Osteo-osteoma( from the Greek words osteon - "bone" and idos - "likeness") is a benign new bone formation that develops extremely slowly and is not more than ten percent of the number of all benign tumor processes in the bones of the human skeleton.
Osteoid osteoma( a term that is a full-fledged synonym) affects boys and adolescents in males four times more often than female patients, and in the latter, neoplasms appear predominantly on the face. The age of young patients is usually limited to eight to twenty years.
Classification of osteoid-osteoma
The origin separates osteoid-osteomas into two types. They are:
- Hyperplastic , formed from bone tissue. This group of benign tumors consists of osteoma and osteoid-osteome.
- Heteroplastic , formed from connective tissues. This type of neoplasm is represented by osteophytes.
Hyperplastic
The structure of benign neoplasms( osteome) is completely identical to the structure of ordinary bone tissue.
- Hyperplastic osteomas can be localized on the bones of the skull( including the bones of the facial section of the skull).Being mostly single, they are often introduced into one of the paranasal sinuses: the maxillary, wedge-shaped, latticed or frontal.
- Multiple osteomas located on the bones of the skull and tubular bones are characteristic of Gardner's syndrome. In this syndrome they are always combined with neoplasms of soft tissues, polyps of the intestine and various pathological processes of the ocular retina.
- Multiple can be congenital osteoid osteomas located on the bones of the skull. They are often combined with the numerous malformations of a small patient.
- In half of cases, osteoid-osteomas affect the tissues of the tibia and femur, the process develops somewhat more rarely in the ribs, in the bones of the spine and in the tubular bones( humerus and peroneum).
Heteroplastic
Osteophytes, representing this group of osteomas, are internal and external.
- Internal osteophytes ( called enostoses), germinating inside the medullary canal, are usually single. An exception to this rule is a rare hereditary osteopoxia, characterized by the appearance of numerous formations that do not manifest themselves and are accidentally detected on an X-ray taken in connection with another diagnosis.
- For external osteophytes ( exostoses), formation on the surface of bones is characteristic. The detection of asymptomatic exostoses is also completely random. Sometimes they discover themselves, becoming visually perceptible, as they create a cosmetic defect on the surface of the body. Another reason for the discovery of exostoses is a clinical picture created by overgrowing neoplasms, compressing tissues, nerves and vessels.
Clinical picture
Clinical manifestations of osteoid osteomas are determined solely by the site of their localization:
- Tumors located on the outer side of the skull bones of are very dense, immobile and completely painless neoplasms.
- Osteomas growing inside the skull of the lead to headaches, memory disorders, increased intracranial pressure, epileptic seizures.
- Neoplasms localized in the paranasal sinuses and their appendages can provoke the development of eye and eye pathologies. These include: ptosis( omission of the eyelid), exophthalmos( protrusion of eyeballs), anisocoria( different pupil sizes), diplopia( sensation of bifurcation of objects).
- Osteoid osteomes formed on the surface of long tubular bones of the ( tibial or femoral) at first do not generally cause patients the slightest concern. That is why their detection on the roentgenogram performed on a completely different occasion is completely unexpected for them. Osteomas also reveal during the examination of patients with suspected Gardner's syndrome.
Symptoms of
As mentioned above, the clinical course of benign neoplasms at the initial stage can be characterized as complete asymptomatic and painless, and by the presence of mild aching pain resembling muscle pains. This depends on the location of the tumor process and the size of the tumor.
After a few( four to eight) weeks, becoming unusually strong and accustomed to grow as the night approaches, the pain becomes an integral companion of the tumor process. They exhaust the patient, depriving him of rest and proper rest.
Fortunately for patients, the pain syndrome is well controlled by the use of analgesics - analgesics ( especially salicylates).
Localization of pain can correspond to the place of development of the tumor process, but often they are irradiating( reflected), most often giving in a number of located joints, and sometimes in more remote areas of the body.
Osteo-osteomas, affecting the lower third of the humerus, the outer surface of the tibia, the bones of the foot, hand and forearm, when palpated, reveal a swelling, the density of which is identical to bone tissue density.
If the focus of the tumor is deep, the sensation of palpation is not too painful. With subperiosteal or intraarticular localization of the tumor, palpation causes severe( sometimes intolerable) pain.
Osteomas localized in the immediate vicinity of the articular cartilage, provoke the formation of effusions, often giving grounds for making an erroneous diagnosis: patients are treated for a long time from arthritis.
Of course, such treatment does not bring any relief, nor the expected result. A strong pain syndrome is accompanied by a significant decrease in the motor activity of the affected limb, which often leads to a partial atrophy of her muscles and limp.
Osteoid-osteomas, affecting ribs and vertebrae, lead to the development of scoliosis. The tumor that touched the site bordering the joint becomes the cause of the sympathetic synovitis.
A significant deterioration in the patient's state of health is an indication for urgent surgical intervention. Another indication for the operation is the presence of a visually noticeable cosmetic defect due to the development of a benign neoplasm.
Reasons for
The causes of osteoid osteomas have not been established so far. Moreover: oncologists have so far no unity in their views on the nature of these benign neoplasms.
One group of scientists sees in this pathology the manifestation of a chronic form of non-purulent focal necrotic osteomyelitis. Another group classifies osteo-osteomes as a category of tumors.
Diagnostics of
The main method for detecting osteo-osteomas is X-ray diagnostics.
The X-ray of the pathological neoplasm localized in the outer( cortical) layer of the affected bone represents it in the form of an enlarged focus with very clear boundaries, having a rounded shape and a diameter not exceeding one centimeter. The center of the hearth is moderately darkened.
In medical practice, cases of giant benign neoplasms( nests of which had a diameter of several centimeters), sprouted through the cortex with cases of complete absence or poor development of sclerotized bone tissue, are known.
X-ray of osteoid osteome reveals some similarity to the picture of non-purulent chronic osteomyelitis.
The complexity of osteoma diagnosis is explained by the small size of the focus of the tumor process and the complete absence of specific symptoms that would distinguish this ailment from a number of diseases exhibiting a similar clinical course.
Treatment of
Osteoid osteomas diagnosed in childhood generally do not require intensive treatment. In the absence of acute symptoms, specialists choose the tactics of regularly conducted dynamic observation.
If the disease was started, the only method of treatment is surgery. The methods of radiotherapy when exposed to osteomas have already proved to be of low effectiveness.
The nature and scale of surgical intervention for osteomya therapy is determined solely by the size and location of the tumor process.
The exact location of the osteoid osteoma is determined by computed tomography. This is especially important if the osteoma is located in the cavity of the acetabulum, in the posterior part of the vertebra or in the tissues of the head of the femur. From this information depends on where( in front or behind) will be made operative access to the affected tissues.
In patients with osteoid osteomas, modern surgeons prefer the method of partial marginal subperiosteal bone resection because it guarantees complete recovery of the patient, eliminating the possibility of relapses. When scraping tissues, recurrences of the disease are not uncommon.
After a successful surgical procedure, the pain stops completely. If it was not performed at the proper level( that is, the focus of the pathological process was not completely removed), the former unbearable pains return the next day. Because they can not go by themselves, the patient will need a repeated, more radical, surgical intervention.
Since the cases of malignancy of osteoid osteomas in medical practice are not described, the prognosis for patients' life is favorable.