 was 63%
(59% for males, 70% for females).

Osteosarcoma is the most common type

of malignant bone cancer, accounting
for 35% of primary bone malignancies.
There is a preference for the
metaphyseal region of tubular long
bones.
50% of cases occur around the knee. It is
a malignant connective (soft) tissue
tumor whose neoplastic cells present
osteoblastic differentiation and form
tumoral bone.

The causes of osteosarcoma are not

known.
Questions remain about whether radium,
or fluoride, in drinking water can act as "
environmental triggers" for increasing
the incidence of the disease.[
citation needed] A low selenium or
Vitamin D3 level or a high level of
inflammation, as measured by
interleukin-6, interleukin-8, or Nf-kB,

 Tumor Necrosis Factor Alpha may have a significant role

as tumor suppressors and tumor initiators respectively.
Recent studies show that an increased level of c-Fos can
lead to osteosarcoma.
since c-Fos is ubiquitous in its over expression it can not
only increase the osteoblast resulting in the symptoms of
osteosarcoma.
Therefore it is recently believed that a biological effect
that may cause osteosarcoma is an error in the molecular
pathway that controls c-Fos, causing an overexpression
with no other counter stimuli to stop over production

 The exact cause of osteosarcoma is unknown.

However, a number of risk factors are apparent,
as follows

Rapid bone growth: Rapid bone growth

appears to predispose persons to
osteosarcoma, as suggested by the increased
incidence during the adolescent growth spurt,
the high incidence among large-breed dogs (eg,
Great Dane, St. Bernard, German shepherd),
and osteosarcoma's typical location in the
metaphyseal area adjacent to the growth plate
(physis) of long bones.

 Environmental factors: The only known environmental

risk factor is exposure to radiation. Radiation-induced
osteosarcoma is a form of secondary osteosarcoma and
is not discussed further in this article.
Genetic predisposition: Bone dysplasias, including Paget
disease, fibrous dysplasia, enchondromatosis, and
hereditary multiple exostoses and retinoblastoma (germline form) are risk factors.
The combination of constitutional mutation of the RB
gene (germline retinoblastoma) and radiation therapy is
associated with a particularly high risk of developing
osteosarcoma, Li-Fraumeni syndrome (germline p53
mutation), and Rothmund-Thomson syndrome
(autosomal recessive association of congenital bone
defects, hair and skin dysplasias, hypogonadism, and
cataracts).

JENIS SARKOMA:
OSTEOSARKOMA.
KONDROSARKOMA, SARKOMA
EWING
Osteosarcoma SUNBURST
Chondrosarcoma PERIFER ATAU
SENTRAL, ro: PENGAPURAN
Sarcoma ewing sumsum tulang

GIANT CELL TUMOR

STROMA VASKULER DAN
SELULER
TUMOR JINAK, NAMUN MEMILIKI
BBRP DERAJAT KEGANASAN
PD JENIS YG GANAS, TUMOR INI
MJD ANAPILAKTIK DG DAERAH2
NEKROSIS &PERDARAHAN

SERING PD DEWASA MUDA

>> PD WANITA
CENDERUNG KAMBUH
TERSERING: UJUNG2 TLG
PANJANG, TERUTAMA LUTUT &
UJUNG BWH RADIUS
GEJALA PLG SRG: NYERI DISERTAI
KETERBATASAN GERAKAN SENDI
DAN KELEMAHAN

OSTEOMA
MRP LESI TULANG YG DITANDAI O
PERTUMBUHAN TLG YG
ABNORMAL
JINAK
TDK NYERI
PD RO: OSTEOMA perifer
TAMAPAK SBG RADIOPAK YG
MELUAS DR PERMUKAAN TLG

OSTEOMA SENTRAL TAMPAK SBG

SUATU MASSA SKLEROTIK
BERBATAS TEGAS DI DL TULANG
INTERVENSI: EKSISI SBG
DIAGNOSTIK

KONDROBLASTOMA
JARANG
PD ANAK LAKI2 REMAJA
PD EPIFISIS
SERING: HUMERUS
GEJALA: NYERI SENDI
PEMBEDAHAN

THANKS