Osteoid-osteoma of bone: symptoms, diagnosis and treatment regimen

Bones, like other organs, can be subjected to negative effects of 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 most morphologically mature benign tumor, developing, as a rule, in the diaphysis of long tubular bones. It is formed from osteoclasts and resembles the usual bone in its structure. Most often, the disease is detected as a child, and usually it is a random finding during X-ray examination for another reason.

By localization, the tibia is leading, 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 weight when loading the bones. In the altered part of the skeleton the cells are located chaotically, between them is a loose connective tissue.

Causes

Osteoid-osteoma can arise for a number of reasons.

1. Metaplasia of bone tissue, that is, its degeneration into another kind of cells.
2. Violation of the laying of the bone in the embryonic period due to the effects of radiation, physical or chemical agents.
3. Hereditary predisposition to such diseases.
4. Presence of chronic infectious diseases or foci of inflammation in the patient (rheumatoid arthritis, lupus, syphilis).
5. Violation of calcium metabolism or the excretion of uric acid (gout).
6. Prolonged sluggish inflammation in the paranasal sinuses (gaimorovoy, frontal).

Unfortunately, all these factors are only indirect. Scientists can not fully explain what causes the development of this disease.

Classification

Osteoid-osteoma can be of several kinds. Allocate classifications by origin, histological structure and location.

1. By origin:

• Hyperplastic osteoma. Formed from bone cells, which are located on the entire circumference of the bone or accumulate only on one side of it. 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 the tendon of the shoulder or hip.

2. By structure and location:

• Solid, with concentrically located closely fitting osteocytes. As a rule, they appear in flat bones;
• Spongy, resembling healthy bones. Between the osteocytes is located fat tissue, blood vessels and bone marrow. They occur in tubular bones;
• The cerebral cavity is rich in bone marrow. They are rare, usually in the airways of the facial skull.

Symptoms

The most common osteoid-osteoma of the tibia, so on her example we will analyze 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 becomes unbearable, they intensify towards night and a little abate during the day, but nevertheless 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 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 blood vessels and nerves, causing local neurologic symptoms in the form of paresis, paralysis, visual impairment, smell, the appearance of headaches or seizures.

Diagnostics

Osteoid-osteoma of the bone 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 resembles that of a chronic 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), and 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 deny the presence of metastases, it is necessary to make a scintigraphy.

Surgery

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:

• The size of the osteoma is more than a centimeter;
• Violation of the function of neighboring organs;
• Stunting 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 is the removal of the bone site together with the periosteum and a site of healthy tissues. This is done to avoid relapse.

Medication Therapy

Osteoid-osteoma does not lend itself 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 locally, as well as in the form of tablets to achieve a complex effect.

At small tumor sizes, surgery is not indicated, as it is accompanied by discomfort for the patient and may be more traumatic than a neoplasm. Therefore, the patient is being monitored for dispensary so that appropriate measures are taken in time in case of an increase in the size of the pathological focus. Specific drug therapy is not carried out.

Treatment with folk remedies

Is there an osteoid-osteoma that can be treated with folk remedies? 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 prevention

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 causes of their appearance may be insufficient resection of the tumor due to fuzzy X-rays.

Operations on the face, as a rule, do not lead to visible cosmetic defects. If the osteoma is large in size, then after the main treatment, the patient is recommended to perform a reconstructive plastic surgery.

Specific prevention does not exist. Annual preventive examinations make it possible to detect and remove the tumor on time.