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Orto > Tumori Si Coxartroza Clinic > Flashcards

Tumori Si Coxartroza Clinic Flashcards

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

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
Q

T cu mieloplaxe clinic

A 
Debut insidios
Dureri reumatoide 6-8 luni
Tumefactie redusa dura nereg
Impotenta fct
Fractura de os patol
26
Q

T cu mieloplaxe radio

A

Form osteolitica epifizara/epimetafizara, intraosoasa, bine delimitata, neomogena (bule de sapun)
Subtiaza corticala
G2: reactie periostala in foc de ierburi
G3: distruge corticala

27
Q

T cu mieloplaxe ddx

A

Chist anevrismal
Osteosarcom
Osteoblastom
Condrosarcom

28
Q

T cu mieloplaxe tratament

A

G1: chiuretaj si plombaj cu os spongios sau ciment acrilic/mixt
G2,3: rezectie oncologica+reconstructie

29
Q

Displazia fibroasa definitie

A

Leziune pseudotumorala intraosoasa b
Inlocuieste t osos normal cu t fibros din cauza perturbarii osteogenezei mezenchimale
Afecteaza osul in intregime

30
Q

Displazia fibroasa clinic

A 
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
Q

Displazia fibroasa radio

A

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
Q

Displazia friborasa ddx

A 
Encondrom
Coe
Coa
MM
Condro/osteosarcom
Tum cu mieloplaxe
33
Q

Displazia fibroasa tratament

A

Tratament sistemic ca in osteoporoza: bifosfonati, derivati de ca si d3
Tratamentul fracturilor
Monitorizare clinica/radio

34
Q

Osteosarcom definitie si tipuri

A 
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
Q

OS clinic

A

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
Q

OS examen biologic nespecific

A 
Vsh>100
FAL crescuta
Ca crescut
Crp crescut
Anemie
37
Q

Os radio

A

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
Q

OS ddx

A

Osteomielita ac/cr
Tbc osoasa
Fibro/condrosarcom

39
Q

OS tratament

A

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
Q

Condrosarcom definitie

A

Tumora formatoare de t cartilaginos care nu produce niciodata t osteoid, cu localizare meta.
Se poate exinte in dia OL

41
Q

CS examen clinic

A

Durere intermitenta de intensitate redusa
Tumefactie=> masa dura
Comoresiune v-nv sau viscerala
Rar: fr spontane

42
Q

CS radio

A

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
Q

CS ddx

A 
Metastaza osoasa
Condrom perif
T cu miloplaxe
Osteosarcom jucta cortical
Displazie fibroasa
Infarct intraosos
44
Q

CS trat

A

Doar chir: rezectie in limite onco
Reconstructie cu proteze tum, grefe masive cortico spongioase artrodeze
Radical: Amputatie/dexarticulatie de necesitate

45
Q

Sarcom ewing (angio reticulo endoteliom ) definitie

A

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
Q

SE examen clinic si biologic

A 
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
Q

SE radio

A

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
Q

SE ddx

A

Osteomielita acuta
Metastaza osoasa
Granulom eozinofil

49
Q

SE tratament

A 
Radio
Chimio pre si post op
Chir rezectie
Tija blocata
Burlan de plastic cu ciment
Etc
50
Q

Trat TB

A

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
Q

Trat tm: chimio

A

Polichimioterapie secventiala de lunga durata
3-4 zile in fiecare luna, 6-12 luni
Cisplatina, metrotrexat, adriamicina, mitomicina c

52
Q

Trat TM radioterapie

A

TM ft radiosensibile, intermediar rs, radiorezistente
Efect antalgic, recalcifiere, decompresie medulara
Efect bun asupra metastazelor osoase
venite din san prostata plaman

53
Q

Trat TM chirurgie in fct de extensia tum

A

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
Q

Trat TM clasificarea stadiala a lui enneking

A

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
Q

Coxartroza simptome

A

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
Q

Coxartroza inspectie

A

Atitudini vicioase in flexie adductie rotatie ext

Statica in pozitie soldita cu sprijin pe mb inf sanatos

57
Q

Coxartroza palpare

A 
Hipo/a-trofie de cvadriceps
Cracmente artic
Afectarea rotatiei ext
Semn patrick pozitiv
\+- hipotrofie fesa
58
Q

Coxartroza perioada finala

A

Impotenta fct totala
Pozitie vicioasa
Redoare artic importanta
Dureri permanente refractare la trat

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