Osteoid osteoma

Description:

Ossiform osteoma (Xing. an osteoid osteoma)  - the single new growth high-quality, as a rule, which is not exceeding the I cm in the diameter, having accurate contours and located in any bone of a skeleton except bones of a skull and a breast.

According to statistical data the ossiform osteoma makes 9-11% of all benign tumors of a skeleton. The ossiform osteoma is preferential diagnosed aged from 5 up to 25 years. Men are ill twice more often.

Usually an osteoid osteoma - the solitary tumor which is localized in any department of a skeleton (is more often in long tubular bones). On the frequency of defeat the femur, then tibial and humeral bones is on the first place.

Osteoid osteoma reasons:

Now there are two opinions concerning the osteoid osteoma nature. One authors consider an osteoid osteoma as chronic focal and necrotic not purulent osteomyelitis, others carry an osteoid osteoma to tumors.

Pathogeny:

Under a microscope the border of an ossiform osteoma well decides against the background of the surrounding sclerosed bone tissue on a large number of vessels. The central (ossiform) part of a tumor consists from fancifully intertwining tyazhy and trabeculas of osteoid. the osteoblasts surrounded with accumulations and friable, richly vaskulyarizovanny fibrous stroma. Osteoblasts in tumoral fabric large, as if bulked up, with roundish big kernels. Often mitosis figures meet. In an ossiform part of a tumor osteoblasts are located in the form of a rim along the forming bone beams. Hemopoietic cells and inclusions of fatty tissue in an osteoid osteoma are not defined. The habit view of osteoid reminds an intricate ligature. In places in a tumor osteoclasts - the single or forming small groups meet. In "younger" tumors osteoid makes the prevailing part of a new growth, but in process of "aging" in a tumoral node there are sites of calcification, and in mature tumors, along with osteoid, also the real fibrous bone consisting of compact trabeculas is visible. When in the location of an osteoid osteoma there is a change, among osteoid it is possible to meet also cartilaginous tissue. The last is found also in the tumors growing under a joint cartilage. In general the metaplasia of ossiform fabric in cartilaginous is not characteristic of an osteoid osteoma. Such is structure of an osteoid osteoma in the central area. Around it in the form of a strip 1-2 mm wide the fibrous fabric rich with vessels in which the trabecular drawing is not defined any more is located. Further away knaruzh the layer of the sclerosed cortical plate is found. In rare instances it is absent.

Osteoid osteoma symptoms:

As the leading clinical symptom of an osteoid osteoma serves pain which intensity increases in process of development of a tumor. Diagnostically an important sign is change of pain at night, strengthening of the last is more often. Quite often pains have the irradiating character, complicating thereby diagnosis and simulating other diseases. One of characteristic clinical symptoms of an ossiform osteoma is stopping of pains reception of analgetics. Besides, gait disturbance, restriction of movements in joints, a swelling is noted. What the center of a tumor is located closer to a joint with, from that function of a joint suffers more. At damage of a backbone symptoms of a disease consist in restriction of movements, strengthenings of oxycinesias. Difficulty of diagnosis of an osteoid osteoma consists in the small sizes of the tumoral center which do not exceed 1,5 cm, and also lack of specific symptoms of a disease. It complicates statement of the correct diagnosis. Quite often sick for years are treated without effect.

Diagnosis:

Radiographic reveal the center of destruction of a bone tissue of an oval form with accurate contours. Around the center - an osteosclerosis zone at the expense of periosteal and to a lesser extent endosteal changes. For specification of nature of defeat and more accurate identification of the center KT is shown.

The differential diagnosis of an osteoidosteoma is carried out with a bone Brodie's abscess.

Treatment of an osteoid osteoma:

The only method of treatment of an ossiform osteoma is an operative measure. Operation volume entirely depends on option of a tumor and localization. Operation of the choice should be considered a bone resection with removal of "nest" of a tumor and a contiguous zone of a sclerosis the uniform block. Lead to a recurrence of a disease, as a rule, the inadequate operative measures consisting in a partial oncotomy. Radical removal of an ossiform osteoma conducts to an absolute recovery. Cases of an ozlokachestvleniye are not observed. After radical removal, as a rule, the osteoid osteoma does not recur.