Benign and malignant tumors of bones and cartilage tissue. Bone tumors (Bone neoplasms)

The problem of tumors has become a national problem and representatives of all specialties of medicine and related sciences are occupied with it. In recent years, new methods for diagnosing and treating this pathology have been developed, the number of disabled people has decreased, and the results of treating patients have improved due to the development of new saving operations for bone tumors. Modern plastic and reconstructive surgery sometimes makes it possible to replace huge defects in bones and joints that arise after tumor removal, which expands the orthopedist’s capabilities in the rehabilitation of this category of patients.

Bone tumors are more common in men - 1.3 per 100,000 population. The closer to the equator, the more common tumors are: in Mozambique - 2.0 among the indigenous population and 3.9 among Europeans living in this country. The mortality rate of patients with bone tumors in men over 75 years of age is 10.2 per 100,000 population, and among women - 5.7. Primary tumors are more common in young people, and myelomas and metastatic tumors - in people over 50 years of age.

The localization of malignant bone tumors is as follows: 78.1% - in long tubular bones, 12.4% - in the paranasal sinuses; 9.4% - maxillofacial region.

It has been proven that penetrating radiation, even in small doses, contributes to the development of malignant tumors. This is confirmed by a sharp increase in tumors thyroid gland in our Republic after the Chernobyl disaster.

To properly understand the essence of bone tumors, formulate a diagnosis and choose the optimal treatment method, let’s consider the classification of bone tumors by M.V. Volkov. It is simple, easy to remember and easy to use. It can be represented in the following form.

1. Primary tumors of osteogenic origin:

A. Benign(osteoma, osteoid-osteoma, osteoblastoclastoma, chondroma, chondroblastoma, fibroma, benign chordoma, etc.)

B. Malignant(osteogenic sarcoma, chondrosarcoma, malignant osteoblastoclastoma, malignant chordoma).

2. Primary tumors of non-osteogenic origin:

A . Benign(hemangioma, lymphangioma, lipoma, fibroma,

neuroma).

B. Malignant(Ewing's tumor. Reticulosarcoma, liposarcoma,

fibrosarcoma).

3. Secondary tumors, paraosseous and metastatic.

Let us recall some well-known provisions of pathological anatomy about tumors. Benign tumors are characterized by a clear boundary between the diseased and healthy areas of tissue, slow growth, pushing the tissue apart, correct location; tumor cells with little division activity, do not give relapses and metastases, can become malignant: osteochondromas, enchondromas, osteoblastoclastomas, etc.

Malignant tumors are characterized by infiltrative growth in surrounding tissues, lack of clear boundaries, mitotic fields, severe cell atypia, disorder of differentiation and maturation, and metastasis with a fatal outcome.

Features of diagnosing tumors in children

Diagnosis of tumors in children is one of the difficult problems of modern orthopedics, radiology and pathological anatomy. This is due not only to the variety of diseases, but also to the characteristic initial course of a number of diseases without the manifestation of clear symptoms. They are often recognized late, when the disease is clearly manifested. The painful focus, as a rule, lies deep in the bone box, while a child, unlike an adult, is not always able to evaluate his feelings and formulate his complaints. Early diagnosis of tumors is difficult due to the extraordinary similarity of individual tumors. Just as a clinician cannot unconditionally rely only on his clinical data, a radiologist cannot be sure of the presence of a certain disease based on a description of a radiograph alone. The path of diagnosing a bone tumor only on the basis of pathologist data without taking into account clinical and radiology is dangerous.

Thus, diagnosing skeletal diseases is a difficult and responsible matter. It requires the comprehensive use of existing methods for recognizing bone tumors.

In the early stages, many bone diseases do not have specific symptoms. In this regard, it is necessary to use individual, even insignificant data, which together determine the “difficult diagnosis”. These include anamnesis, first complaints, duration of the disease and comparison of the size of the tumor with the duration of the disease, results of an external examination, general condition the patient, his age, gender, localization of the tumor.

The difficulties in diagnosing bone lesions due to tumor growth are that the first complaints arise in children only when the painful focus either reaches a large size and compresses nearby nerve trunks, or, going beyond the boundaries of the bone to the periosteum, involves it in the process and manifests itself in pain.

IN Determining the nature of the pain is an essential part of a difficult diagnosis. Most often, pain is the first symptom of malignant tumors, since the periosteum is involved in the process. At first, the pain is intermittent. Later, the sick child clarifies their location. At first, the pain is periodic, then it becomes constant, observed at rest, even when the diseased limb is immobilized with a plaster splint, the pain does not subside either day or night. Sometimes the pain does not correspond to the location of the tumor. In these cases, it is necessary to think about the irradiation of pain along the nerve trunks. Thus, when the focus is localized in the proximal part of the thigh, pain can be localized in the knee joint, radiating along the femoral nerve. Night pain is very typical, significantly debilitating the patient.

With some malignant neoplasms, pain appears earlier than the lesion is detected on a regular x-ray. In these cases, it is necessary to resort to modern methods of examining the patient: computed tomography and nuclear magnetic resonance imaging, which allow us to identify a lesion about 2 mm in size.

Benign tumors are almost always painless. The pain in these cases is often secondary, due to mechanical pressure from a large tumor of nearby nerve trunks. Only osteoid ostomy (Fig. 125) manifests itself as a strong pain syndrome caused by increased intraosseous pressure in the “tumor nest”. In addition, these pains are well relieved with aspirin, and in case of malignant neoplasms, the pain syndrome is relieved for a short time only with narcotic substances.

N Some bone tumors located endosteally (Fig. 126) first manifest themselves as a pathological fracture (osteoblastoclastoma, chondroma). There is an opinion that such fractures, when healing, can lead to “self-healing,” which raises some doubts.

When clarifying the history of the disease, find out, first of all, the first symptoms of the disease. Children and parents often pay attention to previous trauma, although it has been established that trauma has nothing to do with the appearance of tumor growth. With ordinary traumatic injury, pain, swelling, and dysfunction appear immediately after the injury, but with tumors, these clinical symptoms appear after some time, sometimes even after several months. Ask whether the patient has undergone physiotherapeutic treatment, especially thermal procedures, and its effectiveness. Patients with tumors note that the use of heat increases pain and enlarges the affected segment. FTL is contraindicated for tumors, as it stimulates tumor growth.

The general condition of the patient with bone tumors does not suffer. In benign tumors it does not change at all, excluding osteoid osteoma. Malignant tumors, especially in young children, can begin as an acute inflammatory process and, for example, the onset of Ewing’s sarcoma often “proceeds” under the diagnosis of “Osteomyelitis” (Fig. 124).

A child’s good appearance does not exclude the presence of a malignant neoplasm, since cachexia develops only in the terminal stage of the process. Children simply do not live to see cancer, but die much earlier.

The appearance of an organ affected by a bone tumor, a swelling that palpably has a dense consistency. At in malignant tumors pain precedes swelling and the appearance of swelling in malignant tumors - late symptom. Only with osteoblastoclastomas with significant thinning of the cortical layer at the site of the tumor during palpation can one feel a bone crunch (crepitus), which appears due to damage to the thin cortical layer during palpation.

Metastatic tumors are never palpable, and osteolytic forms most often manifest as a pathological fracture.

In the area of ​​detectable deformation, over a benign tumor, the skin does not change. In malignant cases, the skin is pale, thinned, with translucent venous vessels (“marble skin”), it is difficult to move over the tumor and does not fold. When tumors disintegrate, they may ulcerate (Fig. 124).

Impaired limb function depends on the location of the lesion in relation to the joint: osteogenic sarcoma, localized in the epimetaphysis of the thigh, causes painful contracture, and gigantoma (GBC), even when the tumor breaks into the joint, does not disrupt the function of the limb (joint), because painless. Restriction of movements is often associated with a pathological fracture, which can be the first sign of a tumor, and in case of malignant neoplasms it indicates incurab tumor integrity and gives a sharp impetus to metastasis.

The age of the patient is essential for deciding the nature of the tumor. For childhood Primary tumors are typical, metastatic ones are extremely rare, and in adults, on the contrary, metastatic ones are 20 times more common. So, for every patient with a primary tumor there are 2-3 metastatic ones. The age of the child plays a significant role in the occurrence of certain types of tumors. Thus, eosinophilic granuloma is more often detected in preschool children, fibrous dysplasia is typical for children 10-12 years old, and for children 5 years old - Ewing's sarcoma, for children over 8 years old and adolescents - osteogenic sarcoma.

The localization of the tumor is very characteristic. Some tumors have their own favorite location, which can be one of the diagnostic symptoms. Thus, chondromas are localized in the small bones of the hand (Fig. 127), gigantoma (GBC) in children - in the proximal metadiaphysis of the shoulder (Fig. 128), and in adults - in the proximal metaepiphysis of the tibia. Osteogenic sarcoma is localized in the distal metaphysis of the femur (Fig. 129), without disturbing the growth zone and spreads into the diaphysis. Ewing's sarcoma most often affects the diaphysis of the leg and forearm.

Laboratory data. A general blood test is performed on all patients. In benign tumors, no changes are detected. In practice, only in patients with Ewing's sarcoma, changes in the type of inflammatory syndrome are determined in a general blood test: high ESR, neutrophilic leukocytosis with a shift of the formula to the left.

Biochemical studies. Biochemical studies currently play a huge role in determining the nature and stage of the pathological process in the bone. A significant increase in serum protein is detected in myeloma. Along with this, Bence-Joyce bodies appear in the urine, which are normally absent.

With non-disintegrating malignant tumors, a decrease in total serum protein occurs due to a decrease in albumin with a slight increase in the level of globulins. With the phenomena of dehydration and tumor necrosis, a decrease in total blood protein with a significant decrease in globulin content can be observed.

In adult patients, determining the amount of sialic acids in the blood serum for bone tumors provides another test for establishing a diagnosis. It has been established that in benign, slowly growing tumors the level of sialic acids does not change and is normal (155 units). In osteoblastoclastoma (OBC), sialic acids reach 231 units, and in malignant tumors – 248 units. After removal of the malignant tumor, the level of sialic acids normalizes by the end of the 2nd week of the postoperative period. A slow decrease in the level of sialic acids after surgery may indicate a non-radical surgical intervention or the presence of metastases.

The level of sialic acids in malignant tumors in children is sharply increased. This is evidenced by the diphenylamine reaction (DPA) indicator. For osteogenic sarcoma it is 221 units, for chondrosarcoma – 224 units, and for benign tumors – 170-180 units, that is, it corresponds to the norm.

An important role in the differential diagnosis of tumors and osteomyelitis is the determination of proteolytic enzymes, the level of which increases with malignant tumors and with the appearance of metastases.

P An increase in blood calcium levels to 12-20 mg% is observed with intense bone destruction in metastatic tumors.

Determination of activity may provide some assistance in diagnosing bone tumors. alkaline phosphatase blood serum. This enzyme is necessary for the breakdown of organic phosphate compounds to form phosphoric acid, which is deposited in the bones in the form of calcium phosphate. The level of phosphatase increases with a lack of calcium and phosphorus in the body (rickets, hyperparathyroidism). The level of phosphatase increases with the formation callus after fractures and after pathological fractures, pathological bone formation, which is osteogenic sarcoma. At the same time, an increase in the level of alkaline phosphatase is not an absolute symptom, however, in combination with other changes it can help in establishing a diagnosis.

A alkaline phosphatase activity increases in osteoid osteoma, if the hyperostosis surrounding the tumor was significant, and in OBC, if it led to a pathological fracture. That is, determining the activity of alkaline phosphatase is one of the auxiliary tests in the complex for diagnosing bone tumors.

X-ray diagnostics Treatment of bone diseases in general, and tumors in particular, presents great difficulties, especially in children, due to the abundance of skeletal diseases similar to the X-ray picture observed during the growth period. X-ray examination plays a leading, although in some cases not final, role in the diagnosis of bone lesions.

When studying the resulting x-ray, you should pay attention to the following signs:

establish the prevalence of the lesion within one bone and its relationship to the growth zone;

localization (Fig. 130) of the lesion (central or peripheral location);

direction of education growth;

clarity of boundaries;

the structure of the tumor tissue (Fig. 131) and the surrounding bone background (sclerosis, porosity).

To resolve these issues, a good quality structural radiograph is required.

The main question that the orthopedist must answer is whether the tumor is good or malignant in this particular case.

This question can be answered quite simply: if the periosteum is involved in the process, then this is a malignant tumor; if there are no periosteal layers, it is benign. For malignant bone tumors Three types of periosteal reactions are characteristic (Fig. 132):

visor periostitis;

spiculous (needle-shaped);

bulbous.

G
boundaries of the lesion. Benign tumors are characterized by clear boundaries, and malignant tumors are characterized by blurred contours both inside the bone and in the vicinity of soft tissues. They produce discontinuous periosteal layers and dense inclusions outside the bone. The nature of the boundaries is quite typical for individual benign formations. Thus, osteoma does not have clear boundaries with the cortical layer of bone (Fig. 133). Merging with it, it is located exostally. OBC in cases of a passive cystic form is surrounded on all sides by a zone of osteosclerosis in the form of a strip, and in cases of an active cystic and lytic form it has no clear boundaries (Fig. 134). Along with the transition of healthy bone to tumor, new small cells are visible.

The structure of the lesion in benign tumors is homogeneous, despite possible inclusions.

With primary malignant tumors, already at the beginning of the disease, blurred boundaries and heterogeneity of the structure due to bone destruction are noted. Thus, with osteogenic sarcoma, patchy osteoporosis with islands of sclerosis is expressed (Fig. 129). Such heterogeneity of the tumor background is one of the early radiological signs of this neoplasm.

More complete information on the structure of the lesion, even with small tumor sizes (up to 2 mm), is provided by modern methods of additional examination of the patient: tomography (Fig. 135), computed tomography, nuclear magnetic resonance, radioisotope diagnostics.

M
orthological research. If the clinical and radiological data are not sufficiently determined, then a pathological examination and biopsy are decisive in deciding the nature of the tumor. The latter can be puncture and open, preliminary and urgent (during surgery). This research method does not always fully help establish the truth, especially since needle biopsy promotes rapid metastasis, because the peri-tumor barrier is disrupted. It is most advisable to perform an open urgent biopsy in the presence of a morphologist. In this case, pay attention to the appearance of the tumor (“fish meat” for sarcoma; “cherry pit” for osteoid osteoma, etc.).

Thus, establishing a diagnosis of bone neoplasm, especially in childhood, is a very difficult task. This requires a full comprehensive examination of the patient.

L tumor treatment. The leading role in the treatment of patients with bone tumors belongs to surgery. Tumor resection within healthy tissue for benign tumors is the main method surgical treatment. If the function of the joint is significantly affected (when one of the articular surfaces is removed) or the strength of the bone diaphysis is weakened after tumor removal, osteoplastic surgery is used. For malignant bone tumors, the surgical method is also used, but more radical operations are performed - amputation and disarticulation, although this intervention can prolong the patient’s life by only a few months. Radiation therapy is used to a limited extent, since such treatment has no effect on the majority of malignant tumors. Only with Ewing's tumor, as a result of radiation exposure, can long-term remission be achieved and the patient's life be extended even by several years.

Chemotherapy for bone tumors has not yet become widespread.

Let's look at some of the most common clinical practice bone tumors.

Bone cancer is not the most common cancer, but due to its mild symptoms it is one of the most dangerous diseases. It is often diagnosed at a late stage, which makes treatment much more difficult. Bone cancer manifests itself in the appearance of neoplasms on bone tissue, cartilage and soft tissues (tendons, muscles, fat, ligaments), often these are benign or have degenerated into malignant, metastatic tumors.

What is bone cancer

The human skeleton often becomes a refuge malignant neoplasms. Cancer can affect bone tissue, cartilage, muscles, joints, ligaments, and fiber. Exists primary a type of bone cancer, such as rib cancer, but more common is metastatic type of cancer when the malignant tumor is in bone tissue is a consequence of oncology of other parts of the body, for example, breast, esophagus, etc.

Symptoms of bone cancer

The disease has no clear signs of progression, which makes it difficult to recognize. Bone pain due to cancer can be similar to arthritis or gout. Often, patients consult a doctor already in a late stage disease, which makes it difficult to cure. The main symptoms of bone cancer:

• painful sensations, which intensify after exercise or at night;
• swelling of the affected area;
• weakening bone structure, that leads to frequent fractures;
• bad feeling, fatigue, loss of appetite, fever.

Hands

Oncology localized in the bones of the hands is not observed so often, especially in the primary form. These are mainly metastases from breast, prostate and lung cancer. In this situation, bone tumors are detected on CT and MRI. Primary tumors on the bones of the hands rare, but they do occur it is worth paying attention to following symptoms:

• swelling, hardening and discoloration in the affected area;
• pain in the joints of the hands;
• general deterioration of the body – weight loss, fever, fatigue;
• increased sweating, especially during sleep.

Legs

A malignant tumor on the leg bone is uncommon (approximately 1% of the total number of cancers). Exist primary lesions bone, cartilage and soft tissues of the legs and secondary, that is metastases for certain types of neoplasms (breast and prostate glands, lung cancer). How does leg bone cancer manifest?

• pain in joints and local areas of the legs;
• the color of the skin above the tumor changes – it seems to become thinner;
• decreased immunity, fatigue, sudden weight loss;
• lameness may appear, the swelling interferes with movement.

Hips

Ewing's sarcoma, or osteogenic sarcoma, is located in the pelvic region, the junction of the pelvic and femur. Symptoms in this case Very greased Therefore, cancer is often diagnosed in the final stages. Clinical signs diseases are:

• Codman's triangle is a special shadow that doctors see on an X-ray;
• skin pathology – it becomes thinner, color changes and lumpiness appears;
• alternation of osteolytic (foci of bone tissue destruction) and osteosclerotic zones (seals);
• problems in the functioning of the pelvic organs, nearby vessels and nerve endings.

Causes

The exact reasons for the development of bone cancer have not yet been clarified, but doctors identify several risk factors:

1. heredity - Rothmund-Thomson disease, Li-Fraumeni syndrome, the presence of the RB1 gene, which causes retinoblastoma;
2. Paget's disease, which affects bone structure;
3. precancerous neoplasms (chondroma, chondroblastoma, osteochondroma, ecostosis of cartilage and bone, and others;
4. exposure to radiation rays on the body, prolonged exposure to ionizing radiation;
5. injuries, fractures, bruises.

Types of bone cancer

There are several types of disease, some of them may be primary, but mostly it is secondary form of the disease:

• osteosarcoma is a common form, more common in young people and adults under 30 years of age;
• chondrosarcoma – malignant formations V cartilage tissue;
• Ewing's sarcoma - spreads to the bone and soft tissues;
• fibrous histiocytoma - affects soft tissues, bones of the extremities;
• fibrosarcoma – rare disease, affects the bones of the limbs, jaws, soft tissues;
• giant cell tumor - develops on the bones of the legs and arms, responds well to treatment.

Stages

Exists four stages of the course of bone tissue oncology, doctors distinguish additional substages:

• first stage - the neoplasm is localized on a bone site, low degree of malignancy;
• 1A – the tumor grows, it puts pressure on the bone walls, swelling forms and pain occurs;
• 1B – cancer cells affect the entire bone, but remain in the bone;
• second stage - cancer cells begin to spread into soft tissues;
• stage three – tumor growth;
• the fourth (thermal) stage is the process of metastasis to the lungs and lymphatic system.

Diagnostics

The signs of bone cancer are similar to the symptoms of many diseases; the most accurate diagnosis is clinical tests and functional diagnostics:

• blood test for tumor markers - it will reveal an increase in the body thyroid-stimulating hormones, alkaline phosphatase, calcium and sialic acids and decreased plasma protein concentrations;
• X-ray - visual analysis of the image can reveal the affected areas;
• CT (computed tomography) - determines the stage of the disease and the presence of metastasis; a contrast agent is used to improve diagnosis.

Can be used to clarify the diagnosis MRI(Magnetic resonance imaging) using contrast, which shows the presence or absence of accumulation of cancer cells in the affected area. PET (positron emission tomography) determines the nature of the tumor. To date this is the most modern way functional diagnostics.

Biopsy gives 100% exact result diagnosing the nature of the tumor, whether it is primary, secondary and its type. For bone tumors, three types of biopsy are used:

1. Fine needle aspiration - a syringe is used to remove fluid from the tumor area. At difficult cases the process is combined with CT.
2. Thick-needle – more effective for primary tumors.
3. Surgical – performed by making an incision and taking a sample; it can be combined with tumor removal, therefore it is performed under general anesthesia.

Treatment

The treatment system includes both traditional methods, so latest developments by scientists:

1. NIERT - the technique is used for metastasis to reduce the pain effect and slow down the growth of cancer cells.
2. "Rapid Arc" - a variety radiation therapy, when the tumor is intensively exposed to a directed beam, treating it at different angles.
3. Cyberknife is a high-precision device that removes tumors with minimal impact on the body.
4. Brachytherapy – an implant with a radiation source is placed inside the tumor, which gradually kills cancer cells.

Chemotherapy

Standard chemotherapy involves introducing certain medicines, which destroy malignant tumors. Success is more noticeable in treatment on initial stages diseases. In addition, the metastatic process is prevented, the base for the development of new cells is destroyed. Chemotherapy is carried out under strict medical supervision, drugs completely kill the immune system and have many negative effects on the body side effects(hair loss, nausea, mouth ulcers, slow growth in a child).

Surgery

Various operations to remove malignant tumors are the most common measure in the treatment of bone oncology. Often the intervention is prescribed simultaneously with taking a biopsy. When removing a tumor, it is important not to leave cancer cells in the body, so a wide excision is used, when nearby healthy tissue is also removed and their edges are analyzed for the presence of cancer cells. This type of surgery is used for cancer hip area and limbs, if the affected area is small.

There are cases where wide excision cannot guarantee desired result. Extensive lesions of the limbs and jaw bones require amputation. In the case of jaw bones, it is carried out tissue transplantation or the use of a bone graft. For tumors of the bones of the skull and spine, operations are performed to scrape out the affected areas from the bone, while preserving the bone.

Radiation therapy

Treatment ionizing radiation, otherwise, radiation therapy is the exposure of cancer cells to radiation rays in doses that are safe for humans. However, the disease is resistant to radiation therapy and requires high doses of radiation, which negatively affects the body, especially the brain. It is often used for Ewing's sarcoma; radiation is used as an addition to chemotherapy and for prophylactic purposes in the postoperative period. Effective use of modern beam technologies: remote therapy, exposure of cancer cells to protons.

How long do people live with bone cancer?

The survival prognosis depends on many factors - the stage at which the patient went to the doctor, type cancer, treatment method and patient age. With prompt access to an oncology clinic, patient survival reaches 70 percent. This means the likelihood of surviving the first 5 years after discovery and treatment of the disease. Unfortunately, when contacting late stages and with secondary metastasis, the chances of successful treatment are very low.

Video

Osteoma. Among benign tumors Osteoma of the bones is quite common. This tumor is most often found in people under 30 years of age, although it can also occur in older people. Most often it is found in the paranasal sinuses and less often in the tubular bones. As a rule, it is single, but you can often find multiple osteomas located in symmetrical areas of the same-named bones of the limbs.

Pathomorphology. Osteoma arises from the deep layers of the periosteum and consists of differentiated bone tissue. It happens three types: compact, spongy (spongy) and mixed.

Clinical picture. The disease is asymptomatic and is discovered accidentally. Osteoma is usually palpated as a smooth-walled tumor that sits tightly on the bone and is therefore immobile. The skin and soft tissue over the tumor are unchanged. Palpation of the tumor does not cause pain. Pain appears when the tumor enlarges significantly, when it compresses nerves or blood vessels, and also if the tumor is located near a joint.

Diagnostics. Radiologically, a spongy or mixed-structure bone formation is determined, located on the surface of the bone (rarely inside the bone - enostoma) and having a trabecular structure of greater or lesser density, but always with smooth, clear contours. Osteoma is like an addition to the main bone and in tubular bones it is most often localized in the metaphysis.

It is necessary to differentiate osteoma from osteochondroma, osteogenic sarcoma, if its rapid growth is noted. In osteochondroma, the surface of the tumor is lumpy on palpation, while in osteoma it is smooth. Osteochondroma can be felt during palpation more than it is visible on an x-ray. This is explained by the fact that its cartilaginous part is not visible on the x-ray.

Treatment and prognosis. The course of osteoma is long. The process of malignancy occurs rarely. Osteoma should be surgically removed only if the function of the limb is impaired, as well as if malignancy is suspected.

Osteochondroma occurs most often in young (up to 30 years of age) age, localized in the metaphysis of long tubular bones, in the area of ​​the knee joint, pelvic bones, scapula, and occasionally in the spinal column.

Pathomorphology. In osteochondroma, a bone base and a cartilaginous apex are distinguished, which can be calcified in the form of irregular foci. The degree of calcification varies, from partial to complete calcification.

Clinical picture. The disease is usually asymptomatic. The tumor is discovered accidentally or due to dysfunction of the affected limb, since as the tumor grows, it presses on the surrounding tissue. On palpation, a dense, tuberous tumor is determined, not fused with the surrounding tissues and skin. Osteochondroma is more clinically defined. Than on the x-ray.

The course of osteochondroma is usually favorable, but its growth is faster than osteoma. Osteochondroma also often develops into osteosarcoma. In these cases, patients experience pain and the tumor grows rapidly. The onset of malignancy is not always immediately noticeable.

Diagnosis. The leading diagnostic method is X-ray examination. Radiologically, osteochondroma is a tumor with a bone base. The compact substance of the bone passes into the compact substance of the tumor. The cartilaginous apex, if it is not calcified, is not visible on radiographs, but when it is calcified, areas of bone tissue without clear contours are visible. The transformation of osteochondroma into sarcoma is radiologically determined by the disappearance of the bone contour and periostitis at the base of the tumor.

Treatment for osteochondroma, only surgery. The tumor is removed within healthy tissue with a wide base excision.

Forecast at proper treatment quite favorable.

Chondroma It is found in people under 20 years of age, but sometimes occurs in older people. According to N.N. Trapeznikov, chondroma accounts for 10-15% of all benign bone tumors. Chondroma is localized mainly in the short tubular bones of the hand and foot, less often in anterior section ribs, epiphyses of tubular bones, pelvic bones and vertebrae.

Pathomorphology. Depending on the location in relation to the bone, they distinguish between ecchondroma - a tumor localized outside, and enchondroma - a tumor localized inside the bone.

Macroscopically, differentiated cartilaginous tissue is determined, resembling normal cartilage, sometimes with foci of calcification.

Clinical picture. Characterized by a long and asymptomatic course. With chondroma of the bones or feet, slowly increasing thickenings can be identified. When the tumor is located near large joint its deformation is determined. Chondroma has a smooth surface and dense consistency. The skin over the tumor is unchanged. Palpation does not cause pain. Pain may occur due to a tumor that impedes the function of the limb, or malignancy.

The course of chondroma is long and usually favorable. However, in old age it can acquire a malignant course, which is characterized by rapid increase tumors, pain.

Diagnosis established on the basis of clinical x-ray examination. At x-ray examination determine round or oval areas of enlightenment outside or inside the bone with clear, even contours. With ecchondroma, at the level of the bone defect in the soft tissues, a shadow of a tumor with a rim is often visible, which indicates ossification of the tumor along the periphery - its maturation.

Treatment For patients with chondroma, only surgery is performed and consists of bone resection with simultaneous replacement of the defect with a graft. In case of chondroma of the fingers, their amputation is performed.

Forecast after radical operations quite favorable. Chondroma undergoes malignancy more often than other benign tumors.

Solitary bone cyst occurs most often in children and adolescents. The causes are unknown, but quite often there is a history of trauma. Some researchers suggest infectious origin tumors, since sometimes streptococci are found in its contents.

Pathomorphology. Most often the tumor is found in the metaphyses of long tubular bones. The epiphysis and other parts of the tubular bones are not affected. The tumor increases in size from the center to the periphery, as a result of which the compact substance of the bone gradually becomes thinner and pathological fracture. The tumor cavity is filled with bloody contents, and its wall is lined with fibrous connective tissue, separating the cyst cavity from the bone marrow cavity.

Clinical picture. The disease is initially asymptomatic, but later pain occurs. Upon palpation, a smooth-walled tumor of dense consistency, pear-shaped or oval, is determined, not fused with the surrounding tissues. The skin over it is not changed. A pathological fracture can occur with little force. The fragments heal quite quickly, and in such cases recovery occurs.

Diagnosis is based on clinical and radiological examination. X-ray examination reveals bone hyperostosis (enlargement of the bone in diameter), a clearing in the metaphysis, which has an oval shape with clear contours and thinning of the compact substance. In the area of ​​clearing of the bone, a cellular structure is visible. There is no periosteal or soft tissue reaction around the bone.

It is necessary to differentiate a solitary cyst from a giant cell tumor, fibrous dysplasia, non-osteogenic fibroma, and enchondroma.

Treatment patients consists of radical excision (resection) of the bone with its replacement with a graft.

Forecast with proper treatment, favorable. Malignancy of the tumor occurs very rarely.

Cartilaginous exostoses (hereditary osteochondroma) occur in children before puberty. They are developmental anomalies, as they develop in the epiphyseal growth zones of long tubular bones. These neoplasms can be single, but much more often – multiple.

Pathomorphology. At the beginning of development, exostoses are cartilaginous, and then a bone base and a cartilaginous apex are formed. Therefore, cartilaginous exostoses, especially if they are single, resemble osteochondroma.

Multiple and single cartilaginous exostoses can be localized in the most various areas skeleton. However, they more often affect long bones. In these cases, various types of deformations and shortening of the limbs occur, since in pathological process the bone growth zone is included.

Clinical picture. Cartilaginous exostoses initially do not manifest themselves in anything other than shortening the limb. In the future, pain may occur if the tumors compress the spinal roots or other soft tissue formations. Sometimes a lumpy, dense tumor that is not associated with soft tissues is palpable. The skin over the tumor is unchanged. In children, cartilaginous exostoses are not detected on x-ray.

The course of the disease is benign and long-term. In rare cases, malignant transformation of the tumor is observed.

Diagnosis is based on clinical and radiological examination data. Most When establishing a diagnosis, pneumo- and angiography assist. In difficult cases, it is recommended to perform a puncture or trepanobiopsy.

Treatment is radical removal tumors within healthy tissue.

Forecast favorable.

Osteoblastoclastoma (giant tumor) refers to benign neoplasms bones, which can quite often turn into malignant ones. Some researchers attribute it to osteodystrophy or to a tumor-like fibrous osteodystrophic process.

• What are bone tumors
• Symptoms of Bone Tumors
• Diagnosis of bone tumors
• Treatment of Bone Tumors
• Prevention of bone tumors

What are bone tumors

The main proportion of bone tumors are osteosarcoma (50–60%), Ewing's sarcoma, chondrosarcoma and fibrosarcoma. In general, about 30 types of bone tumors are known.

What Causes Bone Tumors

The causes of bone tumors are still poorly understood. Trauma plays a role.

The causes of primary bone neoplasms are generally unknown. Persons suffering from chronic inflammatory disease bones (Paget's disease) are at higher risk of developing osteosarcoma in adulthood or old age, but this disease occurs in a very small number of people.

Secondary bone tumors always develop as a result of primary tumors in other organs. Sometimes a primary tumor may be the first manifestation of a primary cancer that is completely asymptomatic.

Symptoms of Bone Tumors

Both primary and secondary bone tumors cause pain, which may be the first noticeable and significant symptom. The pain, as a rule, is localized deeply and is aching, constant in nature, disturbing both at rest and during physical activity. At first, the pain is not constant and worries more at night or when walking in case of damage lower limb. As the tumor grows, the pain becomes constant.

The pain intensifies with movement and, if the lower limb is affected, can lead to the development of lameness. A visible swelling may appear at the location of the pain, and it can also be detected by touch. Fractures are not very common, but can occur both in the area where the tumor is located and in its immediate vicinity. General symptoms occur during a widespread process and are expressed in a decrease in body weight, increased fatigue, and weakness.

When classifying bone tumors, in addition to histological forms, the following are used:
- TNM and pTNM classification. They are applicable to all primary malignant bone tumors with the exception of malignant lymphoma, multiple myeloma, juxtacortical osteo- and juxtocortical chondrosarcoma.
- histopathological grade of malignancy. There are two-, three- and G four-stage systems for assessing malignancy.
- R-classification (based on the absence or presence of residual tumor after treatment),
- Classification according to the stage of the disease (stage Ia, stage Ib, stage IIat1, stage IIb, stage III, stage IVa, stage IVb).

Diagnosis of bone tumors

Diagnosis of bone tumors, in addition to examination, history taking and standard blood tests, involves:
Clinical examination
Use of medical imaging techniques:
o magnetic resonance imaging,
o X-ray computed tomography,
o ultrasound examination,
o radiographic methods,
o radioisotope methods,
o positron emission tomography)
morphological diagnosis of the tumor with establishment of the tumor type
cytological examination strokes and smears-imprints

X-rays in mutually perpendicular projections help determine whether a tumor is benign or malignant.

Radiological signs of malignancy:
Large tumor
Bone destruction
Tumor growth into soft tissue.

X-ray signs of benignity:
Well outlined education small sizes
Thick rim of sclerosis around the tumor
No tumor growth into soft tissue.

Ancillary studies - CT, MRI and TCT scanning of the affected bone help determine the stage, extent of the tumor and its anatomical relationship with adjacent tissues.

If a malignant tumor is suspected, a CT scan is performed chest to exclude metastases to the lungs (most frequent localization metastases in sarcomas).

Biopsy. If necessary, it is advisable to immediately perform a radical resection or amputation of the limb.

Treatment of Bone Tumors

Surgery- the main method of treating bone tumors.

- Benign tumors. Intralesional or intracapsular excision of the tumor is performed. It is possible to replace the defect with a bone graft
- Malignant tumors. Resected within healthy tissue (at least 2 cm away from the visible border of the tumor) Metastases. Single (1-2) isolated pulmonary metastases of sarcoma (especially osteo- or chondrosarcoma) are subject to resection.

Adjuvant therapy for malignant tumors:
- Radiation therapy. Some tumors (such as Ewing's sarcoma) are very sensitive to radiation therapy. In other cases, radiation therapy - helper method treatment
- Chemotherapy. For osteosarcoma - doxorubicin (doxorubicin hydrochloride), cisplatin (intra-arterial or intravenous), methotrexate, thiophosphamide, cyclophosphamide (cyclophosphamide), dactinomycin, bleomycin). For Ewing's sarcoma - cyclophosphamide (cyclophosphamide), vincristine, actinomycin D (dactinomycin), adriamycin (doxorubicin hydrochloride).

Treatment of bone tumors may include surgery, chemotherapy and also radiation. The choice of treatment tactics depends on many reasons. In the case of well-differentiated tumors, it is often sufficient surgical intervention. As a rule, organ-preserving operations are performed. Only in some cases amputations are provided. For some types of tumors, combined or complex treatment using chemotherapy and radiation therapy, but usually it is assumed surgical excision tumors as the main method. At certain types tumors (with Ewing's sarcoma, for example) good effect gives radiation therapy.

Chemotherapy usually used in addition to surgical techniques and may precede surgery. Due to the possible effects of chemotherapy and radiotherapy on the reproductive system, young men are usually offered the option of using a sperm bank.

Forecast. IN last years The survival rate of patients with primary bone cancer has greatly increased, which has become possible thanks to the emergence of new multidisciplinary approaches that include adjuvant and neoadjuvant chemotherapy and radiotherapy in addition to surgical interventions. In addition, thanks to the development of gentle techniques, it is now possible to carry out less radical operations than before. It is very important that patients with bone cancer are treated specialized centers, where, in accordance with a specific disease, they can be prescribed the optimal combination of treatment methods.

Prevention of bone tumors

It is important to carry out regular preventive examinations And timely appeal seek professional and specialized medical help if alarming symptoms. Medical observation and treatment of potentially precancerous diseases/conditions.

Which doctors should you contact if you have bone tumors?

Oncologist

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Bone tumor - growth pathological cells in the bones. A bone tumor can be benign or malignant.

Benign bone tumors are relatively common; malignant ones are rare. Benign or malignant tumors may be primary, if they come directly from bone cells, or secondary (metastatic), when malignant tumors from another organ (for example, breast or prostate) spread to the bones. In children, malignant bone tumors are often primary; in adults – usually metastatic.

The most common symptom of bone tumors is bone pain. In addition, sometimes an increase in bone volume or swelling is noticeable. Often the tumor, especially if it is malignant, weakens the bone, resulting in a fracture (pathological fracture) with little stress or even at rest.

At constant pain in a joint or limb, the patient must undergo an x-ray examination. However, X-rays only show the presence of a tumor and usually cannot determine whether it is benign or malignant. CT scan(CT) and magnetic resonance imaging (MRI) often help determine the exact location and size of the tumor, but also do not provide a definitive diagnosis.

For accurate diagnosis This usually requires taking a sample of tumor tissue to examine under a microscope (biopsy). For many tumors, a piece of tissue can be obtained by inserting a needle into the tumor ( aspiration biopsy); however, this can often only be done surgically(open incisional biopsy). When a malignant tumor is detected, it is extremely important to immediately begin treatment, which may include drug therapy, surgery and radiation therapy.

Benign bone tumors

Osteochondromas(osteocartilaginous exostoses) are the most common type of benign bone tumors. Most often, osteochondromas occur in young people aged 10 to 20 years. These tumors grow on the surface of the bone and appear as hard growths. The patient may have one or more tumors; The tendency to develop multiple tumors is sometimes inherited. About 10% of people who have more than one osteochondroma will develop a malignant bone tumor called chondrosarcoma during their lifetime. People who have only one osteochondroma are unlikely to develop chondrosarcoma.

Benign chondromas most often occur in young people aged 10 to 30 years and develop in the central part of the bone. These tumors are often discovered during X-ray examinations ordered for other reasons. On an x-ray they have a characteristic appearance, which often makes it possible to make an accurate diagnosis. Some chondromas are accompanied by pain. If there is no pain, the chondroma does not need to be removed or treated. However, X-rays should be repeated periodically to monitor tumor growth. If a tumor cannot be accurately diagnosed on x-ray or if it is accompanied by pain, a biopsy may be necessary to determine whether the growth is benign or malignant.

Chondroblastomas– rare tumors that develop in the terminal sections of the bones. They most often occur in young people aged 10 to 20 years. These tumors can cause pain, which is why they are discovered. Treatment consists of surgical removal of the tumor; Sometimes tumors recur after surgery.

Chondromyxoid fibromas– very rare tumors that occur in people under 30 years of age and are usually accompanied by pain. Chondromyxoid fibromas have a characteristic appearance on radiographs. Treatment consists of surgical removal of the tumor.

Osteoid osteomas– very small tumors that usually develop in the bones of the arms or legs, but can occur in other bones. They are usually accompanied by pain, which is worse at night and is partially relieved by small doses of aspirin. Sometimes the muscles surrounding the tumor atrophy; this condition often goes away after the tumor is removed. To determine the exact location of the tumor, a bone scan using radioactive isotopes is prescribed. Sometimes it may be necessary to determine the location of the tumor additional research, for example CT and special X-ray methods. Surgical removal of the tumor is the only way to radically eliminate pain. Some people do not agree to surgery and prefer to take aspirin continuously.

Giant cell tumors most often occur in people after 20-30 years. These tumors usually begin to develop at the end of the bone and can grow into adjacent tissue. As a rule, tumors are accompanied by pain. Treatment depends on the size of the tumor. When a tumor is surgically removed, the resulting defect is filled with bone graft or synthetic bone cement to preserve the bone structure. Sometimes, for very large tumors, it is necessary to remove the entire affected segment of bone. In about 10% of people, tumors return after surgery. Sometimes giant cell tumors develop into malignant ones.

Primary malignant bone tumors

Multiple myeloma, the most common type of primary malignant bone tumor, comes from cells bone marrow producing blood cells. Most often it occurs in older people. This tumor may affect one or more bones; Accordingly, pain occurs either in one place or simultaneously in several places. Treatment must be comprehensive and often includes chemotherapy, radiation therapy and surgery.

Osteosarcoma(osteogenic sarcoma) is the second most common primary malignant bone tumor. Osteogenic sarcoma most often occurs in people between 10 and 20 years of age, but can occur at any age. This type of tumor sometimes develops in older people suffering from. About half of osteosarcomas develop in the knee joint, but in general they can originate from any bone. These tumors tend to metastasize to the lungs. Typically, osteosarcomas cause pain and swelling of the tissue (edema). The diagnosis is made based on the results of a biopsy.

Treatment for osteogenic sarcomas usually includes chemotherapy and surgery. Chemotherapy is usually prescribed first; often the pain subsides already at this stage of treatment. The tumor is then surgically removed. About 75% of operated patients live at least 5 years after diagnosis. As surgical techniques continually improve, it is now common to save the affected limb, but in the past it often had to be amputated.

Fibrosarcomas And malignant fibrous histiocytomas similar to osteogenic sarcomas By appearance, localization and symptoms. The treatment is similar.

Chondrosarcomas– tumors consisting of malignant cartilage cells. Many chondrosarcomas grow very slowly and are often cured radically with surgery. However, some of them are highly malignant and tend to metastasize (spread) quickly. The diagnosis is made based on the results of a biopsy. Chondrosarcoma must be completely removed, since chemotherapy and radiation therapy are ineffective for this tumor. The need to amputate a limb is rare. If the entire tumor is removed, more than 75% of patients are completely cured.

Ewing tumor(Ewing's sarcoma) affects men more often than women, mainly between the ages of 10 and 20 years. Most of these tumors develop in the bones of the arms or legs, but they can occur in any bone. Pain and swelling (edema) are the most frequent symptoms. The tumor sometimes reaches very large sizes and sometimes affects the entire length of the bone. CT and MRI often help determine the size of the tumor, but a biopsy is required for an accurate diagnosis. Treatment includes surgery, chemotherapy, and radiation therapy, curing more than 60% of patients with Ewing's sarcoma.

Malignant bone lymphoma(reticular cell sarcoma) most often affects people aged 40-60 years. It can originate from any bone or other organ and then metastasize to the bones. This tumor usually causes pain and swelling, and the damaged bone breaks easily. Treatment consists of combined chemotherapy and radiation therapy, which is no less effective than surgical removal tumors. Amputation is rarely required.

Metastatic bone tumors

Metastatic bone tumors are malignant tumors that have spread to the bone from a primary site located in another organ.

Malignant tumors of the breast, prostate, and thyroid gland most often metastasize to the bones. Metastases can spread to any bone, but usually bones in the elbow and knee are affected. If a person who is being treated or has been treated for cancer develops bone pain or swelling, the doctor will usually order a test to look for a metastatic tumor. These tumors are detected by X-ray examination, as well as by scanning using radioactive isotopes. It happens that symptoms of a metastatic bone tumor appear before the primary tumor site is detected. Usually this is pain or a broken bone at the site of the tumor. The location of the primary malignant tumor can be determined by the results of a biopsy.