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Tumori Si Coxartroza Clinic Flashcards

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1
Q

Clasif histopat

A
  1. Cu diferentiere osoasa exclusiva/predominanta
    B: osteom osteoid osteoblastom
    M: osteosarcom
  2. Cu dif cartilaginoasa exclusiva/predom
    B:condrom condroblastom fibrom condromixoid
    M: condrosarcom
  3. Cu ounct de plecare medular
    Ale tramei conj: fibrosarcom, fibrom desmoid,
    Ale sist hp: limfom mielom plasmocitom
    Ale SN: neurinoame
    Ale sist vasc: hemangioame angiosarcoame
    Grasoase: lipom liposarcom
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2
Q

Neclasificabile

A

Sarcom ewing
Tum cu cel gigante
Sarcoame nediferentiate
Lez pseudo-tum: displazice/distrofice
Ex:osteom infarct osos, chist, lacuna metafizara, chist anevrismal
Lez multifocale: boala exoostozanta, encondromatoza, displazia fibroasa, osteosarcomatoza, neurofibromatoza

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3
Q

Clasif in fct de varsta

A

Adult: metastaze, tum cel gig, fibrosarcom, reticulosarcom, plasmocitom
Pubertate: chist osos esential tipic, fibroame nonosifiante

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4
Q

Clasif in fct de localizare

A

Pe schelet
Pe piesa osoasa propriu zisa
Exo/endo osoase: epi/meta/dia
In fct de reg

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5
Q

Indicatii scintigrafie

A

Gradul de activitate osteoblastica
Lez multiple suspecte: carcinoame multiple, MM, limfom osos
Stadializare tum primara
Lez multifocala in alta parte

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6
Q

Indicatii CT

A

Lez mici in corticala osului: osteom osteoid, osteoblastom

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7
Q

Indicatii RMN

A

Procese de calcificare: miozita osifianta, condrosarcom perif

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8
Q

Indicatii angiografie

A

Rap tumorii cu vasele
Microcirculatia tumorala
Tehnici de chemoembolizare

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9
Q

Indicatii biopsie

A

Tum suspect maligne

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10
Q

Chist osos esential caracteristici

A

Lez distrofica localizata, pseudotum, B, cu continut lich
- activ: <5ani, nu respecta epi, umple meta, corticale subtiri, risc fractura de 50%
-inactiv: >10,respecta epi separata de o lama de os spongios
Unica
Localizare in meta oase lungi
Coaste calcaneu ileon omoplat

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11
Q

COE radio

A

Formatiune osteolitica, intraosoasa, in meta sup, ovalara, ax lung paralel cu diafiza
Bine delim, inferior de cupa de ou( banda de scleroza), sup de cartilajul de crestere
Omogena/neomogena cu septuri in interior(multiloculata)
Adult: chisturi remaniate in dia(bule de sapun/fagure) cu zone de condensare anarhice
Creste diam circumf osoase
Ingustarea corticalei

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12
Q

Ddx

A 
Chist anevrismal
Tum cel gig
Encondrom
Tumora bruna
Osteosarcom osteogenic
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13
Q

Tratament

A

Injectare intrachistica cu metilprednisolon
Inj intrachistica de maduva osoasa autologa si subtitutie osoasa
Trepanoevidare si plombaj cu grefa in evolutie
Decompresiune prin forare multipla
Lavaj cu sol salina
Foraj cu brose kirschner/surub canelat

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14
Q

Osteocondrom definitie si tipuri

A

Tb osteocart cu risc de malignizare in meta

  • solitar (mic, prolif in afara osului ca stalagmite stalactite)
  • multiple=maladia ombredanne
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15
Q

Osteocondrom radio

A

In metafiza: aprope de genunchi sau departe de cot
Solitar: Baza de implantare mare sesila /pediculata, se poate fractura si deveni corp liber
Corticala tum se continua cu corticala osului ca spongioasa
Bine delim, contur nereg/policiclic, neuniforma/microcalcificari
Multiple: mari, conopidiforme
Sinostoze radio cub/tibio peroniere distale

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16
Q

Osteocondrom: clinic

A 
Asimptomatic
Form dura nedureroasa la palpare
Asoc cu statura mica, incurbari ale oaselor, coxa valga genu valgum, 
Se descopera in prima decada
Durere data doar de compresiuni/fracturi
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17
Q

Osteocondrom ddx

A

Encondrom
Condrosarcom
Sarcom periostal

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18
Q

Osteocondrom tratament

A

Rezectia in tesut sanatos cu tot cu baza de implantare

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19
Q

Encondrom caracteristici

A

Tb cart centrala(encondrom) sau perif (excondrom)
Solitar/multiplu (encondromatoza ollier)
Tendinta de malignizare
10-50 de ani
Meta-dia oase tubulare mici mana si picior

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20
Q

Encondrom examen clinic

A

Asimptomatic sau

Simptomatic: dureri, tumefactii, limitare mobilitate, fractura de os patologic

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21
Q

Encondrom radio

A

Form tum osteolitica, bine delimitata, marg nereg , neomogena, trabeculatie discreta, microcalcificari interne

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22
Q

Emcondrom ddx

A

Condrom solitar central: coe, chist anevrismal, fibrom condromixoid
Condrom solitar periferic: exostoza osteogenica, sarcom juxtacortical, osificare posttraum

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23
Q

Encondrom tratament

A 
Excizie:
Trepanatie: deschidem osul
Chiuretaj: scoatem continutul tumoral
Avivare pereti: curatam
Plombare: cu grefa proprie, grefa donator, stent osos
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24
Q

Tum cu mieloplaxe(cu cel gigante/ osteoblastom) caracteristici si clasificare

Study These Flashcards
A

Formatiune borderline
Epifizara cu intindere spre meta
Metastazeaza
20-40ani
Gradul 1: inactiva, absolut benigna
G2: activa, tum de tranzitie cu activitate prolif, grad de atipism
G3: cert maligna, agresiva, morfo sarcomatoasa, metastazeaza

25
T cu mieloplaxe clinic
``` Debut insidios Dureri reumatoide 6-8 luni Tumefactie redusa dura nereg Impotenta fct Fractura de os patol ```
26
T cu mieloplaxe radio
Form osteolitica epifizara/epimetafizara, intraosoasa, bine delimitata, neomogena (bule de sapun) Subtiaza corticala G2: reactie periostala in foc de ierburi G3: distruge corticala
27
T cu mieloplaxe ddx
Chist anevrismal Osteosarcom Osteoblastom Condrosarcom
28
T cu mieloplaxe tratament
G1: chiuretaj si plombaj cu os spongios sau ciment acrilic/mixt G2,3: rezectie oncologica+reconstructie
29
Displazia fibroasa definitie
Leziune pseudotumorala intraosoasa b Inlocuieste t osos normal cu t fibros din cauza perturbarii osteogenezei mezenchimale Afecteaza osul in intregime
30
Displazia fibroasa clinic
``` Tumefactie Durere intermitenta Incurbari oase lungi Inegalitati de lungime Cu/fara fr de os patol Pete cafea cu lapte Tulb de crestere, pubertate precoce, Htiroidism, Hparatiroidism ```
31
Displazia fibroasa radio
Form pseudochistice nereg, rotunde/ovale, proximal metadia, lasand distal os normal sau nu, aspect multilocular, bine delim printr un lizereu opac, aspect de fagure, cu/fara calcif Cav medulara se largeste, corticala se subtiaza=> os cu aspect neregulat, neuniform ingrosat Femur:deformare in carja Inegalitati osoase
32
Displazia friborasa ddx
``` Encondrom Coe Coa MM Condro/osteosarcom Tum cu mieloplaxe ```
33
Displazia fibroasa tratament
Tratament sistemic ca in osteoporoza: bifosfonati, derivati de ca si d3 Tratamentul fracturilor Monitorizare clinica/radio
34
Osteosarcom definitie si tipuri
``` Tm care produce t osteoid Osteoitic: preponderent proce osteolitic Sediu in corticala, r periostala moderata Productie osoasa de neoformatie redusa Prognostic sever ``` Osteogenic/osificant: capacitate osteoproductiva hcelularitate Ritm de crestere si malignitate moderate Mixt
35
OS clinic
Durere intermitenta/continua atroce cu exacerbari nocturne Palpabila la oase superficiale, deformarea reg acoperita de teg lucioase cu circ colat Face corp comun cu osul Hidartroza htrofie musc Fr de os patol Sdr febril, impregnatie neoplazica
36
OS examen biologic nespecific
``` Vsh>100 FAL crescuta Ca crescut Crp crescut Anemie ```
37
Os radio
Osteolitic: Form osteolitica, imprecis delim, neomogena, centrala/excentrica, metafizara, contur nereg, distruge corticala, invazia partilor moi Osteogenic: osteocondensare meta R periostala in foc de ierburi
38
OS ddx
Osteomielita ac/cr Tbc osoasa Fibro/condrosarcom
39
OS tratament
Chimio: preop: metrotrexat, adriamicina, cisplatinum Postop Chir: rezectie in limite onco Reconstructie cu proteze, grefe masive cortico spongioase, atrodeze Radical: amputatie/dezarticulatie de necesitate Radioterapie: doze mari pt recidive/ forme inoperabile
40
Condrosarcom definitie
Tumora formatoare de t cartilaginos care nu produce niciodata t osteoid, cu localizare meta. Se poate exinte in dia OL
41
CS examen clinic
Durere intermitenta de intensitate redusa Tumefactie=> masa dura Comoresiune v-nv sau viscerala Rar: fr spontane
42
CS radio
Forma centrala: geode variabile ca talie, cu contur policiclic/nereg, imprecis delim Debut in int osului spre corticala Rar r periost Forma perif: calcificari cu aspect policiclic de popcorn Zona de implantare: corticala lizata si nereg Ddz osteocondrom Forma cu cel rare: osteoliza epi cu extensie meta fara lezarea corticalei Ddx mieloplaxe
43
CS ddx
``` Metastaza osoasa Condrom perif T cu miloplaxe Osteosarcom jucta cortical Displazie fibroasa Infarct intraosos ```
44
CS trat
Doar chir: rezectie in limite onco Reconstructie cu proteze tum, grefe masive cortico spongioase artrodeze Radical: Amputatie/dexarticulatie de necesitate
45
Sarcom ewing (angio reticulo endoteliom ) definitie
TM care nu produce t osteoid/ condroid Se dezv din elem reticuloendot ale maduvei hematopoietice Transforma t osos in maduva rosie Localizare meta dia OL si plate
46
SE examen clinic si biologic
``` Dureri cu perioade de remisiun3 Inflamatie Tumefactie fusiforma, dura cu teg calde si circ colat Manif pleuro pleurale=>loc costala Manif unitare=>loc pelvina Manif medulare=>loc vert ``` Vsh ⬆️ anemie leucocitoza LDH⬆️
47
SE radio
Formatiune tumorala cu osteoliza si osteocondensare imprecis delimitate in reg diafizo juxta metafizara Extindere medulara in intreaga diafiza Aspect ros de molii Reactie periostala in bulb de ceapa (1 strat de o.condensare 1 strat de o.liza) Subtiere corticala+ingrosarea diafizei
48
SE ddx
Osteomielita acuta Metastaza osoasa Granulom eozinofil
49
SE tratament
``` Radio Chimio pre si post op Chir rezectie Tija blocata Burlan de plastic cu ciment Etc ```
50
Trat TB
Tumora asimpt=>control anual Tumora mare, jena fcț, dureroasa, risc fr patologica: - trepanatie osoasa - chiuretaj - avivare pereti - plombare cu grefa osoasa (cortico-) spongioasa Sau amputatia extremitatii osoase afectate Radioterapie: tumori inaccesibile chirurgiei si impiedicarea recidivelor
51
Trat tm: chimio
Polichimioterapie secventiala de lunga durata 3-4 zile in fiecare luna, 6-12 luni Cisplatina, metrotrexat, adriamicina, mitomicina c
52
Trat TM radioterapie
TM ft radiosensibile, intermediar rs, radiorezistente Efect antalgic, recalcifiere, decompresie medulara Efect bun asupra metastazelor osoase venite din san prostata plaman
53
Trat TM chirurgie in fct de extensia tum
1 chirurgie intralezionala: ablatia tumorii fara reconstructie ex: exostoza pediculata 2 chir tumorala marginala: se umple golul lasat de exereza tum cu grefon (cortico-)spongios 3 chir tumorala larga: se trece in tesut sanatos sau chirurgie radicala in care osul leziunea zona periferica sunt ridicare in bloc (se impune adesea amputatia)
54
Trat TM clasificarea stadiala a lui enneking
G1 malignitate ⬇️ G2 malig⬆️ T0 tum perfect inchisa intr o capsula T1 tum se intinde dincolo de pseudocapsula sau t peritum dar ramane intr o loja anatomica inchisa T2 tum se intinde dincolo de loja sau se dezv de la inceput intr un spatiu celulo grasos fara limite precise M0 fara meta M1 cu meta
55
Coxartroza simptome
Debut insidios lung cu durere intermitenta moderata+-iradiata in genunchi Evolutie: dureri cu caract mecanic Inghinale fesier trohanterian+- irad genunchi Scaderea perimetrului de mers Mers schiopatat dureros in baston
56
Coxartroza inspectie
Atitudini vicioase in flexie adductie rotatie ext | Statica in pozitie soldita cu sprijin pe mb inf sanatos
57
Coxartroza palpare
``` Hipo/a-trofie de cvadriceps Cracmente artic Afectarea rotatiei ext Semn patrick pozitiv +- hipotrofie fesa ```
58
Coxartroza perioada finala
Impotenta fct totala Pozitie vicioasa Redoare artic importanta Dureri permanente refractare la trat

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