Bones, like other organs, can be negatively affected by the external environment. This provokes the formation of malignant and benign tumors with different triggers and variants of the clinical course.
Osteoid osteoma
Osteoma is the morphologically most mature benign tumor that develops, as a rule, in the diaphysis of long tubular bones. It is formed from osteoclasts and in its structure resembles ordinary bone. Most often, the disease is detected in childhood, and usually it is an accidental finding during x-ray examination for another reason.
The tibia is the leader in localization, followed by the femur, humerus, forearm bones, and flat skull bones. In a healthy bone, osteoblasts form a concentric pattern. This arrangement allows you to better distribute weight under load on the bones. In the altered section of the skeleton, the cells are randomly located, between them there is loose connective tissue.
Causes
Osteoid osteoma can occur for a variety of reasons.
- Bone metaplasia, that is, its degeneration into another type of cell.
- Violation of the laying of bones in the embryonic period due to exposure to radiation, physical or chemical agents.
- Hereditary predisposition to this kind of disease.
- The patient has chronic infectious diseases or foci of inflammation (rheumatoid arthritis, lupus, syphilis).
- Impaired calcium metabolism or uric acid excretion (gout).
- Long sluggish inflammation in the paranasal sinuses (maxillary, frontal).
Unfortunately, all of the above factors are only indirect. Scientists can not yet fully explain what exactly causes the development of this disease.
Classification
Osteoid osteoma can be of several types. Classifications are distinguished by origin, histological structure and location.
- By origin:
- hyperplastic osteoma. Formed from bone cells that are located around the entire circumference of the bone or accumulate on only one of its sides. A tumor can grow both outward and inward of an organ. Typical location: face, skull, forearm, thigh, lower leg;
- heteroplastic osteoma. It is a connective tissue that grows on the bone due to prolonged mechanical irritation of the site. Most often localized to the tendons of the shoulder or thigh.
2. By structure and localization:
- solid, having concentrically located tightly adjacent osteocytes. Generally appear in flat bones;
- spongy, resembling healthy bones. Between osteocytes is adipose tissue, blood vessels and bone marrow. Found in tubular bones;
- cerebral, abundantly filled with bone marrow cavity. They are rare, usually in the airways of the facial skull.
Symptoms
The most common osteoid-osteoma of the tibia, therefore, on its example, we will analyze the clinical manifestations of the disease. As a rule, a tumor of this localization does not manifest itself for a long time, so patients may not even suspect the presence of a neoplasm. The osteoid-osteoma of the femur (second in frequency) also does not seek to find itself.
Over time, patients begin to appear weak aching pains, which in localization and intensity are similar to muscle discomfort after exercise. After a couple of months, the pain becomes unbearable, they intensify by night and subside a little during the day, but nonetheless permanently cause discomfort to a 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 located deep in the bone, then 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 blood vessels and nerves, causing local neurological symptoms in the form of paresis, paralysis, visual impairment, smell, the appearance of headaches or convulsive attacks.
Diagnostics
Osteoid-bone osteoma is detected by chance on an x-ray. And after the neoplasm was discovered, the doctor prescribes additional tests to determine the nature of the tumor, its histological structure, size and the presence of metastasis.
Targeted radiography allows you to determine the structure of the tissues around the tumor: a dense (compact) substance or porous (spongy), depending on where the osteoid osteoma is located. A photo of the affected bone makes it possible to examine in more detail the location of the tumor, size and density.
The picture resembles that of chronic non-purulent osteomyelitis, which can confuse a specialist who has not previously encountered such diagnoses. In addition, the difficulty lies in the fact that the focus of the pathological process is quite small (less than a centimeter in diameter), and there are also no specific symptoms that would indicate the presence of a disease.
If possible, the doctor directs the patient to computed or magnetic resonance imaging. Neoplasm must be punctured for histological examination. This eliminates the malignant course of the process. To confirm or deny the presence of metastases, scintigraphy is necessary.
Surgery
How is osteoid osteoma treated? An operation with such a diagnosis is considered necessary only if the tumor affects the growth of the bone, deforms it, or causes severe pain. Indications for surgical treatment are:
- osteoma sizes are more than a centimeter;
- impaired function of neighboring organs;
- growth retardation or bone deformation;
- aesthetic defect.
There are several ways to remove a tumor. The choice depends on the location of the tumor, the experience and capabilities of the surgeon. As a rule, lesions of limb bones are 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 is the removal of a bone site along with the periosteum and a section of healthy tissues. This is done to prevent relapse.
Drug therapy
Osteoid osteoma is not amenable to conservative treatment. But with it, you can remove the symptoms of the disease. First of all, of course, to relieve the patient from pain. For this, non-steroidal anti-inflammatory drugs are used in the form of ointments, creams or gels topically, as well as tablets to achieve a complex effect.
With a small tumor, the operation is not indicated, as it is accompanied by discomfort for the patient and may be more traumatic than the neoplasm. Therefore, the patient is set up for follow-up, so that in case of an increase in the size of the pathological focus, appropriate measures are taken in time. Specifically, drug therapy is not carried out.
Treatment with folk remedies
Is osteoid-osteoma amenable to traditional therapy? Treatment of this kind can only begin after consultation with a specialist, because it can aggravate the symptoms and trigger tumor growth.
There are recipes for relieving pain, such as decoctions of hawthorn flowers or elderberry tincture. But the therapeutic effect of these drugs is unknown, so you should 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 radiation reduced the size of the osteoma. Do not reassure yourself. Better go to a qualified doctor.
Forecast and Prevention
The small size of the tumor and its benignness allow the patient to give a favorable prognosis. After surgical treatment, relapses are extremely rare. The reasons for their appearance may be insufficient tumor resection due to fuzzy x-rays.
Facial surgery, as a rule, does not lead to visible cosmetic flaws. If the osteoma is large in size, then after the main treatment, the patient is recommended to undergo reconstructive plastic surgery.
There is no specific prophylaxis. Annual preventive examinations make it possible to detect and remove the tumor in time.