In some cases, dense skeletal cells in humans form a benign neoplasm – bone osteoma. It is recommended to deal with it immediately, before severe complications arise.
The development of medical industries allows doctors to select the optimal therapy for each form of such tumors, taking into account the age of the patients and their concomitant diseases. Most often, children and adolescents encounter osteomas, but there are known cases of pathological lesions being detected in older people. After their surgical removal, relapses are extremely rare.
General information
Among tumors/tumor-like lesions of the skeleton, benign bone tumors account for about 50% of cases, of which the most common are bone-forming benign tumors: osteoma and osteoid-osteoma , which are independent nosological units. These types of tumors are characterized by slow, non-aggressive growth and a favorable course: they do not grow into surrounding tissues, do not metastasize, and do not become malignant. ICD-10 code: D16 - Benign neoplasms of bones and articular cartilage.
Osteomas
What is osteoma? It is a benign osteogenic tumor of mature/differentiated bone tissue. They occur predominantly in people 20-35 years old, with the exception of osteomas of the facial bones, which are more common in women. A specific feature of osteomas is the identity of its structure with normal bone tissue. The localization of osteomas varies significantly and is determined by its type. Thus, spongy osteoma is localized mainly on the long tubular bones of the extremities, most often on the humerus/femur. Compact osteoma affects predominantly flat bones of the vault/base of the skull (osteoma of the orbital region, osteoma of the occipital bone and frontal bone, osteoma of the frontal sinus and other maxillary sinuses of the nose, mandible), as well as other flat bones (osteoma of the scapula and ribs). Osteoma, as a rule, is a single tumor and a multiple variant of development ( Gardner–Turner syndrome ) is much less common. Osteoma is much less common in long and short bones.
The most common location of osteomas is on the bones of the skull
Osteoma is determined mainly in the form of a painless, single smooth/lumpy protrusion with clear boundaries and a dense consistency. The tissue of osteoma macroscopically represents dense or spongy bone, and macroscopically the tissue of compact osteoma is similar to the structure of the cortical layer of bone, however, it differs from it in the general plan of the structure: the Haversian canals (osteon canals) are arranged randomly and have a nonspecific shape. The tissue of cancellous osteoma is presented in the form of an interlace of convoluted bone beams of different maturity, which are enclosed in cellular fibrous tissue.
Osteoid osteoma
Osteoid osteoma is a benign tumor of bone tissue that includes a central avascular node (nidus), a fibrovascular ring and a reactive rim of dense bone surrounding it. As a rule, osteoid osteomas are a single (solitary) neoplasm with clear contours, the size of which does not exceed 1 cm in diameter, and is localized in any bone of the skeleton with the exception of the sternum, clavicle, phalanges of the fingers and skull bones. It can be located in both cortical and cancellous bone.
Macroscopically, osteoid osteomas have an ovoid/spherical shape with a loose formation in the central sections with increasing tumor density towards the periphery; on a section they are gray-red in color. It accounts for 9-12% of all benign bone tumors. It is more often detected in men aged 5-25 years. (80% of cases), and in persons after 40 years of age they are practically not observed. In terms of frequency of lesions, it occupies the proximal femur, followed by the tibia and, somewhat less frequently, the humerus and vertebrae.
Pathogenesis
A pathoanatomical study clearly identifies the boundary of osteoid osteoma against the background of surrounding sclerotic bone tissue containing a large number of vessels. The center of the tumor (osteoid part) consists of interwoven trabeculae/strands of osteoid, which are surrounded by clusters of loose vascularized fibrous stroma and large osteoblasts located along the developing bone beams in the form of a rim. There are mitotic figures. The general appearance of the osteoid is similar to an intricate script. Less common in tumors are single/group osteoclasts.
In relatively “young” tumors, it is the osteoid that makes up the main part of the neoplasm, but as the tumor “aging”, areas of calcification appear, and in fully mature tumors, in addition to osteoids, fibrous bone, which consists of compact trabeculae, is also detected. Cartilaginous tissue is also found in tumors growing under the articular cartilage. This is the structure of the central zone of osteoid osteoma, and around it there is fibrous tissue in the form of a strip of 1-2 mm, which is rich in vessels and the trabecular pattern in it is no longer defined. Further outward there is another layer of sclerotic cortical plate.
Classification
Osteoma
Depending on the type of structure of tumors, they are distinguished:
- Hard compact osteoma formed by dense compact bone tissue.
- Spongy osteoma - formed by a porous spongy substance with cavities filled with fibroreticular tissue.
In relation to the bone organ, there are periosteal osteomas, located on the outer surface, and endosteal osteomas, located on the inner surface of the bone (Fig. below).
Osteoid osteomas
Based on localization in the bone (radiologically), several types of osteoid osteoma are distinguished: medullary, cortical, subperiosteal and protruding into soft tissue.
Prognosis and prevention
The main task of medical workers - to cure osteoma - seems to be a feasible measure if the detection of a lesion in the bone occurred in the early stages of the formation of the disease. The prognosis in this case is as favorable as possible - benign bone tumors rarely recur.
However, even if osteoma is detected late, one should not give up. Advances in medicine make it possible to correct the course of the disease, even in its advanced forms, and improve a person’s well-being.
Specific prevention of the development of osteoma has not been developed, since the root causes of its occurrence have not been definitively established. Therefore, doctors will recommend methods to prevent the progression of pathology - proper nutrition, avoidance of injuries and radiation exposure, and severe stress. Giving up harmful individual habits will also help avoid the development of osteoma.
Causes
The exact causes of osteoma remain unclear to this day, and existing theories of the origin of osteomas from the periosteum of mature bone or remnants of embryonic cartilage do not provide an exhaustive answer to all questions. Some authors associate the occurrence of osteomas with frequent injuries to bone tissue and previous inflammatory processes.
Presumably, factors contributing to the development of osteomas are: genetic predisposition, inflammation/previous infections and diseases ( rheumatism , syphilis , gout ), hypothermia.
The reasons for the development of osteoid osteoma have also not been studied. Some authors consider this type of tumor as chronic non-purulent focal necrotizing osteomyelitis , while other authors classify it as a tumor.
Causes
Experts were unable to definitively determine why bone cells suddenly begin active division. The medical research they conducted made it possible to put forward several basic theories - from negative hereditary predisposition to previously severe infectious diseases suffered by a person.
Main provoking factors:
- congenital anomalies - the onset of failure of bone cell division occurred at the stage of intrauterine development of the fetus;
- traumatic option - improper fusion of fragments, when local thickening occurs at the site of the callus;
- poor quality of medical procedures, for example, puncture of the maxillary sinus;
- various inflammatory processes in chronic bones - from rheumatism to gout, syphilis, osteomyelitis;
- unadjusted diet - a minimum amount of fresh vegetables and fruits, fermented milk products with calcium and phosphorus;
- living in a region with a short period of sunny days – vitamin D deficiency;
- irradiation with radiation rays - carrying out radiation therapy for tumors of other locations.
Excessive weight of a person and abuse of tobacco and alcohol products can provoke the appearance of osteoma of the hip joint. Among the provoking factors, doctors also indicate severe stressful situations, past psychological trauma, and living in unfavorable environmental conditions.
Symptoms
Osteomas
The clinical manifestations of osteoma are determined by its location and size. Since the tumor grows extremely slowly, they can remain unnoticed for a long time and not manifest themselves in any way. As the tumor increases in size and direction of growth, various types of symptoms may occur due to the topographical specificity of the affected area. Thus, when the tumor is localized on the outer side of the skull bones, it appears only visually/palpably in the form of a very dense, painless, immobile formation with a smooth surface and clear boundaries. If the tumor is located on the inside of the skull bones, symptoms vary depending on topographic features:
- When localized in the paranasal sinuses, it can manifest with various eye symptoms: diplopia (double vision), ptosis (drooping eyelid), exophthalmos (bulging of the eyeball), anisocoria (different pupil sizes) and decreased vision.
- Osteoma of the frontal bone - severe headaches , increased intracranial pressure , memory impairment.
- Osteomas of the upper jaw are manifested by difficulty in nasal breathing, diplopia .
- Osteoma on the zygomatic arch - appears as a restriction in mouth opening
- Osteoma of the lower jaw - neuralgic pain, paresthesia , pain when chewing.
- Osteomas of long bones (femur) or short bones (talus) manifest with muscle pain when walking, gait disturbance and swelling of the legs.
The table below shows the main symptoms of osteomas depending on their location.
Osteoid osteomas
The main clinical symptom of osteoid osteoma is pain, which increases significantly as the tumor grows and develops. The pain also gets worse at night. The presence of pain, according to some authors, is due to sclerosis of the surrounding bone. Sometimes, pain radiates to adjacent joints, simulating other diseases and thereby complicating diagnosis.
When the tumor is located close to a joint, its function is affected: there is swelling in the joints, limited movement, and impaired gait. When the spinal column is damaged, there is increased pain during movement and limitation of movements. A characteristic manifestation of osteoid osteoma is relief of pain after taking analgesics.
Treatment methods for osteoma
After conducting a comprehensive medical examination of the patient and making sure that the osteoma is benign, the doctor prescribes treatment taking into account the person’s age and the characteristics of his body. Thus, in most cases, control examinations of the pathological focus and maintaining a healthy lifestyle are recommended.
Only if rapid tumor growth is detected will active methods of therapy be required. Indications for surgical intervention are:
- suspicion of malignancy of the process;
- large size of the tumor;
- formation of a malfunction of the organs adjacent to the tumor;
- deformations of bone structures.
As a rule, osteoma removal is carried out within healthy tissue - truncation. Cutting off the entire limb or part of it is required when confirming a cancerous lesion - bone sarcoma. If the lesion has been removed from the skull area, then plastic surgery is subsequently performed.
If surgical treatment is not possible, doctors select drug therapy to relieve pain, reduce the severity of other unpleasant symptoms, and improve the quality of life. Traditional medicine recipes, for example, hawthorn infusions and elderberry infusions, can complement complex treatment. However, they should not replace taking medications from the pharmacy.
Tests and diagnostics
Osteomas
The main and most informative method for diagnosing osteoma is radiography, in which the tumor is detected as a formation denser than bone with clear boundaries. Spongy osteoma on the radiograph is heterogeneous; alternating areas of rarefaction and compaction are characteristic (photo below). For small tumors, a computed tomography may be prescribed. If necessary, a histological examination is carried out, in which a characteristic feature is a violation of the architectonics of the compact bone, the virtual absence of osteon canals and narrowing of the vascular canals.
Differential diagnosis is carried out with osteosarcoma , chondroma , ossifying fibroma , osteoid osteomas - with sclerosing osteomyelitis , osteochondrosis , osteoperiostitis , osteogenic sarcoma .
Osteoid osteomas
For diagnosis, radiography is used, which reveals an oval-shaped focus of bone tissue destruction with clear contours with a zone of osteosclerosis around the focus due to periosteal/endosteal changes (photo below).
At the initial stage of tumor development, a visible boundary between the central zone and the rim is clearly defined, which is erased as the tumor calcifies. The difficulty in identifying osteoid osteoma on an x-ray is the small size of the tumor focus, which, as a rule, does not exceed 1.5 cm. To more clearly visualize the focus and determine the nature of the lesion, computed tomography or MRI is indicated with thin sections to obtain the highest possible quality images, since surgical tumor removal methods are performed under the control of radiation methods.
Histological examination reveals osteogenic tissue containing a large number of vessels. The central part of the tumor is represented by areas of bone formation/destruction with intertwining cords and beams. In more mature tumors, minor foci of sclerosis are detected, and in completely “mature” tumors, areas of fibrous bone are detected.
Diagnosis of pathology
Thanks to timely seeking medical help, early diagnosis of benign neoplasms is the “gold standard” for the treatment of all pathologies, including osteomas. Modern advances in oncology make it possible to identify a pathological focus even if it is minimal in size.
Basic research methods have been developed:
- X-ray is an accessible way to visualize a bone formation, its size and structure;
- computed tomography is a widely informative study that allows for differential diagnosis of the disease if the radiological signs of osteoma are questionable;
- biopsy - taking biomaterial from the tumor for further examination of the cells under a microscope, which will exclude atypia in them;
- scintigraphy – allows you to detect multiple small lesions in the bones;
- ultrasound examination - to clarify the processes of compression of internal organs, nerve fibers, and the causes of functional failures in their activity.
Laboratory diagnosis of osteomas is not very informative. Blood tests, general and biochemical, as well as tumor markers, will be recommended by the doctor to get a general idea of the patient’s health. Only after carefully comparing and evaluating all the information from the above procedures, the oncologist will give a qualified opinion and select the correct treatment for the disease.
List of sources
- Burdygip I.N. Osteoid osteoma and osteoblastoma of the spine (clinic, diagnosis and surgical treatment): Dis. Ph.D. honey. Sci. M., 1993.- 182 p.
- Zatsepin S.T. Bone pathology of adults. - M.: Medicine, 2001. 639 p.
- Kolesov, V. S. Benign tumors of the face, jaws and oral cavity organs / V. S. Kolesov, A. M. Solntsev. Kyiv: Kyiv University Publishing House. 1985. 168 p.
- Karpenko A.K., Magonov E.P. The role of MRI in the diagnosis of osteoid osteoma / “RADIATORY DIAGNOSTICS” No. 3, 2014. p. 50-52.
- Epidemiology of skeletal tumors: educational manual / Chernyakova Yu.M., Ivanov S.A., Yadchenko V.N. — 2012.