23.11.2019
The term “osteoblastoclastoma” was proposed by A.V. Rusakov in 1959. The International Histological Classification of Primary Tumors and Tumor-Like Bone Diseases uses the term “giant cell tumor.”
Until now, there are different names for giant cell tumors: giant cell tumor of the epulid type, brown tumor, gigantoma, giant cell sarcoma, osteoclastoma, local fibrous osteodystrophy.
In the etiology of this tumor, according to some authors, bone trauma plays a significant role. Giant cell tumors are classified as true tumors - blastomas. Currently, both surgeons and pathologists recognize these tumors as benign, although prone to recurrence. This led to the replacement of the terms “giant cell sarcoma” and “giant cell tumor” with the term “giantoma”. Giant cell tumors can have a sarcomatous structure.
Osteoblastoclastoma is a benign osteogenic tumor. Occurs in the jaw bones. The tumor develops mainly in young people, most often in women 11–30 years old. According to Yu. I. Bernadsky, osteoblastoclastomas account for 20.7% of the number of tumors of the facial bones.
Osteoblastoclastoma can be located along the periphery of the bone and in the thickness of the bone tissue. When localized on the alveolar process of the jaw, it is considered a giant cell epulid. In the lower jaw, the tumor is most often detected in the area of premolars and molars, in the upper jaw - in the area of premolars. Rare localizations include damage to the zygomatic bone.
Osteoblastoclastoma—education clinic
Unnoticed by the patient, a uniform thickening appears in one of the areas of the lower or upper jaw, often painless. Tumor growth continues for 3–10 years, but sometimes it is more intense.
When palpating the formation, its dense areas alternate with softened ones. Its shape is convex, dome-shaped, and sometimes thinning of the jaw walls occurs, which manifests itself as Dupuytren’s symptom (crepitus). The teeth in the formation zone are mobile, their electrical excitability is reduced, and resorption of tooth roots by 1/3 of the length is noted in the lesion. The mucous membrane above the tumor is either unchanged or slightly anemic; the venous network of the mucous membrane in the area of the tumor is expanded.
When an odontogenic inflammatory process occurs, signs of acute inflammation prevail. The diagnosis can be established through a comprehensive clinical and radiological examination.
Based on clinical and radiological data and the morphological picture, three main forms of osteoblastoclastoma are distinguished: cellular, cystic, lytic.
The cellular form is more often observed in adulthood and old age, and is characterized by very slow development. When examining the patient, a dense swelling with a lumpy surface is determined; it is not possible to clinically distinguish the tumor from healthy areas of the bone; the jaw is often spindle-shaped. Teeth located in the tumor area rarely change their position. The electrical excitability of the pulp of intact teeth is not impaired. The mucous membrane covering the tumor is somewhat anemic.
With the cystic form of the tumor, the first symptoms of the disease in most cases are complaints of toothache. During palpation examination, individual areas of the tumor are pliable when pressed (symptom of “parchment crunch”); the thinned bone above the tumor has a smooth-convex, dome-shaped shape.
The lytic form is rare, more often in childhood and adolescence, and accounts for 10% of all osteoblastoclastomas of the jaws. The development of this form of osteoblastoclastoma occurs quite quickly. In some cases, the first sign of a developing tumor is pain. When the cortical layer thins, along with independent pain at rest, pain appears on palpation. The venous network of vessels of the mucous membrane covering the tumor is dilated. Teeth often shift and become mobile, and the electrical excitability of the pulp decreases. Pathological fractures of the jaw may occur in the affected area; when localized on the upper jaw, it is possible to grow into the maxillary sinus, nasal cavity and other bones of the facial skeleton. When the formation is punctured, a brown or yellowish liquid is detected, which is associated with the breakdown of red blood cells and the formation of hemosiderin, sometimes with blood. The punctate does not include cholesterol crystals, which are usually found with cysts.
Etiology
The frequency of this tumor among all primary bone tumors is about 4–9.5%. The share of GCTs in the structure of all benign bone tumors is 18–23%. Most often, the disease is detected in the third decade of life; very rarely, the tumor is observed in children under 15 years of age and in patients with incomplete osteogenesis. Women are affected by GCT more often than men, in a ratio of 1.5:1. The most common location of the tumor is the metaepiphyseal sections of long tubular bones: distal femur - 23–30%, proximal tibia - 20–25%, distal radius - 10–12%, proximal humerus - 4–8% . Less commonly, GCT is observed in the sacrum - 4-9%, in the vertebral bodies - 3-6%, in the small bones of the hand - 1-5%, foot - 1-2%. In most cases, GCT is a benign tumor, but primary malignant forms occur in 1–1.5% and secondary malignant tumors are diagnosed in 10–25% of cases.
Osteoblastoclastoma - X-ray picture
Radiologically, with a cellular form of a tumor, a shadow from many small and larger cavities or cellular formations, separated from each other by bone partitions of varying thickness, is noted at the site of the lesion. No reaction from the periosteum is observed. The picture is in many ways similar to the X-ray picture of ameloblastoma.
The cystic form on the radiograph resembles an odontogenic jaw cyst and ameloblastoma. The difference between the cystic form of ameloblastoma is that its border with the bone often has fine scalloped outlines in the form of extremely small bays.
In the lytic form of osteoblastoclastoma, the tumor produces a structureless focus of clearing.
What are the symptoms of bone tumors?
Most patients with bone tumors complain of pain. The pain, as a rule, is long-lasting, causing discomfort with low intensity, the so-called “dull” pain. The pain persists even when the patient is resting, and it intensifies at night. Trauma is not the cause, but pain increases after injury. In weakened bones, a pathological fracture occurs, which increases pain. Some tumors cause fever and night sweats. Sometimes neoplasms are painless. Some tumors are discovered by chance during x-rays after ankle injuries.
What should be done in case of this kind of painful situation?
If a person thinks they may have a bone tumor, they should see a doctor right away.
What measures are taken at the diagnosis stage?
The doctor takes a detailed history of the patient in order to know the patient's medical history. The medical history includes all the details - from the drugs used to all previous diseases. The size and mobility of the tumor, its relationship to the joints and whether it has invaded are examined, and other systems are examined if necessary. First, the patient is given an x-ray. Different bone tumors produce different X-ray images. Some show excess calcification, some show bone resorption. Sometimes we see a combination of the two.
Is x-ray enough to identify a tumor, or is some other method necessary? Some tumors can be seen on X-rays, but we use detailed imaging techniques such as tomography, MRI, scintigraphy, PET scans and pulmonary tomography to determine the type of tumor. We use CT scans to see details of the bone, and MRIs to see how the tumor is growing in the bone or to see whether the tumor has spread to other distant sites. Bone scintigraphy provides information about the biological activation of the tumor and whether there are metastases.
Osteoblastoclastoma - microscopic picture
Microscopically, in osteoblastoclastoma, a large number of small, slightly elongated cells with a rounded nucleus (such as osteoblasts) are distinguished, among which massive accumulations of giant multinucleated cells (osteoclasts) are identified. In mononuclear cells, mitoses are observed; in multinucleated cells, they are absent. The formed elements of the tumor are also represented by fibroblasts and xanthoma cells. Areas of hemorrhage undergo a macrophage reaction with the corresponding phagocytic cells. In some areas of the tumor, islands of osteoid tissue are found. The tumor is saturated with decayed red blood cells and is imbibed by the blood pigment - hemosiderin, which gives it a brown color. The presence of the latter and multiple hemorrhages, often in the form of blood cysts, is due to the peculiarity of blood flow in the tumor.
Blood in osteoblastoclastoma circulates outside the vascular bed through intertissue gaps. The absence of endothelium allows it to penetrate the tumor tissue and accumulate there. In this case, the formed elements of the blood are destroyed, forming an accumulation of hemosiderin. Sometimes an abundance of fibrous tissue may be found in the tumor.
How is bone cancer treated?
Treatment of bone tumors is always the result of teamwork. The main members of this team are an orthopedic oncologist, an oncologist, a radiologist, a radiation oncologist, and a pathologist. The goal of treatment is to overcome the cancer and protect the affected limbs. Are there improvements in the treatment of bone tumors as medicine advances? Are there changes in surgical techniques? Previously, in order to remove a tumor from the body, there was mainly a method of amputation of limbs. But a surgical approach is now available that can both remove the tumor and protect the limbs. Surgery can be performed by removing the center of the tumor or removing it along with a small area of healthy skin. The goal of treatment is to ensure the functioning of the limb after cancer therapy. This is facilitated, in particular, by the development of reconstructive surgery. Also often used are prosthetics, bone grafts, which are pieces of bone taken from other parts of the skeleton, used to heal the affected area, and biological reconstruction techniques.
Osteoblastoclastoma - differential diagnosis
Osteoblastoclastoma (cystic and cellular forms) must be differentiated from ameloblastoma and radicular cyst, the lytic form - from osteogenic sarcoma (in contrast to osteolytic sarcoma, thinning and swelling of the cortical layer of the jaw are noted in osteoblastoclastoma) and fibrous osteodysplasia (characterized by slow growth and preservation of the continuity of the cortical layer on the radiograph). layer of the jaw), fibromyxoma, central fibromas of the jaws.
Clinical and radiological examination without histological comparison is sometimes insufficient to establish an accurate diagnosis of osteoblastoclastoma. The frequency of discrepancy between the clinical diagnosis and pathohistological diagnosis is 30%; the most common discrepancies arise when differentiating osteoblastoclastoma from ameloblastoma - 16%
About the method
A bone biopsy is the procedure of removing a piece of bone tissue for examination. It is carried out if the use of other diagnostic methods does not allow an accurate diagnosis to be made.
The procedure is carried out in the following cases:
- The need to distinguish between benign and malignant tumors;
- In order to evaluate previously prescribed therapy;
- To determine the exact characteristics of oncology.
The procedure is complex, but capable of yielding maximum information about the tumor. It is no coincidence that it is called the most informative diagnostic procedure in oncology.
Having received a sample of the affected bone tissue as a result of a biopsy and examined it in the laboratory, the doctor can get a complete picture of all the characteristics of the tumor and, based on this knowledge, formulate the optimal tactics for subsequent treatment.
Osteoblastoclastoma - treatment
Treatment for osteoblastoclast of the jaws is surgical. In cystic and cellular forms, careful curettage of the lesion is usually sufficient. If the tumor occupies large areas of the jawbone, it is possible to perform resection of the lower jaw, if necessary, with simultaneous bone grafting. In the lytic form, partial resection of the jaw without breaking the continuity of the mandibular bone (continuum resection) or resection of a fragment of the jaw with simultaneous bone grafting is more often used. Radiation therapy does not provide sufficient therapeutic effect. However, this method of treatment is prescribed to patients for whom any surgical intervention is contraindicated due to their general somatic status. Usually short-focus X-ray therapy, remote gamma therapy, bremsstrahlung and high-energy electron radiation are used. The average radiation dose ranges from 30–50 Gy/kg. The prognosis for treatment is favorable, but the possibility of malignancy and metastasis of the tumor due to the benign nature of the tumor cannot be excluded. Incorrect treatment tactics usually lead to relapses of the tumor process.
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What are the other methods for bone tumors?
Some bone tumors are sensitive to radiation therapy. Radiation therapy can be used as a stand-alone treatment or in combination with other treatments. Chemotherapy can be used for treatment depending on the biological behavior of the disease. It can be used before or after surgery.
Is there a difference between the sexes regarding the risk of developing this disease?
We can provide information on this issue in the USA. Malignant bone tumors are detected in 2500 cases per year, benign ones - in 200,000-300,000. Bone metastases occur in 250,000 - 300,000 cases per year. There were no differences between the sexes in terms of the risk of bone tumors.
What would you like to say about the follow-up of patients after treatment?
Follow-up of the patient is done initially at short intervals, and the follow-up itself will continue for many years. With this method, recurrence of the disease or its spread to other organs is detected at an early stage and a treatment plan is drawn up. At this stage, the patient needs psychological support and a return to a full social life. Lung, breast, thyroid and prostate cancers are the main causes of metastases, in addition to primary malignant bone tumors. In addition, it is necessary to carefully investigate the causes of bone pain that occurs in old age.
What is amputation?
Amputation is the removal of an affected part of the body in order to save the patient's life if it is impossible to save the organ. For example, if we are talking about the development of a disease in the leg, the leg must be amputated. But we are now far from such a surgical approach thanks to developments in diagnostics and treatment. If in the 80s 90% of patients diagnosed with cancer would have been treated with amputation, now this percentage is less than 10%.
Patient survival prognosis
With timely diagnosis and timely treatment, the 5-year survival rate of patients with osteosarcoma reaches 70%, and for primary lymphoma it is more than 60%. For chondro- and fibrosarcoma, the 5-year survival rate is about 70%.
Our experience shows that treating bone cancer is possible!
The developed and tested methods of our Oncology Center are aimed at curing this disease, reducing its symptoms, preventing the progression of the disease and improving the quality of life!
The Russian-Japanese Oncology Center uses only proven and well-proven methods.
Bone biopsy technique
When performing an intraoperative biopsy, samples obtained during the operation are transferred to specialists for further research.
At the same time, the duration of anesthesia and rehabilitation periods are influenced by the nature of the operation performed.
As a DIY procedure, a bone biopsy involves removing the necessary material using needles, either thin or thick, through the skin.
This biopsy method is called puncture. And depending on the choice of needle, it can be fine-needle or thick-needle.
For a puncture biopsy, local anesthesia is used. Ultrasound or CT can also be used to monitor the movement of the needle in the bone tissue.
The choice of method of carrying out the procedure is the prerogative of the doctor.
To conduct a bone biopsy at the Onco.Rehab integrative oncology clinic, you will have to consult with a doctor who, taking into account your wishes, as well as the necessary factors, will choose the optimal method.