Osteochondroma of the bone is a disease of young people and adolescents, the causes of which are still not understood.

Due to a violation of enchodral ossification, a growth can be formed on the surface of the bone, which is called osteochondroma. It consists of a bone base covered with a thin cartilaginous shell.

The growth of osteochondroma is as intense as the growth of the entire skeleton, that is, with the end of growth, the growth also stops increasing. After this, the formation of a cartilage tumor is possible - chondroma or secondary chondrosarcoma, during the development of which the volume of the cartilage coating greatly increases, since it is this tissue that takes part in the degeneration into a malignant formation.

Symptoms of osteochondroma

Osteochondroma has characteristic clinical manifestations. Usually she:

• located on tubular bones near the joints;
• by adolescence it moves closer to the middle part of the bone;
• sometimes localized on the scapula, pelvic bones, vertebrae, ribs (rarely);
• never found on the facial skull;
• ranging in size from 2 to 12 cm;
• dense consistency;
• with a smooth surface;
• with clear boundaries;
• motionless;
• no pain.

Pain syndrome and functional disorders of the limbs appear when osteochondroma compresses blood vessels, tendons, nerve trunks, and muscles. With a small size of osteochondroma, it does not manifest itself in any way.

Sometimes a kind of bag is formed above the osteochondroma, filled with fibrin deposits and cartilaginous bodies with calcification. It can be felt in the form of an additional soft and easily removable formation.

A case of osteochondroma of the scapula, manifested by brachialgia

Malignancy of solitary osteochondroma is observed in 1-2%, multiple osteochondromas - in 5-10% of cases. More often it occurs when localized in the pelvic bones and scapula, and is manifested by a noticeable acceleration of tumor growth. Characteristic changes on radiographs are blurred contours and increased calcifications in the soft tissue component of the tumor. There is a significant discrepancy between the clinical and radiological sizes of the tumor. The only treatment for osteochondromas is surgery. The operation consists of wide exposure of the base of the tumor, deep resection of it along with part of the healthy bone, and removal of the tumor with the synovial membrane covering it. Prolonged delay of surgery often leads to malignancy of the tumor. Plastic surgery of the marginal bone defect is not required. After removal of the osteochondroma, a stable recovery occurs [6]. We present our own observation.

Patient A., 22 years old, for the first time noticed paroxysmal pain in the proximal parts of the left upper limb of an aching, pulling nature, lasting from several minutes to 1 hour. The pain occurred in a sitting position with a deviation on the back of a chair, with a frequency of 2-3 times. /month On the visual analogue scale (VAS) pain – 3 points. This condition did not affect the quality of life, therefore, according to the patient, he did not consult a doctor. After 1 year, the nature and intensity of the pain syndrome changed: periodically there were shooting pains in the arm up to 5 points on VAS. The patient sought medical help from a general practitioner at his place of residence, who associated the condition with increasing stress at school and work and diagnosed: cervical osteochondrosis, cervicobrachialgia on the left. Recommendations were given: reducing the intensity of exercise, taking metamizole sodium for pain. If pain increases, use non-steroidal anti-inflammatory drugs. In case of exacerbation, consult a neurologist. The patient's condition remained unchanged for a year. After 1 year, during a medical examination, the patient underwent fluorography (FOG) of the chest (the patient had not undergone medical examinations before), which revealed a neoplasm in the left subscapular region (Fig. 1).

The patient was sent for further examination. A spiral computed tomography (CT) scan of the left scapula with multiplanar and three-dimensional reconstruction was prescribed (Fig. 2).

The pain syndrome persisted, the patient was examined by a neurologist. Taking into account complaints, anamnesis, clinical picture, features of the development of pain syndrome, data from instrumental examination methods, a clinical diagnosis was made: chronic brachialgia (with a neuropathic component) on the left, of moderate severity, due to compression of the secondary trunks of the brachial plexus by solitary osteochondral exostosis (osteochondroma) of the subscapularis area of ​​the left shoulder blade. Considering that the pain was neuropathic in nature, the patient was prescribed pregabalin 150 mg twice a day [3]. This dosage turned out to be sufficient to relieve pain.

After 1 week The patient underwent surgical removal of the formation in the traumatology and orthopedic department.

During the operation, macroscopically: a node of 7x6x6 cm is represented by a cartilaginous “cap”, spongy bone tissue, bone fat marrow in the interbeam spaces, the structure corresponds to osteochondral exostosis (osteochondroma).

Morphological examination: the specimen is represented by modified bone and cartilaginous cells; in the area of ​​accumulation of cartilaginous tissue, areas of uneven ossification are visible - the structure corresponds to osteochondral exostosis.

After 3 months Repeated X-ray examination of the left scapula: no evidence of relapse of osteochondroma was obtained (Fig. 3).

The pain syndrome has regressed. The last dynamic CT scan was performed 2 years later (long-term result): no evidence of relapse of osteochondroma was obtained (Fig. 4).

In conclusion, it is advisable to conduct an expert assessment of this clinical case:

1. The general practitioner violated the principle of conducting clinical examination of patients (absence of FOG of the chest organs for more than 2 years).
2. The doctor formally assessed the pain in the arm as a manifestation of cervical dorsopathy, without taking into account the patient’s young age and his lack of degenerative changes.
3. Additional studies (radiography, CT scan of the spine) regulated by the standard of medical care for dorsopathies (order of the Ministry of Health and Social Development of the Russian Federation dated July 21, 2006 No. 561) [4], valid at the time of the patient’s visit to the doctor, were not performed.
4. Attention was not focused on the involvement of the upper limb in the pathological process (probably, the clinic of damage to the brachial plexus was already developing due to pressure and tumor growth).

During the interview and clinical examination of this patient, it was possible to detect signs of a possible serious illness (threat signs - “red flags”) [1]:

• young age;
• pain at rest;
• pain is constantly progressive, long-lasting (more than 1 year);
• pain occurs in a certain position (when leaning on the back of a chair);
• non-mechanical pain (no relief after rest);
• transformation of nociceptive pain into neuropathic pain.

I would like to remind you once again that only a thorough analysis of the characteristics of the course of the disease in a particular patient, interdisciplinary knowledge about pain in the back, neck and limbs are the key to successful diagnosis and treatment of patients [2]. Conversely, a formal approach and stereotypical clinical thinking complicate not only the identification of patients with specific causes of pain syndromes, but also the whole work.

Diagnosis of osteochondroma

After a physical examination, the doctor refers such a patient to:

• X-ray examination (reveals the presence of a formation connected to the bone with a wide leg or base, it may have calcareous inclusions, the cortical layer of osteochondroma with clear contours smoothly and continuously passes into the cortical layer of the bone, cartilage is not visualized);
• CT/MRI (rarely used as additional studies in unclear cases);
• morphological analysis of formation (rare).

Osteochondroma or osteochondral exostosis

A benign exophytic formation, consisting of a bone base, covered with cartilage tissue on top and located on the surface of the bone.

The formation can be single or generalized in the form of hereditary multiple exostotic chondrodysplasia. According to the ICD for oncology (ICD-O3), osteochondroma is coded as 9210/0; according to ICD-10, MEC is coded as Q78.6.

Treatment of osteochondroma

The only existing radical treatment method is surgery. It involves removing the osteochondroma along with the stem and base. Patients need it with:

• fast-growing osteochondromas;
• a sharp increase in the cartilaginous part of the formation;
• large formations;
• functional disorders and pain syndrome;
• severe skeletal deformities.

For the rest of the patients, doctors advise to remain under observation and periodically perform X-ray control examinations.

Advantages of treatment in Israel

• Qualified doctors, many of whom are world famous.
• Equipping clinics with high-tech diagnostic and treatment equipment.
• Professional performance of surgical removal of tumors.
• Comfortable conditions.
• Reasonable prices.

By contacting an Israeli clinic, you will undergo comprehensive treatment under the guidance of leading experts in the field, a full course of rehabilitation, and you will be able to forget about the disease forever and return to your normal life.

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5. 1

(1 vote, average: 5 out of 5)

Rehabilitation period

After the operation, a plaster splint is applied to the leg. The limb is immobilized for 2 months, during which a gentle regime should be observed and any stress should be avoided. Non-steroidal anti-inflammatory drugs are used, if necessary, to relieve pain.

During the rehabilitation period, the patient may be prescribed physiotherapeutic procedures, classical massage, daily exercise therapy and gymnastics.

Can osteochondroma turn into cancer?

Malignization is the process of transformation of benign cells into malignant ones. The patient must be referred to an oncologist if the tumor enlarges in adulthood. Malignancy is promoted by a thickness of the cartilage shell of more than 2 cm and the frequent occurrence of discomfort.

The absolute indication for surgical intervention is the presence of a connection between the neoplasm and the “mother” bone through the bone marrow canal. But sometimes doctors adhere to a wait-and-see approach, constantly monitoring the condition of the tumor. If there is no positive dynamics of the process, then there is no risk of malignant degeneration of the cells.

Causes

The etiology of the development of solitary osteochondromas has not been definitively established. Many orthopedists and traumatologists adhere to the version that a benign neoplasm is a developmental defect that progresses with growth and the formation of the skeleton. Another reason for the development of osteochondroma can be radiation therapy, which was carried out in childhood. Post-radiation tumors are most often multiple, affecting not only long tubular bones, but also vertebral bone structures. To form osteochondroma, irradiation at doses above 1000 rad is sufficient.

Osteochondromatosis, or the formation of multiple benign tumors, develops due to a genetic predisposition. Hereditary pathology is usually diagnosed in patients under 20 years of age. Transmission of osteochondromatosis occurs in an autosomal dominant manner. One mutant allele, which is localized in the autosome, is enough for the disease to manifest itself.

Osteochondroma in the picture and the tumor removed during surgery.

Classification

Osteochondromas of the femur are sessile, that is, they tightly adhere to the bone structures. And some benign tumors are equipped with a small, strong stalk, so they rise slightly above the bone surface. Neoplasms are also classified depending on their number:

• solitary, resembling a stem or trunk of a plant, formed at various stages of tubular bone growth and representing osteochondral formations. Such tumors are characterized by rather painful symptoms due to constant microtrauma of the tendon. Single neoplasms also provoke poor circulation due to compression of nearby blood vessels;
• multiple (osteochondromatosis). This multicentric form of pathology is usually due to a genetic predisposition. Multiple compactions look like tubercles covered with a shiny fibrin sheath and vary significantly in shape and location.

Osteochondromas of any type can provoke destructive and degenerative changes in bone tissue. This leads to lower limb deformation and stiffness.

Stages

When determining a treatment regimen, the doctor must take into account the stage of development of osteochondroma of the femur. The prognosis for full recovery, the degree of risk of malignancy, and the duration of the rehabilitation period also depend on it. Pathology detected at an early stage can in most cases be eliminated before complications develop and without consequences for the functioning of the musculoskeletal system.