Bones, like other organs, can be exposed to the negative effects of the external environment. This provokes the formation of malignant and benign tumors with different triggers and clinical course options.
Osteoid osteoma
Osteoma is morphologically the most mature benign tumor that develops, as a rule, in the diaphysis of long tubular bones. It is formed from osteoclasts and resembles normal bone in its structure. Most often, the disease is detected in childhood, and is usually an incidental finding on x-ray for another reason.
In terms of localization, the tibia leads, followed by the femur, humerus, forearm bones and flat bones of the skull. In he althy bone, osteoblasts form a concentric pattern. This arrangement allows better distribution of weight when loading on the bones. In the altered part of the skeleton, the cells are arranged randomly, with loose connective tissue between them.
Reasons
Osteoid osteoma can occur for a variety of reasons.
- Metaplasia of bone tissue, that is, its transformation into another type of cell.
- Violation of bone formation in the embryonic period due to exposure to radiation, physical or chemical agents.
- Hereditary predisposition to such diseases.
- The patient has chronic infectious diseases or foci of inflammation (rheumatoid arthritis, lupus, syphilis).
- Impaired calcium metabolism or excretion of uric acid (gout).
- Prolonged sluggish inflammation in the paranasal sinuses (maxillary, frontal).
Unfortunately, all these factors are only indirect. Scientists are not yet able to 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. It is formed from bone cells that are located around the entire circumference of the bone or accumulate on only one side of it. The tumor can grow both outside and inside the body. Typical location: face, skull, forearm, thigh, lower leg;
- heteroplastic osteoma. It is a connective tissue that grows on the bones due to prolonged mechanical irritation of the site. Most often localized to the tendons of the shoulder or hip.
2. By structure and localization:
- solid, having concentrically located closely adjacent osteocytes. Usually appear in flat bones;
- spongy,resembling he althy bones. Between the osteocytes is adipose tissue, blood vessels and bone marrow. Found in tubular bones;
- medullary cavities richly filled with bone marrow. They are rare, usually in the respiratory sinuses of the facial skull.
Symptoms
The most common osteoid-osteoma of the tibia, so we will analyze the clinical manifestations of the disease using its example. 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. Osteoid osteoma of the femur (the second most common) also does not seek to detect itself.
Over time, patients begin to experience mild aching pain, which, in terms of localization and intensity, is similar to muscle discomfort after exercise. After a couple of months, the pain becomes unbearable, they intensify at night and subside a little during the day, but nevertheless permanently cause discomfort to a person.
As the tumor grows, it begins to contour under the skin, especially in those 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 compress blood vessels and nerves, causing local neurological symptoms in the form of paresis, paralysis,sight, smell, headaches or seizures.
Diagnosis
Osteoid-osteoma of the bone is detected by chance on an x-ray. And after the neoplasm has been detected, the doctor prescribes additional tests to determine the nature of the tumor, its histological structure, size and presence of metastasis.
Spot radiography allows you to determine the structure of the tissues around the tumor: dense (compact) substance or porous (spongy), depending on where the osteoid osteoma is located. A photo of the affected bone makes it possible to consider 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 the disease.
If possible, the doctor refers the patient to computed or magnetic resonance imaging. Be sure to puncture the neoplasm for a histological examination. This allows you to exclude the malignant course of the process. To confirm or deny the presence of metastases, it is necessary to do a scintigraphy.
Surgical treatment
How is osteoid osteoma treated? Surgery for this diagnosis is considerednecessary only if the tumor affects the growth of the bone, deforms it or causes severe pain. Indications for surgical treatment are:
- Osteoma larger than a centimeter;
- violation of the function of neighboring organs;
- stunting or bone deformity;
- aesthetic defect.
There are several ways to remove a neoplasm. The choice depends on the localization of the tumor, the experience and capabilities of the surgeon. As a rule, damage to the bones of the extremities is operated on by traumatologists or orthopedists, osteomas of the skull, 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 together with the periosteum and a section of he althy tissues. This is done to prevent relapses.
Drug therapy
Osteoid osteoma is not amenable to conservative treatment. But with the help of it you can relieve the symptoms of the disease. First of all, of course, to save 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 in the form of tablets to achieve a complex effect.
Surgery is not indicated for small tumors, as it is accompanied by discomfort for the patient and may be more traumatic than a neoplasm. Therefore, a dispensary observation is established for the patient, so that in case of an increase in the size of the pathological focus, they are taken in timeappropriate measures. No specific drug therapy available.
Treatment with folk remedies
Can osteoid osteoma be treated with folk remedies? Treatment of this kind should only be started after consultation with a specialist, because it can aggravate symptoms and provoke tumor growth.
There are recipes to relieve 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 on some risk. There are some prejudices against official medicine, as well as many examples where compresses or targeted ultraviolet radiation have reduced the size of the osteoma. Don't get your hopes up with this. Better go to a qualified doctor.
Forecast and prevention
The small size of the tumor and its benign nature allow the patient to have 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-rays.
Surgeries on the face, as a rule, do not lead to visible cosmetic defects. If the osteoma is large, then after the main treatment, the patient is recommended to undergo reconstructive plastic surgery.
There is no specific prevention. Annual preventive examinations make it possible to detect and remove the tumor in time.
