Refrat Giant Cell Tumor Tendon Sheath
-
Upload
anonymous-qnh8ag595b -
Category
Documents
-
view
228 -
download
0
Transcript of Refrat Giant Cell Tumor Tendon Sheath
7/26/2019 Refrat Giant Cell Tumor Tendon Sheath
http://slidepdf.com/reader/full/refrat-giant-cell-tumor-tendon-sheath 1/18
Referat
GIANT CELL TUMOR OF TENDONSHEATH
Pembimbing :
dr. Abidin, SpOT
Dissn !"e# :
A"mir$ R!s$"ie
%%&.'&%&.&%(
)EPANITERAAN ILMU *EDAH
RS T) II M.RID+AN MEURA)SA A)ARTA
A)ARTA
'&%(
7/26/2019 Refrat Giant Cell Tumor Tendon Sheath
http://slidepdf.com/reader/full/refrat-giant-cell-tumor-tendon-sheath 2/18
)ATA PENGANTAR
Ass$"$m$"$i-m r. b
A"#$md"i""$#ir!bbi"$"$min seg$"$ p/i b$gi A""$# S+T $0$s seg$"$ r$#m$0 d$n #id$1$#2
N1$, s#!"$$0 ser0$ s$"$m $0$s n$bi bes$r M#$mm$d SA+. Terim$ -$si# 1$ng sebes$r2bes$rn1$
-ep$d$ Le0n$n )!"!ne" C)M dr. Firm$ns1$#, Sp*, )!"!ne" Prn$ir$$n dr. S$b$r!e""$#, Sp*,
)!"!ne" Prn$ir$$n dr. Abidin, SpOT, Le0n$n )!"!ne" C)M dr. Giri M$rse"$, SpOT, Le0n$n
)!"!ne" C)M dr. Sen/$ .A, Sp.*P $0$s -esedi$$n $-0n1$, d$n -esemp$0$n 1$ng diberi-$n
seb$g$i pembimbing -ep$ni0er$$n s0$se bed$# di Rm$# S$-i0 M!#. Rid$n Mer$-s$.
Re3er$0 ini dissn n0- memen#i 0g$s -ep$ni0er$$n I"m *ed$# di RS. M!#. Rid$n
Mer$-s$ 1$ng merp$-$n s$"$# s$0 d$ri pr$s1$r$0 -e""s$n. Re3er$0 ini memb$#$s d$n
meng$n$"is$ berb$g$i #$" mengen$i Gi$n0 Ce"" Tm!r !3 Tend!n S#e$0#.
Pen"is s$d$r b$#$ d$"$m pen1sn$n re3er$0 ini m$si# b$n1$- se-$"i -e-r$ng$n. O"e#
-$ren$ i0 -ri0i- d$n s$r$n 1$ng memb$ngn di#$r$p-$n demi perb$i-$n Re3er$0 ini.
Sem!g$ Re3er$0 ini bergn$ b$gi sem$ pi#$- 1$ng 0er-$i0.
+$ss$"$m4$"$i-m r. b
$-$r0$, Febr$ri '&%(
5 Pen"is 6
2
7/26/2019 Refrat Giant Cell Tumor Tendon Sheath
http://slidepdf.com/reader/full/refrat-giant-cell-tumor-tendon-sheath 3/18
DAFTAR ISI
Kata Penghantar77777777777777777777777777777'
Pendahuluan777777777777777777777777777777...8
Tinjauan Pustaka7777777777777777777777777777...(
De3inisi77777777777777777777777777777.7(
Epidemi!"!gi777.77777777777777777777777.7..(
E0i!"!gi7777777777777777777777777777.77(
P$0!3isi!"!gi7777.7777777777777777777777.7...(
Di$gn!sis7777777777777777..77777777777.7...9
Di$gn!sis *$nding77777777777777777777777777
Pen$0$"$-s$n$$n777777777777...7777777777777...%'
Pr!gn!sis77777777777777777777777777777.%8
Penutup777777777777777777..77777777777777%(
)esimp"$n7777777777777777777777777777.%(
Daftar Pustaka7777777777777777.7777777777777.%9
BAB I
PENDAHULUAN
3
7/26/2019 Refrat Giant Cell Tumor Tendon Sheath
http://slidepdf.com/reader/full/refrat-giant-cell-tumor-tendon-sheath 4/18
Gi$n0 ;e"" 0m!r !3 0end!n s#e$0# 1$ng /g$ diseb0 seb$g$i 0en!s1n!<i$" gi$n0 ;e"" 0m!r
$d$"$# 0m!r /in$- 1$ng p$"ing mm -ed$ se0e"$# -is0$ g$ng"i!n. % Tm!r ini sering 0er/$di
p$d$ p$sien 1$ng bersi$ =&2(& 0$#n, deng$n pn;$- insidensi p$d$ si$ 8&2(& 0$#n d$n s$ng$0
/$r$ng di0em-$n p$d$ p$sien 1$ng bersi$ dib$$# %& 0$#n $0$ di$0$s 9& 0$#n.'
GCTTS 0id$- se"$" ber$s$" d$ri se"bng 0end!n 0e0$pi /g$ ber$s$" d$ri ;$ir$n
sin!<im.' GCTTS sering 0er/$di p$d$ p$sien 1$ng bersi$ di$0$s =& 0$#n d$n di-"$si3i-$si-$n
men/$di d$ 0ipe, 1$i0 "!-$" d$n di3s.%
Pen1eb$b d$ri 0m!r ini 0id$- di-e0$#i, 0e!ri 1$ng p$"ing di0erim$ se;$r$ "$s
men1$0$-$n b$#$ GCTTS ber$s$" d$ri #iperp"$si$ re$-0i3 $0$ regener$0i3 1$ng ber#bng$n
deng$n pr!ses in3"$m$si.% Tm!r ini merp$-$n 0m!r /in$- 1$ng per0mb#$nn1$ "$mb$0, 0id$-
menimb"-$n r$s$ s$-i0, d$n 0id$- berme0$s0$sis n$mn d$p$0 se;$r$ $gresi3 mers$- /$ring$n
se-i0$rn1$.=
GCTTS memi"i-i Insiden -e-$mb#$n "!-$" 1$ng 0inggi, ber-is$r 288>. ?$ri$bi"i0$s ini
d$p$0 men;ermin-$n e-sisi 1$ng 0id$- "eng-$p d$ri "esi, 0er0$m$ n!d" s$0e"i0. F$-0!r risi-!
n0- -e-$mb#$n me"ip0i $d$n1$ pen1$-i0 sendi degener$0i3 1$ng berde-$0$n, ;eder$ p$d$
sendi DIP d$ri /$ri $0$ sendi in0erp#$"$nge$" ib /$ri, d$n $d$n1$ er!si 0"$ng.
BAB II
TINJAUAN PUSTAKA
4
7/26/2019 Refrat Giant Cell Tumor Tendon Sheath
http://slidepdf.com/reader/full/refrat-giant-cell-tumor-tendon-sheath 5/18
II! Definisi
Gi$n0 ;e"" 0m!r !3 0end!n s#e$0# 1$ng /g$ diseb0 seb$g$i 0en!s1n!<i$" gi$n0 ;e"" 0m!r
$d$"$# 0m!r /in$- 1$ng p$"ing mm -ed$ se0e"$# -is0$ g$ng"i!n.% GCTTS 0id$- se"$" ber$s$"
d$ri se"bng 0end!n 0e0$pi /g$ ber$s$" d$ri ;$ir$n sin!<im.'
GCTTS sering 0er/$di p$d$ p$sien
1$ng bersi$ di$0$s =& 0$#n d$n di-"$si3i-$si-$n men/$di d$ 0ipe, 1$i0 "!-$" d$n di3s. %
*en0- di3s diseb0 seb$g$i pigmen0ed <i""!n!d"$r s1n!<i0is 5P?NS6 d$n bi$s$n1$
men1er$ng e-s0remi0$s b$$#. *en0- di3s bersi3$0 $gresi3 "!-$", p$d$ mmn1$ beber$p$
d$p$0 -$mb# se0e"$# e-sisi.%
II" Epide#i$l$gi
Gi$n0 ;e"" 0m!r !3 0end!n s#e$0# "ebi# sering 0er/$di p$d$ p$sien 1$ng bersi$ =&2(&
0$#n, deng$n pn;$- insidensi p$d$ si$ 8&2(& 0$#n. Tm!r ini s$ng$0 /$r$ng di0em-$n p$d$
p$sien 1$ng bersi$ dib$$# %& 0$#n $0$ di$0$s 9& 0$#n. Pen1$-i0 ini "ebi# b$n1$- dideri0$
!"e# peremp$n dib$ngding-$n pri$, deng$n r$si! =:'.'
II% Eti$l$gi
Pen1eb$b gi$n0 ;e"" 0m!r !3 0end!n s#e$0# 0id$- di-e0$#i. Te!ri p$0!genesis 0e"$#
menn/--$n $d$n1$ 0r$m$, me0$b!"isme 0erg$ngg "ipid, pr!"i3er$si !s0e!-"$s, in3e-si,
g$ngg$n pemb"# d$r$#, me-$nisme -e-eb$"$n 0b#, per$d$ng$n, ne!p"$si$, d$n g$ngg$n
me0$b!"isme. Te!ri 1$ng p$"ing di0erim$ se;$r$ "$s men1$0$-$n b$#$ GCTTS ber$s$" d$ri
#iperp"$si$ re$-0i3 $0$ regener$0i3 1$ng ber#bng$n deng$n pr!ses in3"$m$si.%
II & Pat$fisi$l$gi
D$"$m *eber$p$ pene"i0i$n pemben0-$n gi$n0 ;e"" 0m!r $d$ beber$p$ 3$-0!r 1$ng
mene0-$n, per0$m$ 1$i0 $d$n1$ perb$#$n si-"in, dim$n$ si-"in mem$in-$n per$n pen0ing
d$"$m meng$0r per/$"$n$n memb$gi se" me"$"i p!s pemeri-s$$n pen0ing d$"$m si-"s se".
)$ren$ perb$#$n d$ri beber$p$ si-"in, 0er0$m$ si-"in D%, 0e"$# 0er"ib$0 d$"$m per-emb$ng$n
ne!p"$sm$.=
5
7/26/2019 Refrat Giant Cell Tumor Tendon Sheath
http://slidepdf.com/reader/full/refrat-giant-cell-tumor-tendon-sheath 6/18
)ed$, $d$n1$ e<$"$si Immn!#is0!-imi$ 1$ng 0er-$i0 deng$n e-spresi mi;r!p#0$"mi$
1$ng merp$-$n 3$-0!r 0r$ns-ripsi d$"$m "esi gi$n0 ;e"". Mi;r!p#0$"mi$ 0er-$i0 deng$n 3$-0!r
0r$ns-ripsi 5Mi036, $ngg!0$ sb3$mi"i #e"i-s2"!!p2#e"i@ 3$-0!r 0r$ns-ripsi, bi$s$n1$ din1$0$-$n
d$"$m !es0e!-"$s m!n!n-"e$r d$n m"0in-"e$r, 0er"ib$0 d$"$m di33erensi$si 0ermin$" !es0e!-"$s.
Dis3ngsi $-0i<i0$s !es0e!-"$s 1$ng meng#$si"-$n e-spresi Mi03 1$ng $bn!rm$" ser0$ 0e"$#
0er"ib$0 !es0e!p!r!sis. Se/m"$# se" gi$n0 "$inn1$ d$ri berb$g$i /enis 0erm$s- !es0e!-"$s seper0i
se"2se" gi$n0 0er"i#$0 d$"$m berb$g$i 0m!r, se;$r$ 0r$disi!n$" di$ngg$p ber$s$" m!n!si0, 0er"i#$0
d$"$m berb$g$i 0"$ng d$n "esi e@0r$!sses.=
)e0ig$ $d$"$# se" s0r!m$. Se" s0r!m$ Fibr!b"$s0"i-e, 1$ng se"$" #$dir seb$g$i -!mp!nen
d$ri 0m!r se" r$-s$s$ p$d$ 0"$ng 5GCT6, d$p$0 di$m$0i di-ed$ s$mpe" in <i<! d$n -"0r.
Mes-ipn mere-$ di$smsi-$n n0- memi; pr!ses -$n-er di GCT, #is0!genesis se" s0r!m$
GCT $d$"$# -r$ng di-e0$#i. H$" ini di-e0$#i b$#$ se" b$0$ng mesen;#1m$" 5MSC6 d$p$0
ber-emb$ng -e !es0e!b"$s. *-0i 0e"$# dis$/i-$n b$#$ se"2se" s0r!m$ GCT /g$ d$p$0
mengemb$ng-$n n0- !es0e!b"$s. Seb$# -!ne-si $n0$r$ MSC d$n se" s0r!m$ GCT di;$ri
deng$n menggn$-$n d$ pende-$0$n "$b!r$0!rim 1$ng berbed$.=
II' Diagn$sis
Ge/$"$ 0$m$ 1$ng di0em-$n berp$ n1eri ser0$ pembeng-$-$n d$n mng-in di0em-$n
e3si sendi ser0$ g$ngg$n ger$-$n p$d$ sendi. Mng-in /g$ penderi0$ d$0$ng ber!b$0 deng$n
ge/$"$2ge/$"$ 3r$-0r 5%&>6. D$p$0 /g$ 0er/$di pembes$r$n m$ss$ se;$r$ "$mb$0. Lebi# d$ri 0ig$
per emp$0 p$sien 0er;$0$0 meng$"$mi pembeng-$-$n p$d$ "!-$si 0m!r.=
P$d$ pemeri-s$$n 3isi- d$p$0 di0em-$n m$ss$ 1$ng -er$s d$n n1eri 0id$- di0em-$n
p$d$ "ebi# d$ri &> p$sien. Disse A0r!p#1 , e3si p$d$ persendi$n $0$ #$ng$0 p$d$ "!-$si
0m!r.
P$d$ GCT dib$gi men/$di beber$p$ gr$de $0$ s0$ging :
S0$ge I :
2 *enign "$0en0 d$ri gi$n0 ;e"" 0m!r.
6
7/26/2019 Refrat Giant Cell Tumor Tendon Sheath
http://slidepdf.com/reader/full/refrat-giant-cell-tumor-tendon-sheath 7/18
2 Tid$- $d$ $-0i<i0$s $gr$si3 "!-$".
S0$ge II :
2 *enign $;0i<e gi$n0 ;e"" 0m!r.
2 P$d$ pen;i0r$$n 0er"i#$0 g$mb$r$n $"0er$si s0r-0r 0"$ng ;!r0i-$"
S0$ge III :
2 Tm!r "!-$" $gresi3.
2 P$d$ pen;i0r$$n 0er"i#$0 g$mb$r$n "esi "i0i- menge"i"ingi med"$ d$n -!r0e-s 0"$ng.
2 Tm!r d$p$0 me"e$0i -!r0e-s d$n pene0r$si -e /$ring$n "n$-.8
7
7/26/2019 Refrat Giant Cell Tumor Tendon Sheath
http://slidepdf.com/reader/full/refrat-giant-cell-tumor-tendon-sheath 8/18
Pemeri-s$$n r$di!"!gi
merp$-$n s$"$# s$0 pemeri-s$$n
1$ng pen0ing d$"$m meneg$--$n di$gn!sis p$d$ GCT. G$mb$r$n R$di!"!gi 1$ng bi$s$
did$p$0-$n p$d$ GCT $d$"$#:
2 R$di!gr$3i p!"!s menn/--$n g$mb$r$n 0m!r /in$- dib$0$si b$1$ng$n /$ring$n "n$- 5(&>
-$ss6.
2 T$mp$- d$er$# r$di!"sen p$d$ /ng 0"$ng deng$n b$0$s 1$ng 0id$- 0eg$s.
2 Ad$ B!n$ 0r$nsisi $n0$r$ 0"$ng n!rm$" d$n p$0!"!gi-, bi$s$n1$ -r$ng d$ri % ;m.
2 Lesi bi$s$n1$ e-s0en0ri-, bersi3$0 e-sp$nsi3 se#ingg$ -!r0e-s men/$di 0ipis.(
G$mb$r %. g$mb$r$n -"inis GCT
8
7/26/2019 Refrat Giant Cell Tumor Tendon Sheath
http://slidepdf.com/reader/full/refrat-giant-cell-tumor-tendon-sheath 9/18
P$d$ pemeri-s$$n mi-r!s-!pis, $d$ b$n1$- se"2se" gi$n0 m"0in-"e$r. Se"2 se" s0r!m$
$d$"$# se"2se" m!n!n-"e$r #!m!gen deng$n ben0- se-i0$r $0$ b"$0 0e"r, in0i bes$r d$n
n-"e!"s 0id$- /e"$s. In0i d$ri se" s0r!m$ 1$ng iden0i- deng$n in0i d$"m se"2se" gi$n0, seb$# 3i0r
1$ng membed$-$n 0m!r se" r$-s$s$ d$ri "esi "$in 1$ng /g$ meng$ndng se"2se" r$-s$s$. Fi0r
"$in d$ri 0m!r se" r$-s$s$ $d$"$# b$#$ se"2se" gi$n0 mng-in berisi se" in0i 1$ng ber-r$n
s$ng$0 bes$r. D$"$m beber$p$ 0m!r, se"2se" gi$n0 d$p$0 dip$nd$ng me"$nd$ in0i "ebi# bes$r d$ri
s0r!m$.9
G$mb$r '. g$mb$r$n r$di!gr$3i GCTTS
9
7/26/2019 Refrat Giant Cell Tumor Tendon Sheath
http://slidepdf.com/reader/full/refrat-giant-cell-tumor-tendon-sheath 10/18
II( Diagn$sis Banding
! Aneur)s#a *$ne +)st
)e"$in$n ini b-$n ne!p"$sm$. E0i!"!gin1$ 0id$- di-e0$#i, didg$ -$ren$ $d$n1$
-e"$in$n <$s-"$r 1$ng diseb$b-$n !"e# g$ngg$n sir-"$si d$r$#. )ir$2-ir$ &> "esi ini
di/mp$i p$d$ si$ (2'& 0$#n. )e"$in$n ini /g$ d$p$0 di0em-$n p$d$ 0i$p b$gi$n d$ri s-e"e0.
P$d$ 0"$ng p$n/$ng bi$s$n1$ 0er"e0$- di d$er$# me0$3isis.(
G$mb$r$n r$di!"!gin1$ 0$mp$- d$er$# 1$ng r$di!"sen p$d$ 0"$ng 1$ng memberi -es$n
$d$n1$ des0r-si 0"$ng. Lesi ini bersi3$0 e-sp$nsi3, -!r0e-s men/$di s$ng$0 0ipis d$n
mengembng -e"$r. G$mb$r$n s$ng$0 mirip deng$n giant cell tumor. *$0$s d$ri "esi n1$ 0eg$s
d$n sering -$"i diser0$i 0epi s-e"er!0i- si3$02si3$0 ini pen0ing n0- membed$-$nn1$ deng$n gi$n0
;e"" 0m!r 1$ng mempn1$i b$0$s 0id$- 0eg$s. (
G$mb$r =. g$mb$r$n #is0!p$0!"!gi GCTTS
10
7/26/2019 Refrat Giant Cell Tumor Tendon Sheath
http://slidepdf.com/reader/full/refrat-giant-cell-tumor-tendon-sheath 11/18
" K$ndr$*last$#a
)!ndr!b"$s0!m$ $d$"$# 0m!r /in$- di epi3isis -$r0i"$g! d$n mmn1$ mn;" di 0"$ng
p$n/$ng 0b"$r, 0er/$di p$d$ p$sien %& s$mp$i'( 0$#n. Lebi# sering 0er/$di p$d$ "$-i2"$-i.
*i$s$n1$ 0er/$di p$d$ epi3isis d$ri dis0$" d$n pr!-sim$" 3emr, pr!-sim$" 0ibi$ d$n pr!-sim$"
#mers, 0emp$0 1$ng bi$s$ /g$ 0er-en$ $d$"$# 0$"s, ;$";$nes d$n p$0e""$. *i$s$n1$ p$sien
d$0$ng deng$n deng$n s$-i0 did$er$# 1$ng "!-$sin1$ /e"$s, $d$ pembeng-$-$n, sendi -$- d$n
ger$-$n 0erb$0$s.
G$mb$r$n r$di!"!gisn1$ : 0$mp$- seb$g$i b$1$ng$n r$di!"sen0, bi$s$n1$ berben0-
bnd$r deng$n b$0$s 1$ng 0eg$s. )$d$ng 0$mp$- pinggir$n 1$ng s-er!0i-. )$"si3i-$si 0erd$p$0
p$d$ -ir$2-ir$ (&>. (
G$mb$r 8. g$mb$r$n -"inis $ner1sm$ b!ne ;1s0
11
7/26/2019 Refrat Giant Cell Tumor Tendon Sheath
http://slidepdf.com/reader/full/refrat-giant-cell-tumor-tendon-sheath 12/18
% N$n, $ssif)ing -i*r$#a . -i*r$/anth$#a0
N!n2 !ssi31ing Fibr!m$ $0$ Fibr!@$n0#!m$ $d$"$# 0m!r /in$- 1$ng $sim0!m$0i-
mmn1$ 0er/$di p$d$ $n$-2$n$-. G$mb$r$n mi-r!s-!pi-, s$0 3ibr!m$ n!n!ssi31ing 0erdiri
d$ri se" spind"e 53ibr!s6. Se-i0$r '&> d$ri sem$ $n$- memi"i-i "esi ini, p$"ing sering di 0"$ng
p$#$ p!s0eri!r dis0$". i-$ se!r$ng $n$- ber$n/$- de$s$, "esi ;enderng meng#i"$ng.
R$di!gr$3i menn/--$n "esi dis0$" 0ibi$ me0$3isis deng$n s;$""!ping end!s0e$" minim$",
1$ng 0id$- /$r$ng p$d$ 0m!r /in$- "$0en. N$mn, i0 men;ermin-$n per0mb#$n epis!de
sebe"mn1$. M$rgin $n0$r$ "esi d$n 0"$ng di se-i0$rn1$ berbed$. Tepi s-"er!0i- 1$ng di
de3inisi-$n deng$n b$i- menn/--$n b$#$ 0m!r se-$r$ng minim$" $-0i3. )r$ngn1$
miner$"is$si in0ern$" 1$ng menn/--$n b$#$ "esi b$i- di /$ring$n ;$ir$n $0$ 3ibr!s$.
G$mb$r (. g$mb$r$n -"inis -!ndr!b"$s0!m$
12
7/26/2019 Refrat Giant Cell Tumor Tendon Sheath
http://slidepdf.com/reader/full/refrat-giant-cell-tumor-tendon-sheath 13/18
& 1ste$klast$#a
Os0e!-"$s0!m$ $d$"$# s$0 ne!p"$sm$ 1$ng meng$ndng se/m"$# bes$r se" r$-s$s$
mirip !s0e!-"$s ber;$mpr deng$n se" m!n!n-"es. Tm!r ini /g$ sering 0er/$di, memben0-
se-i0$r '&> d$ri sem$ 0m!r /in$- 0"$ng. Tm!r ini sering 0er/$di p$d$ 0"$ng20"$ng p$n/$ng,
0er0$m$ p$d$ sendi "00, /$r$ng p$d$ r$#$ng. g$ di 0em-$n p$d$ -ep$"$ d$n "e#er. Did$p$0
p$d$ epi3isis 0"$ng p$n/$ng 1$ng d$p$0 me"$s -e $r$# me0$3isis. Temp$0 1$ng p$"ing sering
0er/$di $d$"$# pr!-sim$" 0ibi$, dis0$" 3emr, dis0$" r$dis d$n pr!-sim$" #mers. g$ d$p$0
di0em-$n di pe"<is d$n s$;rm.%&
• -e"#$n r$s$ n1eri 1$ng 0ers ber0$mb$# p$d$ b$gi$n 0"$ng 1$ng meng$"$mi "esi, )$-,
3r$-0r p$0!"!gis• enis 1$ng /in$- : per0mb#$n 1$ng "$mb$0, e-sp$nsi 0"$ng.
• enis 1$ng g$n$s $0$ $gresi3 : per0mb#$n 1$ng ;ep$0, s$-i0, p$r$s0esi$.
• R$di!"!gi : "esi r$di!"sen seper0i p$d$ ;en0r$" gi$n0 ;e"" gr$n"!m$. T$mp$- d$er$#
!s0e!"i0i- di epi3isis deng$n b$0$s 1$ng /e"$s d$n memberi-$n -es$n m"0i"!-"er
g$mb$r$n s!$p bbb"e. Ser0$ Ter/$di penipis$n -!r0e-.
G$mb$r 8. g$mb$r$n -"inis Fibr!@$n0#!m$
13
7/26/2019 Refrat Giant Cell Tumor Tendon Sheath
http://slidepdf.com/reader/full/refrat-giant-cell-tumor-tendon-sheath 14/18
• His0!p$0!"!gi : 0erd$p$0 b$n1$- se" r$-s$s$ m"0in;"e$0ed di$n0$r$ se" s0r!m$
m!n!n;"$e$r. Tm!r ini mng-in /g$ 0erd$p$0 se"2se" in3"$m$si d$n $re$ ne-r!sis bi"$
0id$- diser0$i perd$r$#$n d$n dep!sisi #em!siderin. Tm!r ini se" r$-s$s$n1$ "ebi# bes$r
d$n n-"ein1$ "ebi# b$n1$- d$ri p$d$ se" r$-s$s$ p$d$ gi$n0 ;e"" gr$n"!m$. p$d$ sedi$$n
#$si" -re0$se, S0r!m$ 1$ng <$s-"er deng$n b$n1$- se"2se" d$0i$gi$n0 ;e"". Di0em-$n
mi0!sis deng$n md$# p$d$ perbes$r$n 8@ d$n %&@. beber$p$ 0emp$0 0erd$p$0 se"
3ibri#is0i!;i0 d$n @$n0!m$ se".
II2
Penatalaksanaan
Ter$pi *ed$#
Ter$pi 1$ng dis$r$n-$n n0- GCTTS $d$"$# deng$n me"$--$n e-sisi "$s s$mp$i 0epis$1$0$n beb$s 0m!r. Re-rensi "!-$" p$d$ GCTTS se-i0$r %'> p$d$ mmn1$ di0em-$n p$d$
-$ss 0epi s$1$0$n 0id$- beb$s 0m!r. Debridemen0 deng$n -re0$se 0m!r /g$ mmn1$
di"$--$n /i-$ 0erd$p$0 er!si 0"$ng. Te-ni- ini me1eb$b-$n seb$# "b$ng di 0"$ng 1$ng d$p$0
diisi deng$n gr$30 0"$ng. T"$ng d$p$0 di$mbi" d$ri b$gi$n "$in d$ri 0b# p$sien sendiri
5$0!gr$306 $0$ d$ri m$1$0 5 $""!gr$306. i-$ peng!b$0$n 0erb$0$s p$d$ -re0$se, 0m!r bis$
G$mb$r (. g$mb$r$n r$di!"!gis 0er"i#$0 d$er$# !s0e!"i0i- di
epi3isis deng$n $d$n1$ s!$p bbb"e
14
7/26/2019 Refrat Giant Cell Tumor Tendon Sheath
http://slidepdf.com/reader/full/refrat-giant-cell-tumor-tendon-sheath 15/18
-emb$"i 5-$mb#6 s$mp$i deng$n 8(> d$ri $-0 -re0$se 0erseb0. Penggn$$n d$ri semen
0"$ng, b-$n d$ri b!ne gr$30 0ing-$0 -e-$mb#$nn1$ sedi-i0.
Lebi# -!mp"e-s peng#$ps$n 0m!r d$n re-!ns0r-si -$d$ng2-$d$ng memer"-$n si0$si
dim$n$ 0m!r 0e"$# men1eb$b-$n -ers$-$n 1$ng ber"ebi#$n $0$ 0er"$ng.
15
7/26/2019 Refrat Giant Cell Tumor Tendon Sheath
http://slidepdf.com/reader/full/refrat-giant-cell-tumor-tendon-sheath 16/18
Ter$pi n!n bed$#
Ter$pi r$di$si merp$-$n pi"i#$n peng!b$0$n n!n !per$si 1$ng 0e"$# 0erb-0i e3e-0i3.
N$mn, #$" ini d$p$0 meng$-ib$0-$n pemben0-$n -$n-er p$d$ seb$n1$- %(> d$ri p$sien 1$ng
menerim$n1$. O"e# -$ren$ i0, 0er$pi r$di$si dign$-$n #$n1$ d$"$m -$ss2-$ss 1$ng p$"ing
s"i0 dim$n$ !per$si 0id$- d$p$0 di"$--$n deng$n $m$n $0$ e3e-0i3.
II3 Pr$gn$sis
Ang-$ -em$0i$n $-ib$0 0m!r se" r$-s$s$ $d$"$# se-i0$r 8> d$n insiden -e-$mb#$n
"!-$" 1$ng 0inggi, ber-is$r 288>. ?$ri$bi"i0$s ini d$p$0 men;ermin-$n e-sisi 1$ng 0id$- "eng-$p
d$ri "esi, 0er0$m$ n!d" s$0e"i0. F$-0!r risi-! n0- -e-$mb#$n me"ip0i $d$n1$ pen1$-i0 sendi
degener$0i3 1$ng berde-$0$n, ;eder$ p$d$ sendi DIP d$ri /$ri $0$ sendi in0erp#$"$nge$" ib /$ri,
d$n $d$n1$ er!si 0"$ng.%
Tid$- $d$ "$p!r$n b$#$ 0erd$p$0 -$ss degener$si g$n$s d$ri 0m!r /in$- se" r$-s$s$
d$ri s$rng 0end!n. Tm!r ini /g$ 0id$- memi"i-i -e;enderng$n n0- berme0$s0$sis signi3i-$n
0er#$d$p pr!gn!sisn1$. %
G$mb$r 9. g$mb$r$n e-sisi m$rgin$" p$d$ GCTTS
16
7/26/2019 Refrat Giant Cell Tumor Tendon Sheath
http://slidepdf.com/reader/full/refrat-giant-cell-tumor-tendon-sheath 17/18
BAB III
KESI4PULAN
%. Tm!r se" r$-s$s$ d$ri s$rng 0end!n $d$"$# 0m!r 1$ng p$"ing mm -ed$ p$d$ 0$ng$n
d$n -$-i, se0e"$# -is0$ g$ng"i!n seder#$n$
'. E0i!"!gi d$ri 0m!r ini 0id$- di-e0$#i se;$r$ p$s0i=. Tm!r ini merp$-$n 0m!r /in$- 1$ng per0mb#$nn1$ "$mb$0, 0id$- menimb"-$n r$s$
s$-i0, d$n 0id$- berme0$s0$sis. N$mn d$p$0 se;$r$ $gresi3 mers$- /$ring$n se-i0$rn1$.
8. Ter$pi pi"i#$n $d$"$# 0ind$-$n bed$# berp$ e-sisi m$rgin$"(. Memi"i-i Insiden -e-$mb#$n "!-$" 1$ng 0inggi, ber-is$r 288> d$n $ng-$ -em$0i$n
se-i0$r 8>
(
17
7/26/2019 Refrat Giant Cell Tumor Tendon Sheath
http://slidepdf.com/reader/full/refrat-giant-cell-tumor-tendon-sheath 18/18
DA-TA5 PUSTAKA
%. $mes R ?er#e1den, MD. Gi$n0 Ce"" Tm!r !3 0#e Tend!n S#e$0#. Ags0s, '&%8.
A<$i"$b"e 3r!m URL : #00p:emede;ine.meds;$pe.;!m
'. $mes C. +i00ig, MD. Gi$n0 Ce"" Tm!r !3 0#e Tend!n S#e$0#. '&%8. A<$i"$b"e 3r!m URL
: #00p:.0m!rsrger1.!rg
=. Ameri;$n A;$dem1 !3 Or0#!pedi;s Srge!ns. Gi$n0 Ce"" Tm!r !3 *!ne. ne '&%&.
A<$i"$b"e 3r!m URL : #00p:.!r0#!in3!.!rg
8. +#ee"ess Te@0b!!- !3 Or0#!p$edi;s. Gi$n02;e"" 0m!r !3 b!ne. M$r;# '&%%. A<$i"$b"e
3r!m URL : #00p:.#ee"ess!n"ine.;!m
(. E-$1d$ I. R$di!"!gi Di$gn!s0i- edisi -ed$. $-$r0$ : *$"$i Penerbi0 F)UI '&&(. #. 92
%.
9. *!ne Tm!r. Gi$n0 Ce"" Tm!r. Ne0!n, M$ss$;#se0ss. ne '&&=. A<$i"$b"e 3r!m
URL: #00p:.b!ne0m!r.!rg
. R$s/$d C. I"m *ed$# Or0!pedi. U/$ng P$nd$ng. *in0$ng L$mmp$0e %. #. =(2
='.. !sep# *. Ms;"!s-e"e0$" Medi;ine %s0 edi0i!n. '&&=
. Ameri;$n A;$dem1 !3 Or0#!pedi;s Srge!ns. Gi$n0 Ce"" Tm!r !3 *!ne. ne '&%&.
A<$i"$b"e 3r!m URL : #00p:.!r0#!in3!.!rg
%&. R!bbins, *- A/$r P$0!"!gi. Edi0!r : Dennis ). *rns, MD ?in$1 )m$r, MD. Edisi
<!"me '.'&&. EGC. H$" : (.
18