Osteoid-osteoma of bone: symptoms, diagnosis and treatment regimen
Bones, like other organs, can be exposed to negative environmental influences. This provokes the formation of malignant and benign tumors with different triggers and variants of the clinical course.
Osteoma is the most morphologically mature benign tumor that develops, as a rule, in the diaphysis of long tubular bones. It is formed from osteoclasts and resembles the usual bone in structure. Most often, the disease is detected as a child, and it is usually a random finding during X-ray examination for another reason.
The tibia is the leader in localization, followed by the femoral, humerus, forearm bones and flat bones of the skull. In a healthy bone, osteoblasts form a concentric pattern. This arrangement allows you to better distribute the weight when the load on the bone. In the altered part of the skeleton, the cells are located chaotically, between them is a loose connective tissue.
Osteoid-osteoma can occur for a variety of reasons.
- Metaplasia of bone tissue, that is, its degeneration into another kind of cells.
- Violation of the laying of bone in the embryonic period due to exposure to radiation, physical or chemical agents.
- Hereditary predisposition to such diseases.
- Presence of chronic infectious diseases or foci of inflammation in the patient( rheumatoid arthritis, lupus, syphilis).
- Disturbance of calcium metabolism or uric acid excretion( gout).
- Prolonged flaccid inflammation in the paranasal sinuses( maxillary, frontal).
Unfortunately, all the above factors are only indirect. Scientists can not fully explain what causes the development of this disease.
Osteoid-osteoma can be of several types. Allocate classifications by origin, histological structure and location.
- By origin:
- is hyperplastic osteoma. It is formed from bone cells that are located on the entire circumference of the bone or accumulate only from one side of the bone. The tumor can grow both outside and inside the organ. Typical location: face, skull, forearm, hip, lower leg;
- heteroplastic osteoma. It is a connective tissue that grows on the bone due to prolonged mechanical irritation of the site. It is most often localized to tendons of the shoulder or hips.
2. By structure and location:
- is solid, with concentrically located closely fitting osteocytes. As a rule, they appear in flat bones;
- is spongy, resembling healthy bones. Between the osteocytes is located fat tissue, blood vessels and bone marrow. They occur in tubular bones;
- is a cerebral, ample bone marrow filled cavity. They are rare, usually in the airway sinuses of the facial skull.
The most common osteoid-osteoma of the tibia, therefore on its example we will disassemble the clinical manifestations of the disease. As a rule, the tumor of this localization does not manifest itself for a long time, therefore patients may not even suspect the presence of a neoplasm. The osteoid-osteoma of the femur( second in frequency) also does not seek to detect itself.
Over time, weak aching pains begin to appear in the patients, which, in terms of localization and intensity, are similar to discomfort in the muscles after physical exertion. After a couple of months, the pain sensations become unbearable, they intensify towards the night and a little abate during the day, but nevertheless permanently cause discomfort to the person.
As the tumor grows, it begins to contour under the skin, especially in places where there is little subcutaneous fat. If the pathological focus is deep in the bone, the palpation of the affected area will not cause a negative reaction. But the location of the tumor inside the joint cavity or under the periosteum will cause increased pain.
Osteomas located in the bones of the skull can squeeze the blood vessels and nerves, causing local neurologic symptoms in the form of paresis, paralysis, visual impairment, smell, headaches or seizures.
The bone osteoid-osteoma is detected accidentally on an X-ray examination. And only after the tumor has been detected, the doctor appoints additional tests to determine the nature of the tumor, its histological structure, size and the presence of metastasis.
Sighting radiography allows you to determine the structure of tissues around the tumor: a dense( compact) substance or porous( spongy), depending on where the osteoid-osteoma is located. The photo of the affected bone makes it possible to examine in more detail the location of the tumor, its dimensions and density.
The snapshot reminds one of chronic non-inflammatory osteomyelitis, which can confuse a specialist who has not previously encountered similar diagnoses. In addition, the difficulty lies in the fact that the focus of the pathological process is sufficiently small( less than a centimeter in diameter), as well as there are no specific symptoms that would indicate the presence of the disease.
If possible, the doctor sends the patient to a computer or magnetic resonance imaging. Be sure to perform a puncture of the neoplasm for carrying out a histological examination. This allows to exclude the malignant course of the process. To confirm or disprove the presence of metastases, it is necessary to make a scintigraphy.
How is osteoid osteoma treated? Operation with such a diagnosis is considered necessary only if the tumor affects bone growth, deforms it, or causes severe pain syndrome. Indications for surgical treatment are:
- osteoma size is more than a centimeter;
- violation of the function of neighboring organs;
- growth retardation or bone deformation;
- aesthetic defect.
There are several ways to remove the lesion. The choice depends on the location of the tumor, the experience and capabilities of the surgeon. As a rule, the defeat of the limb bones is operated by traumatologists or orthopedists, skull osteomas, face or sinuses - maxillofacial surgeons, ENT doctors or neurosurgeons. A prerequisite for any localization of the pathological process - the removal of the bone site is performed together with the periosteum and a site of healthy tissues. This is done to avoid relapse.
Osteoid-osteoma does not respond to conservative treatment. But with it you can remove the symptoms of the disease. First of all, of course, relieve the patient of pain. To do this, use non-steroidal anti-inflammatory drugs in the form of ointments, creams or gels topically, as well as in the form of tablets to achieve a complex effect.
For small tumor sizes, surgery is not indicated, as it is accompanied by discomfort for the patient and may be more traumatic than neoplasm. Therefore, a patient is being monitored to ensure that if the size of the pathological foci is increased, appropriate measures are taken on time. Specific drug therapy is not carried out.
Treatment with folk remedies
Is it possible to treat folk remedies with osteoid-osteoma? Treatment of this kind can begin only after consulting a specialist, because it can aggravate the symptoms and provoke tumor growth.
There are recipes for the removal of the pain syndrome, for example decoctions of hawthorn flowers or tincture of elderberry. But the therapeutic effect of these drugs is unknown, so remember that taking them, you take a certain risk. There are some prejudices against official medicine, as well as many examples where compresses or targeted ultraviolet irradiation reduced the size of the osteoma. Do not be encouraging yourself. It is better to go to a qualified doctor.
Prognosis and prophylaxis of
The small size of the tumor and its good quality make it possible to give the patient a favorable prognosis. After surgical treatment, relapses are extremely rare. The reasons for their appearance may be insufficient resection of the tumor due to fuzzy X-ray images.
Operations on the face, as a rule, do not lead to visible cosmetic flaws. If the osteoma is large in size, then after the main treatment, the patient is recommended to perform a reconstructive plastic surgery.
There is no specific prevention. Annual preventive examinations make it possible to detect and remove the tumor on time.