Bone tumors. Osteoma of the tibia and its treatment

bone tumor- This is the collective name for diseases caused by neoplasms in bone tissue. Modern medicine knows about 30 of their varieties. Like other tumors, bone tumors are divided into benign and malignant.

Regardless of the expected type of tumor, an oncologist's consultation is necessary!

The etiology of bone tumors is poorly understood, practitioners in some cases associate their occurrence with a history of trauma. The main symptom is deeply localized aching pain. the frequency and strength of which increase as the tumor grows.

With a common process, general symptoms are observed, manifested in weakness, weight loss and fatigue.

To diagnose bone tumors, doctors use:

• radioisotope methods,
• radiographic methods,

1. Morphological diagnosis of the tumor with the establishment of its type
2. Cytological studies

Treatment may include surgery, chemotherapy, and radiation. Treatment tactics and prognosis are determined by the attending physician based on a number of factors.

benign tumors

It is called a benign neoplasm that develops from the cells of a mature, in most cases - hyaline, cartilage. It is possible to damage any bones, but most often the tubular bones of the hand are affected, localization in soft tissues and on the cartilages of the larynx is also possible.

Characterized by slow growth. With timely surgical treatment, the prognosis is favorable. In the case of incomplete removal, relapses and malignancy of the tumor are possible, followed by degeneration into chondrosarcoma.

Symptoms increase gradually. At the first stages of tumor development, clinical manifestations may be absent.

As the tumor grows, deformities may occur, and in cases of localization in the joint area, arthralgia and synovitis may occur.

Due to the paucity of symptoms, small chondromas are often detected by chance when a doctor prescribes x-rays for another reason.

The diagnosis is established on the basis of x-ray data and biopsy.

Given the potential malignancy of the tumor, surgical removal is performed by an oncologist surgeon, followed by an oncologist.

It is the most common benign bone neoplasm in medical practice.

Osteochondroma is a growth that initially develops from a jelly-like substance, and subsequently ossifies and becomes cartilage. It can develop both in tubular and flat bones.

This osteo-cartilaginous growth occurs mainly in adolescence and young age. The etiology is not reliably clear.

In some cases, malignancy of the tumor may occur with the development of secondary chondrosarcomas.

Diagnostics

Osteochondroma is diagnosed on the basis of a combination of clinical symptoms and radiological signs.

Additionally, computed and magnetic resonance imaging are used. The final diagnosis is based on X-ray data.

In some cases, differential diagnosis is necessary to differentiate osteochondroma from chondrosarcoma, paraosteal osteosarcoma, and osteocartilaginous proliferation.

An orthopedic doctor deals with the diagnosis and treatment of osteochondroma.

osteoblastoma is a benign bone tumor, histologically identical to osteoid osteoma, but having a large size. It is characterized by pain, progressive growth and a constant increase in size.

Tumor development causes destruction of adjacent tissues.

Osteoblastoma most often develops in the spine. Also, the tumor can affect the femur, humerus and tibia.

The age of the vast majority of patients does not exceed 30 years, men experience this disease 2 times more often than women.

The exact cause of the development of the tumor is unknown.

In order to diagnose osteoblastoma, the attending physician prescribes the following studies:

• a test with analgin (the level of pain reduction when taking analgin);
• consultation of an oncologist and a neurosurgeon;
• survey radiography of the affected area in two projections;
• angiography;
• puncture followed by histological examination.
• bone scintigraphy;

Osteoblastoma is treated by an orthopedic surgeon.

Osteoid osteoma- benign, predominantly solitary neoplasm. The size of the tumor usually does not exceed 1 cm in diameter.

The neoplasm can be located in any part of the skeleton, with the exception of the skull and sternum, the femur, humerus and tibia are most often affected.

Children and young people under the age of 25 are susceptible to the disease, women suffer from osteoid osteoma 2 times less often than men.

The main diagnostic methods in case of suspected osteoid osteoma are:

• radiography. With its help, the nature of the pathological process in the affected area is determined.
• CT scan. It is used for the most accurate study of the characteristics of tumor growth.

Osteoid osteoma is usually treated by orthopedists and traumatologists.

It is a benign neoplasm. It is characterized by a favorable course - slow growth, lack of metastases and germination in surrounding tissues. Osteoma never degenerates into a malignant formation.

It develops mainly in patients of childhood, adolescence and young age (from 5 to 20 years).

The development of the tumor is slow and asymptomatic, there is no risk of transition to a malignant tumor, but despite this, it is necessary to identify and treat osteoma as early as possible, the consequences of osteomas are very difficult for the body.

There are several types of tumors, which differ from each other in structure and location.

Regardless of the type of osteoma, surgical treatment is indispensable.

The main role in the diagnosis of osteoma is played by x-ray examination. The clinical picture may be similar to osteosarcoma and chronic osteomyelitis. Differentiation of osteoma is possible on the basis of the clinical picture of the course of the disease, radiographic and histological data.

Malignant bone tumors

This is a rather rare malignant bone neoplasm, mainly children from 10 years old and young people under 25 years old are susceptible to the disease.

The tumor is localized in long tubular and flat bones.

The etiology is not fully established, but doctors note the presence of a history of trauma and some skeletal abnormalities.

It is an aggressive tumor prone to early metastasis.

Clinical symptoms in the early stages are manifested by pain, swelling, local hyperemia and hyperthermia, as well as local expansion of the venous network.

At later stages, a tumor can be visualized, often accompanied by a pathological fracture of the affected area of ​​the bone.

Ewing's sarcoma is diagnosed using the following studies:

• Radiography. It is the main method, thanks to which the pathological focus in the bone tissue is detected.
• CT and MRI. They allow to detect even the smallest metastases, accurately determine their size and relation to adjacent tissues, nerves, blood vessels and the bone marrow canal.
• Biopsy. Bone marrow involvement is a prerequisite for the diagnosis of Ewing's Sarcoma.
• Auxiliary methods (ultrasound, PET, angiography, bone scintigraphy, polymerase chain reaction).
• Laboratory blood tests

Ewing's sarcoma is treated by oncologists. The attending physician chooses the tactics and methods of treatment, taking into account all the factors of the disease.

In most cases, it is necessary to resort to combined treatment, which includes surgery to remove the tumor, pre- and post-operative chemotherapy, and radiation therapy.

A heterogeneous group of malignant non-epithelial neoplasms of cartilage tissue is called.

It develops mainly in the flat bones of the pelvic and shoulder girdle, rarely found in tubular bones. The tumor can develop both on unchanged bones and be the result of the degeneration of some benign neoplasms.

The age of patients with chondrosarcoma ranges from 30 to 60 years.

Chondrosarcoma does not have an absolutely clear clinical symptomatology. It is manifested, as a rule, by progressive pain and swelling of the affected area.

There may be local hyperthermia, expansion of the venous network in the affected area and stiffness of movements in the nearest joint.

The oncologist is in charge of the treatment. Its effectiveness directly depends on the possibility of surgical removal of the tumor.

In the event that the localization of the neoplasm and the patient's condition allow it to be removed surgically, doctors give a good prognosis.

The impossibility of resection forces one to resort to chemotherapy and radiation therapy, the effectiveness of which without removal of the tumor in the case of chondrosarcoma is several times lower.

Chondrosarcoma does not have a specific clinical picture, therefore, radiographic studies and biopsy play the main role in the diagnosis and confirmation of the diagnosis.

To establish the presence / absence of metastases in the lungs, patients with chondrosarcoma are prescribed chest x-ray.

It is the most common malignant neoplasm of bone tissue.

It is characterized by a rapid course and early metastasis. The affected area in most cases are long tubular bones.

The initial stages are characterized by local pain, similar to the pain experienced in rheumatism.

A little later, swelling and stiffness of movements appear in the adjacent joint. The pain syndrome intensifies, the pains become sharp and unbearable.

Treatment is prescribed by an oncologist, traditionally it includes surgery to directly remove the tumor and chemotherapy in the preoperative and postoperative period.

Clinical data, results of laboratory and instrumental studies are used to diagnose osteogenic sarcoma.

For the final diagnosis, the results are used:

• radiography,
• scanning of the affected area of ​​the bone,
• bone biopsy of the affected area.

Orthopedist-traumatologist of the first category, Research Institute, 2012

A bone tumor is a group of neoplasms (both benign and malignant) that form from bone or cartilage tissue. It is customary to include primary tumors in this category, however, some scientists give this definition to secondary processes that develop in bone tissue during metastasis of malignant tumors that occur in other organs.

Malignant (cancerous) neoplasms on the bone account for only 1% of all recorded cases of the disease. In most cases, they are exposed to young and middle-aged people. The most common affected areas are the lower extremities (2 times more often than the upper ones).

Until now, researchers have not been able to answer the question: “What is the main reason leading to the formation of a tumor?”. However, it has been proven that previous injuries play a significant role in this, as well as hereditary factors and gender (the stronger sex is more likely than women to suffer from this disease).

People suffering from chronic inflammatory diseases of the bone (for example, Paget's disease), as well as infectious diseases of the musculoskeletal system, are also at an increased risk of occurrence and development.

Additional reasons can also be mentioned: previously received high doses of ionizing radiation and performed bone marrow transplant operations.

Traumatologists, oncologists and orthopedists are engaged in the treatment of benign formations, and oncologists exclusively treat malignant formations.

Symptoms of the disease

The first symptoms include the following:

1. Pain sensations. The primary symptoms of the disease are insignificant, so they can be mistaken for the usual pain for many, for example, with osteochondrosis or other diseases of the joints and spine. The pain is localized deep enough, is systematic in nature and occurs not only during physical exertion, but also at rest. As the tumor grows in size, the pain becomes permanent.
2. The appearance and development of lameness is not excluded in the event of a neoplasm on the lower limb.
3. In the place of localization of pain, swelling may appear, which can be determined by palpation and visually.
4. Among the general signs, it is also customary to call: a general deterioration in well-being, a sharp weight loss, constant weakness and fatigue.

Classification

Even despite the fact that a bone tumor has such a low percentage in general statistics, the classification of this disease is quite extensive, and there are more than 30 types of this neoplasm. Initially, all of them can be divided into three main groups:

1. Benign is a neoplasm that is not subject to cancerous transformation and is characterized by a more favorable prognosis in general.
2. Malignant - a tumor characterized by aggressive growth. In this case, there is a constant threat of metastasis to other organs, arising from the endless process of division of the affected cells.
3. An intermediate species is a neoplasm that is similar in structure to a benign species, but in the presence of favorable conditions for degeneration, it can develop into a malignant one.

Typology of malignant bone neoplasms

• Osteosarcoma is the most common malignant neoplasm, accounting for approximately 60% of other types of tumors. It affects people between the ages of 20 and 30. The affected area: knee joints and tubular bones of the legs, pelvic bones. This species is characterized by clearly expressed symptoms already at the initial stage of appearance. Young men are slightly more likely to be affected by osteosarcoma.
• Chondrosarcoma is a neoplasm that usually affects the stronger sex in the age group from 40 to 50 years. Slightly less common is chondrosarcoma in young children. Places of localization: shoulder girdle, ribs, pelvic bones.
• Juxtacortical chondrosarcoma is a rare type of cancer, accounting for only 2% of the total number of chondrosarcomas. The site of the lesion is the metaphyseal part of the femur.
• Ewing's sarcoma is a neoplasm localized in the bone marrow contents of tubular bones. The risk group is children (mainly boys), but the likelihood of occurrence and development at an older age is not excluded.
• Angiosarcoma is a disease characteristic of both men and women who have reached the age of 40-50 years. The localization area is the limbs (mainly the lower ones).
• Fibrosarcoma is a fairly rare type of neoplasm. It is found only in 1-4% of all cases of malignant lesions. Area of ​​localization: knee joint, extremities, jaw damage is possible. Appears in men and women in the age range from 20 to 40 years.
• Myeloma.
• Mesenchymoma and others.

Common types of benign neoplasms

• Osteoma is a tumor that is detected most often in adolescence and in adolescents. The affected area: the bones of the skull, shoulder girdle and hips. The most dangerous localization of the neoplasm is possible on the inner plate of the skull bones. Osteoma is of two types: hyperplastic (a neoplasm that appears from bone tissue) and heteroplastic (from connective tissue).
• Osteochondroma is a tumor that develops in the cartilaginous zone of long tubular bones. In 30%, it is found in the knee region, however, it may appear in the head of the fibula, in the spine, in the pelvic bones and in the proximal part of the humerus.
• Chondroma is a neoplasm that develops mainly from cartilage tissue. Possible affected area: bones of the upper and lower extremities (feet, hands), tubular bones and ribs. In 5-8% of all cases, there is a threat of transformation into a malignant formation.
• Chondroblastoma.
• Lipoma, etc.

The fundamental difference between malignant and benign tumors is the accelerated growth rate of the former. They are characterized by the initial presence of a fixed, compacted, but often painless formation, aggressively increasing in size.

Benign tumors grow much more slowly, gradually expanding the affected area over several years.

Diagnosis of the disease

In addition to examination, history taking and well-known blood tests, the diagnosis of the disease involves the following studies:

1. Clinical examination;
2. Cytological examination;
3. Application of medical imaging methods (X-ray studies, magnetic resonance and positron emission tomography, radioisotope study).

X-ray examination allows you to accurately indicate the type of tumor.

Distinguishing indicators of malignancy

• Education is characterized by significant dimensions;
• There are processes of germination of the neoplasm in soft tissues;
• Destruction of bone cells.

Goodness indicators

• The neoplasm has clearly defined boundaries and is small in size;
• No germination into adjacent soft tissues;
• Around the tumor there is a thick rim of sclerosis.

The stage of tumor development, its prevalence and anatomical interactions with tissues adjacent to it, help determine additional examinations: MRI, angiography, CT, scanning with the affected bone.

Only in the case of using a full complex of examinations, it is possible to accurately determine the type of neoplasm, its parameters, stage of development and the exact location of the affected area of ​​bone tissue.

When detecting a malignant formation, it is very important to determine the stage of its development.

For oncology of bone tissue, as well as for other types of cancerous tumors, four stages of development are characteristic.

1. The neoplasm is located within the bone and does not metastasize to nearby structures. The tumor does not pose a particular danger to the patient, as it is easily amenable to modern methods of treatment until complete recovery. The main danger is that it is quite difficult to identify oncology at this stage due to the lack of pronounced symptoms. The only possibility of detection is systematic observation and regular surveys.
2. The second stage is characterized by the presence of a malignant formation in the bone tissue, but there is a tendency to metastasize. On the adjacent soft tissues, single affected cells are already found.
3. Numerous formations appear on different parts of the bone. Apetic cells are present in greater numbers on adjacent soft tissues and are found in lymph nodes.
4. This stage is characterized by the detection of a malignant formation not only in the bone. Affected cells with blood and lymph flow enter neighboring or distant organs. Metastases are found everywhere.

Treatment

The choice of treatment for neoplasms depends on several factors:

1. Stage of development and quality of neoplasm;
2. The physical characteristics of the tumor and its rate of growth;
3. General physical condition of the patient (age, presence of other diseases, etc.).

Among the generally accepted methods of treating neoplasms are:

• Surgical intervention;
• Radiation therapy;

Systemic drug treatment includes chemotherapy, hormonal therapy, biological treatment.

Sparing surgical operations are prescribed, as a rule, for patients with benign neoplasms. The operation to remove the tumor may be accompanied, if necessary, by resection of the bone - the removal of its part. After that, a bone grafting procedure is performed, in which the missing part of the tissue is replaced with a graft.

Chemotherapy involves the use of anticancer drugs to destroy abnormal cells. This method is not used only in the treatment of chondrosarcoma.

Radiation treatment can be an additional method for surgical intervention, it is acceptable as the main one for those patients who refuse to do a resection, or contraindications to its implementation have been identified.

A modern technique that can replace traditional surgery is cryosurgery.

This method can be used in cases of treatment of certain malignant tumors, or in situations where other therapeutic methods have been unsuccessful.

In order to treat malignant neoplasms, abnormally low temperatures (up to -198 ° C) are used. The destructive force of frost leads to the creation of many ice crystals inside the affected area, which put pressure on the intracellular cavity. As a result, such an impact leads not only to the rupture of apitic cells, but also to the cessation of their nutrition. In the future, this becomes the main obstacle to their growth and division.

Forecasts

The most favorable prognosis awaits the patient if a neoplasm is detected at the first stage of the disease. In 80% of cases of adequate treatment, a 5-year survival rate of the diseased can be ensured. At the next stage, the success rate drops sharply to 62. Treatment of a malignant tumor detected in the last two stages allows patients to live 5 or more years in only 30%.

Prevention

Among the main methods of preventing neoplasms are:

• Regular intake of multivitamin complexes;
• Qualified monitoring of pathologies and chronic diseases, if any;
• Regular preventive examinations;
• Timely appeal for qualified help to experienced medical specialists;
• Observation and professional treatment of potential precancerous lesions.

The nature of the appearance of a bone tumor is still not fully understood, so everyone can suffer from it.

A systematic medical examination, attentive attitude to your body, treatment of the root causes of diseases of the musculoskeletal system - these are simple secrets that will help everyone maintain health until old age.

bone tumors

What are Bone Tumors?

bone tumors is a relatively rare occurrence. Their proportion among other tumors is about 1%. Bone tumors are typical mainly for young people.

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

What provokes / Causes of Bone Tumors:

The causes of bone tumors are still poorly understood. A certain role is given to trauma.

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

Secondary bone neoplasms always develop as a result of primary tumors in other organs. Sometimes a primary tumor can 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, disturbing both at rest and during physical exertion. At first, the pain is not constant and worries more at night or when walking in case of damage to the lower limb. As the tumor grows, the pain becomes constant.

The pain is aggravated by movement and, if the lower limb is affected, can lead to the development of lameness. At the site of localization of pain, a visible swelling may appear, and it can also be determined by touch. Fractures are not very common, but can occur both in the area of ​​tumor localization and in its immediate vicinity. General symptoms occur with a common process and are expressed in weight loss, fatigue, weakness.

When classifying bone tumors, in addition to histological forms, the following are used:
- TNM- and pTNM-classification. They apply to all primary malignant bone tumors except 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 (according to the absence or presence of residual tumor after treatment),
- Classification by disease stage (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
Using 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 the establishment of the type of tumor
cytological examination of smears and smears-prints

Radiography in mutually perpendicular projections helps to determine whether a tumor is benign or malignant.

Radiological signs of malignancy:
large tumor
Bone destruction
Invasion of the tumor into soft tissues.

Radiographic signs of good quality:
Well-circumscribed formation of small size
Thick rim of sclerosis around the tumor
Absence of germination of the tumor in soft tissues.

Ancillary studies - CT, MRI and scanning with "Tc" 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 of the chest is performed to exclude metastases to the lungs (the most common localization of metastases in sarcomas).

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

Treatment of Bone Tumors:

Surgery- the main method of treatment of bone tumors.

- benign tumors. Spend intralesional or intracapsular excision of the tumor. 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 is an auxiliary method of treatment.
- Chemotherapy. With osteosarcoma - doxorubicin (doxorubicin hydrochloride), cisplatin (intra-arterially or intravenously), methotrexate, thiophosfamide, cyclophosphamide (cyclophosphamide), dactinomycin, bleomycin). With Ewing's sarcoma - cyclophosphamide (cyclophosphamide), vincristine, actinomycin D (dactinomycin), adriamycin (doxorubicin hydrochloride).

Treatment of bone tumors may include surgery, chemotherapy, and also radiation exposure. The choice of treatment tactics depends on many factors. In the case of highly differentiated tumors, surgery is often sufficient. 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 is used, but surgical excision of the tumor is usually considered as the main method. For certain types of tumors (with Ewing's sarcoma, for example), radiation therapy gives a good effect.

Chemotherapy usually used in addition to surgical methods and may precede surgery. Because of the possible reproductive effects of chemotherapy and radiotherapy, it is common for boys to be offered the option of using a sperm bank.

Forecast. In recent years, the survival of patients with primary bone cancer has greatly improved, which has become possible due 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 methods, less radical operations can now be performed than before. It is very important that patients with bone cancer are treated in specialized centers where, in accordance with the specific disease, they can be prescribed the optimal combination of treatment methods.

Prevention of bone tumors:

It is important to regularly conduct preventive examinations and timely seek professional and specialized medical care when alarming symptoms appear. Medical supervision and treatment of potentially precancerous diseases/conditions.

Which doctors should you contact if you have Bone Tumors:

Are you worried about something? Do you want to know more detailed information about Bone Tumors, its causes, symptoms, methods of treatment and prevention, the course of the disease and diet after it? Or do you need an inspection? You can book an appointment with a doctor– clinic Eurolaboratory always at your service! The best doctors will examine you, study the external signs and help identify the disease by symptoms, advise you and provide the necessary assistance and make a diagnosis. you also can call a doctor at home. Clinic Eurolaboratory open for you around the clock.

How to contact the clinic:
Phone of our clinic in Kyiv: (+38 044) 206-20-00 (multichannel). The secretary of the clinic will select a convenient day and hour for you to visit the doctor. Our coordinates and directions are indicated. Look in more detail about all the services of the clinic on her.

(+38 044) 206-20-00

If you have previously performed any research, be sure to take their results to a consultation with a doctor. If the studies have not been completed, we will do everything necessary in our clinic or with our colleagues in other clinics.

You? You need to be very careful about your overall health. People don't pay enough attention disease symptoms and do not realize that these diseases can be life-threatening. There are many diseases that at first do not manifest themselves in our body, but in the end it turns out that, unfortunately, it is too late to treat them. Each disease has its own specific signs, characteristic external manifestations - the so-called disease symptoms. Identifying symptoms is the first step in diagnosing diseases in general. To do this, you just need to several times a year be examined by a doctor not only to prevent a terrible disease, but also to maintain a healthy spirit in the body and the body as a whole.

If you want to ask a doctor a question, use the online consultation section, perhaps you will find answers to your questions there and read self care tips. If you are interested in reviews about clinics and doctors, try to find the information you need in the section. Also register on the medical portal Eurolaboratory to be constantly up to date with the latest news and information updates on the site, which will be automatically sent to you by mail.

Other diseases from the Oncological diseases group:

pituitary adenoma

Adenoma of the parathyroid (parathyroid) glands

Thyroid adenoma

Aldosteroma

Angioma of the pharynx

Angiosarcoma of the liver

Astrocytoma of the brain

Basal cell carcinoma (basalioma)

Bowenoid papulosis of the penis

Bowen's disease

Paget's disease (cancer of the nipple of the breast)

Hodgkin's disease (lymphogranulomatosis, malignant granuloma)

Intracerebral tumors of the cerebral hemispheres

Hairy throat polyp

Ganglionoma (ganglioneuroma)

Ganglioneuroma

Hemangioblastoma

Hepatoblastoma

germinoma

Giant condyloma of Buschke-Levenshtein

glioblastoma

Glioma of the brain

Glioma of the optic nerve

Glioma chiasma

Glomus tumors (paragangliomas)

Hormonally inactive tumors of the adrenal glands (incidentalomas)

Fungal mycosis

Benign tumors of the pharynx

Benign tumors of the optic nerve

Benign tumors of the pleura

Benign oral tumors

Benign tumors of the tongue

Malignant neoplasms of the anterior mediastinum

Malignant neoplasms of the mucous membrane of the nasal cavity and paranasal sinuses

Malignant tumors of the pleura (pleura cancer)

Carcinoid syndrome

Mediastinal cysts

Cutaneous horn of the penis

Corticosteroma

Bone-forming malignant tumors

Bone marrow malignant tumors

Craniopharyngioma

Leukoplakia of the penis

Lymphoma

Burkitt's lymphoma

Thyroid lymphoma

Lymphosarcoma

Waldenstrom's macroglobulinemia

Medulloblastoma of the brain

Mesothelioma of the peritoneum

Mesothelioma malignant

Mesothelioma of the pericardium

Pleural mesothelioma

Melanoma

Melanoma of the conjunctiva

meningioma

Optic nerve meningioma

Multiple myeloma (plasmocytoma, multiple myeloma)

Neurinoma of the pharynx

Acoustic neuroma

Neuroblastoma

Non-Hodgkin's lymphoma

Balanitis xerotica obliterans (lichen sclerosus)

Tumor-like lesions

Tumors

Tumors of the autonomic nervous system

pituitary tumors

Tumors of the frontal lobe

Tumors of the cerebellum

Tumors of the cerebellum and IV ventricle

Tumors of the adrenal glands

Tumors of the parathyroid glands

Tumors of the pleura

Tumors of the spinal cord

Tumors of the brain stem

Tumors of the central nervous system

Tumors of the pineal gland

Osteogenic sarcoma

Osteoid osteoma (osteoid osteoma)

Osteoma

Osteochondroma

Genital warts of the penis

Papilloma of the pharynx

oral papilloma

Middle ear paraganglioma

Pinealoma

Pineoblastoma

Squamous cell skin cancer

Prolactinoma

anal cancer

Anus cancer (anal cancer)

Bronchial cancer

Thymus cancer (thymus cancer)

Vaginal cancer

Cancer of the extrahepatic biliary tract

Cancer of the vulva (external genitalia)

Cancer of the maxillary sinus

throat cancer

Brain cancer

Cancer of the larynx

Reference! Bones contain several types of cells. Osteoblasts are responsible for building the foundation of bones, namely the connective tissue and inorganic substances (minerals) that make bones strong.

Osteoclasts help regulate the level of inorganic substances in the blood by influencing the deposition and removal of these substances from the bones, which allows the bones to maintain their desired shape. Bone marrow, found in some bones, contains fatty, and most importantly, hematopoietic cells that produce various blood cells.

Distinguish primary And metastatic (secondary) bone and cartilage tumors.

Primary tumors arise directly from bone or cartilage, while metastatic lesions occur when other tumors (eg, lung, breast, prostate cancer, etc.) spread to the bone.

Benign tumors and tumor-like lesions of the bones

Benign tumors of bone and cartilage tissues include: osteoma, osteoid osteoma, osteoblastoma, osteochondroma, chondromyxoid fibroma.

These tumors do not metastasize and are usually not life threatening. Surgical removal of the tumor is the only method of treatment, as a result of which patients fully recover.

Osteoma - benign tumor growing from bone tissue. Osteomas grow slowly and often, having reached a certain size, they stop growing.

There are three types of osteomas:

1) compact(or solid: osteoma durum) - consists of lamellar bone with few narrow haversian canals, devoid of bone marrow tissue; has a high density;

2) spongy(osteoma spongiosum) - consists of bone crossbars, between which there are bone marrow spaces .;

3) cerebriform(osteoma medullosum) - contains extensive cavities filled with bone marrow.

According to Virchow, there are two groups of osteomas:

Hyperplastic - develop from the skeletal system

Heteroplastic - from the connective tissue of different organs

The first ones are osteophytes - small stratifications on the bones; if they occupy the entire circumference of the bone, then they are called hyperostoses ; if the bone mass is issued in the form of a tumor in a limited place - exostoses if it is enclosed within the bone - enostoses.

Solid exostoses are often found on the bones of the skull, face and pelvis; in the latter case, they can greatly complicate the birth act.

Heteroplastic osteomas are localized in the places of attachment of the tendons and in the muscles; there are extensive bone plates in the dura mater, without having, however, any pathological significance; the same can be said about the bone deposits in the heart shirt, pleura and diaphragm; comparatively rarely find osteomas in the substance of the brain. Until now, they have not been found in the female genital organs, and in the male penis, bone deposits have been found more than once and put them in parallel with normal bones in the penis of some animals.

clinical picture. Osteomas develop very slowly and therefore go unnoticed for a long time. Sometimes the first signs of an osteoma are pain due to nerve compression or facial asymmetry. Clinical symptoms depend on the direction of growth and size of the tumor. Osteoma, located on the outer plate of the bones of the skull, appears as a dense, immovable, painless formation with a masonry surface. Developing on the inner plate of the bones of the cranial vault, osteoma can cause headache, memory disorders, epileptic seizures, and symptoms of increased intracranial pressure. With localization in the area of ​​\u200b\u200bthe "Turkish saddle", hormonal disorders may appear. When localized in the area of ​​the paranasal sinuses (due to irritation of the branches of the trigeminal nerve), a variety of eye symptoms occur - exolfthalmos, diplopia, decreased vision, anisocoria, ptosis, etc. when reaching large sizes, located near the nerve root, localized in the arch or process of the vertebra, osteoma can cause pain, symptoms of spinal cord compression, spinal deformity. Osteomas of long tubular bones grow slowly and are exophytic formations.

Multiple osteomas are casuistry. Nevertheless, they can be part of Gardner's syndrome, a hereditary disease that manifests itself in a clinical triad: colon polyposis, multiple osteomas of various localizations, and soft tissue tumors.

Treatment osteotomy is only surgical. It is indicated for clinical symptoms or for cosmetic purposes. The operation consists in removing the tumor with mandatory resection of the underlying healthy bone plate. In cases of asymptomatic course and small tumor sizes, only dynamic observation is considered appropriate.

Osteoid osteoma(syn. osteoid cortical) - a benign tumor of the cortical layer of the bone, which is a focus of bone resorption, filled with tissue containing a large number of osteoblasts and osteoclasts, surrounded by a zone of osteosclerosis.

Frequency: Osteoid osteoma is detected in young people (11–20 years old), men get sick 2 times more often. Osteoid osteoma is usually a solitary tumor localized in any part of the skeleton (more often in long tubular bones). The femur is first in frequency, followed by the tibia and humerus.

clinical picture. Pain especially at night, localized, aggravated by pressure on the focus. The skin is unchanged. With the localization of the tumor on the lower extremities - lameness. X-ray reveals an oval-shaped focus of bone tissue destruction with clear contours. Around the focus is a zone of osteosclerosis due to periosteal and, to a lesser extent, endosteal changes. To clarify the nature of the lesion and more clearly identify the focus, CT is indicated. Differential diagnosis in osteoid osteoma is carried out with Brodie's bone abscess

Treatment surgical. After radical removal, as a rule, osteoid osteoma does not recur.

osteoblastoma- a tumor that is much larger than osteoid osteoma, but practically does not differ from it in its histological structure. Some authors call osteoblastoma "giant osteoid osteoma". The most common localization of the tumor is the spine, where up to 40% of osteoblastomas of the entire skeleton were found. The age of patients varies between 10 and 20 years. Much less often, osteoblastomas affect the femur, tibia and humerus (30%).

Clinical picture osteoblastoma is very similar to that of osteoid osteoma. Pain in osteoblastoma is permanent, does not depend on the time of day, is more often noted at rest and decreases or disappears for some time after taking analgesics.

Diagnostics osteoblastoma is difficult and should include a complex of clinical, radiological and functional methods. X-ray diagnostics, in addition to routine techniques, should include computed tomography, which helps in making a differential diagnosis and choosing an adequate tactic for the upcoming operation.

Treatment: surgical, consists in the radical removal of pathological tissue, which is the prevention of relapse.

Osteochondroma (osteocartilaginous exostosis)- a tumor of the bone, formed from cartilage cells. It is a colorless mass that most often forms between the ages of 10 and 25 on the epiphysis of a long tubular bone. Since some of these tumors, if left untreated, may become malignant they are usually removed surgically.

Localization: predominantly in long bones (medial surface of the proximal metaphysis of the humerus, distal metaphysis of the femur, proximal metaphysis of the tibia)

X-ray examination: the tumor is presented in the form of an additional shadow connected to the bone by a leg, less often by a wide base. The contours are bumpy, uneven. At large tumor sizes, a pronounced deformation of adjacent bones is detected.

Differential Diagnosis- with single and multiple osteochondral exostoses.

Osteoclastoma ( giant cell tumor ) - occurs at a young age (in persons under 30 years old), affects both the epiphysis and the metaphysis of long tubular bones.

Pathomorphology: along with mononuclear oval cells of the osteoblast type, multinuclear large giant cells of the osteoclast type are found.

Forms: lytic, active cystic, and passive cystic.

Clinical picture: pain in the affected area, sometimes - skin hyperemia, bone deformity, pathological fractures are possible.

X-ray examination: the tumor looks like an oval focus of enlightenment. An important radiological sign of all forms of osteoblastoclastoma, which distinguishes it from tuberculous bone lesions, is the absence of osteoporosis.

Differential diagnosis: examines to exclude dysplasia (chondroma, chondroblastoma, fibrous dysplasia, etc.).

Treatment surgical osteoblastoclastoma. Sparing bone resection with tumor removal and one-stage bone grafting (auto-, homografts or methyl methacryl replacement) is the method of choice. When a tumor of the spine is affected, radiation therapy is used.

Chondroblastoma- an extremely rare, mainly in young people, benign tumor of the epiphyses of long tubular bones.

Clinical picture: moderate pain, slight swelling in the area of ​​the affected bone, restriction of movement in the adjacent joint. The diagnosis is based on the results of X-ray examination (periosteal reaction, calcifications distinguish chondroblastoma from other bone tumors).

Treatment operational.

Chondromyxoid fibroma- a benign painless tumor, consisting of a cartilaginous interstitial substance, in which elongated and stellate cells are located. Its metaphyseal eccentric location in a long tubular bone with thinning and swelling of the cortical layer resembles chondroblastoma. It most often occurs before the age of 30.

Clinical manifestations minimal; for a long time it is asymptomatic; are detected by chance on radiographs in the form of a focus of destruction, sometimes surrounded by a sclerotic rim. Against the background of the focus of destruction, a trabecular pattern and petrificates are visible.

Treatment- operative (excochleation of the tumor with subsequent replacement of the bone defect with a graft).

fibrous dysplasia(fibrous osteodysplasia, fibrous bone dysplasia, Liechtenstein-Braytsev disease) is a disease characterized by the replacement of bone tissue with fibrous tissue, which leads to bone deformity. This is a disease of childhood and adolescence. According to the prevalence of the pathological process, there are polyostotic(several bone involvement) - unilateral and bilateral fibrous dysplasia - and monoosseous(lesion of one bone).

Clinical picture characterized by great diversity and steady progression. Deformations of the bones of the skeleton, often pathological fractures, leading to sharp curvature and shortening of the limbs, severe functional impairment. The bones of the lower extremities are most often affected by deformities. The femurs are characterized by a shepherd's stick deformity. The shins are often saber-shaped in combination with valgus curvature. Lameness is due to the inequality of the length of the limbs, as well as the presence of pain syndrome, which occurs with microfractures of the affected segment. At the same time, pains are also noted at rest and disappear without a trace after a short-term plaster immobilization of the limb.

The radiological picture in fibrous dysplasia is characterized by a sharp thickening of the bone, swelling and thinning of the cortical layer, sometimes a violation of its continuity. Most often, the focus is located in the metaphysis of the bone. The structure of the bone within the affected segment, as a rule, is not the same, areas of compaction alternate with areas of rarefaction. Compacted areas have a smeared "ground glass" appearance.

Treatment of fibrous dysplasia consists in the surgical removal of the pathological focus and the replacement of the resulting defect with implants.

In a separate nosological form allocated osteofibrous dysplasia or as is sometimes found in the literature " aggressive form of fibrous dysplasia". Osteofibrous dysplasia is a benign tumor-like process that affects the long bones of the skeleton in children and adolescents. A characteristic feature of the course of the disease is the inevitability of recurrence of this disease. The tibia is most commonly affected.

Clinical picture similar to fibrous dysplasia and is not specific. The patient has deformities, pain, limitation of movements in the affected segment.

Of the two treatment concepts (conservative orthopedic and surgical), preference is given to the conservative one in case of limited bone damage, absence or mild severity of segment deformity and pain. In the case of progression of the pathological process and the spread of the dysplastic focus over a significant extent of the bone, the question of surgical treatment should be raised without delay.

Bone cyst - a peculiar dynamic disease of the skeleton, characteristic of childhood and adolescence. Solitary (SBC) and aneurysmal (AKC) bone cysts in the International Histological Classification of Bone Tumors are classified as tumor-like bone lesions of not fully elucidated etiology.

Pathogenesis bone cysts remains unclear, but it has been established that they are the result of a hemodynamic disorder in a limited area of ​​​​the bone. The formation of a bone cyst is essentially a dystrophic process. The type of cyst depends on the biomechanical conditions in a particular part of the musculoskeletal system, on acute (in ACC) or prolonged in time (in SCC) hemodynamic disorders in the bone. Despite the common nature of the disease, SCC and ACC are separated, since each of them is characterized by its own clinical symptoms and radiological picture.

Bone cysts account for 55-58% of all benign bone tumors in children and adolescents. SCC are more common (78%) than ACC (22%). The predominant age of onset of the disease with cysts is from 8 to 15 years.

The predominant localization of the pathological focus is the proximal parts of the femur, humerus, tibia, pelvis, spine.

In 25% of observations, cysts are accidentally discovered by parents when bathing a child, when swelling indicates an already existing pathology, when playing games, playing sports, when stiffness of the limb progresses rapidly, pain of an indefinite nature in the affected area. After rest, these symptoms disappear, then reappear. Only X-ray examination allows in such cases to establish a diagnosis.

In 75% of observations, the cyst is manifested by a pathological fracture that occurs against the background of complete health during sudden movements, a fall, or a fracture at the site of a long-term pain.

When ACC is localized in the vertebrae, a protective tension of the muscles on the side of the lesion occurs, and pain intensifies. There is a violation of the supporting function of the spine, and children compensate for it by leaning their hands on the pelvic area, hips, support their heads with their hands. An obligatory clinical symptom is neurological disorders, the severity of which depends on the anatomical features of the affected vertebra, the level of the pathological process, and the degree of compression of the spinal cord membranes. Paresis and paralysis, developing suddenly and in the early stages of the disease, are caused by pathological fractures of the vertebral bodies.

X-ray reveals most often an eccentrically located structureless lytic focus of destruction with a sharp thinning of the cortical layer. Sometimes there is a cellular nature of the focus structure.

I phase - osteolysis;

II - delimitation;

III - recovery, thereby emphasizing the dynamics of the disease and the correspondence of clinical and radiological manifestations.

The duration of clinical symptoms is from 1 month to 3 years.

Treatment Methods aneurysmal and solitary cysts can be both conservative and operative. Depending on the location and stage of the pathological process, the method of treatment is determined. Errors in the conduct of surgical treatment, the technique of its implementation and the nature of postoperative rehabilitation contribute to the recurrence of the disease, which, according to various sources, ranges from 10% to 50%.

International Classification of Diseases for Oncology

(ICD-O, second edition, 1990)

Bone-forming

benign

Osteoid osteoma

osteoblastoma

Malignant

osteosarcoma

Juxtacortical osteosarcoma

Malignant osteoblastoma (primary or secondary)

Cartilaginous benign

Solitary

Chondroma central (enchondroma)

Juxtacortical (periosteal)

Osteochondroma (osteocartilaginous exostosis, ecchondroma)

Chondroblastoma

Chondrodysplasia

Chondromyxoid fibroma

Multiple

Multiple chondromas

Juxtacortical (periosteal) enchondromatosis calcifying and ossifying

Enchondromatosis is predominantly unilateral (Ollier's disease or dyschondroplasia, Maffucci's syndrome)

Osteochondromatosis, congenital multiple exostoses, congenital deformities

Cartilage-forming malignant

Chondrosarcoma (primary and secondary)

Juxtacortical chondrosarcoma

Giant cell tumor (osteoclastoma)

Bone marrow tumors are malignant

Ewing's sarcoma

Malignant bone lymphoma: reticulosarcoma and lymphosarcoma

Vascular tumors

benign

Hemangioma

Lymphangioma

Glomus tumor

intermediate and malignant

Hemangioendothelioma

Hemangiopericytoma

Angiosarcoma

Other connective tissue tumors

benign

Desmoplastic fibroma

Malignant

fibrosarcoma

Liposarcoma

Malignant mesenchymoma

Malignant fibrous histiocytoma

Leiomyosarcoma

Other tumors

"Adamantinoma" of long tubular bones (angioblastoma)

Sarcomas developing against the background of previous processes

Sarcomas in Paget's disease

Sarcomas after radiation

Tumor-like diseases

Solitary bone cyst (simple or unilocular cyst)

ACC (Multilocular Blood Bone Cyst)

Juxtacortical bone cyst (intraosseous ganglion)

Metaphyseal fibrous defect (non-ossifying fibroma)

Eosinophilic granuloma

Solitary eosinophilic granuloma

fibrous dysplasia

Myositis ossificans (heterotopic calcifications)

"Brown tumors" in hyperparathyroidism

Epidermoid cysts

Tumors and tumor-like diseases of synovial nature

Pseudotumor processes

Localized nodular synovitis

Pigmented villo-nodular synovitis

Osteochondromatosis

Chondroma

synovial sarcoma

Features of the diagnosis of tumor lesions of the bones

Diagnosis of tumor lesions of the bones is quite difficult due to the significant diversity and the absence of obvious early symptoms. The depth of the location of the process, the difficulty in assessing one's condition for patients and the lack of clear complaints limit the possibilities of diagnosis. At the same time, clinical diagnosis has its own peculiarities. Complaints, especially in children, occur only when the focus in the bone tissue reaches a significant size. General symptoms can be manifested by an increase in body temperature, general weakness and sharp pains when the process reaches the periosteum. In dysplastic processes, the cause of the disease can often be trauma, which is not detected in the early stages. The leading place in this is the collection of anamnesis. The pain is indefinite, often radiating. With a malignant process, its intensity progresses rapidly, it becomes constant (it bothers even at night).

Local changes in the malignant course of the tumor process - in the bone are detected in the form of swelling, often deformation, and skin changes due to obstruction of the outflow of blood and expansion of the saphenous veins.

With a benign process, the pain syndrome is almost absent, but deformations appear, sometimes pathological fractures occur. With dysplasia, the pain is not sharp, but constant, the gradual development of deformation is possible.

When collecting an anamnesis, great attention should be paid to heredity.

The general condition with dysplasia and benign tumors basically does not change. In a malignant process in young children, the condition resembles an acute inflammatory process with high body temperature, leukocytosis, and elevated ESR. The appearance of the patient does not correspond to the severity of the disease, and emaciation and anemia occur mainly in advanced stages of bone sarcoma. In adults, this process is less intense.

By palpation, it is possible to determine a bone tumor at an early stage of its development only in places where there are few soft tissues, or when the tumor is located periosteally or subperiosteally. Bone metastases are never palpable.

In most cases, it is possible to clarify the consistency of the tumor by palpation with a shallow tumor, while paying attention to the color of the skin over the tumor, the mobility of the soft tissues, the presence of an expanded venous network or pulsation of the vessels.

With some types of dysplasia, it is possible to determine concomitant tumors of skin changes in the form of pigmentation, hyperkeratosis, angiomatous and varicose venous formations (for example, with Maffucci syndrome). When determining the growth of a tumor, especially a malignant one, in dynamics, it is necessary to measure the circumference of the limb on the diseased and on the healthy side at the same level.

Benign and dysplastic bone lesions progress very slowly. The degree of dysfunction of the limb complements the information about the prevalence and nature of bone damage. So, diaphyseally located tumors do not lead to impaired movement, and with epiphyseal localizations they can lead to neuroreflex contractures, especially early in osteogenic sarcomas. With the metaphyseal location of the tumor, the movement in the joint is not disturbed and the pain syndrome is not pronounced. Most often, dysfunction of the joint is associated with a pathological fracture, which, as a rule, occurs at a late stage in the development of the tumor process.

The age of the patient is essential in determining the nature of the tumor. Thus, primary bone tumors are typical for children, metastatic tumors are extremely rare, while in adults metastatic tumors occur 20 times more often than primary malignant tumors.

In some cases, tumor or dysplastic processes have a characteristic localization. So, chondromas are more often located in the phalanges of bones, eosinophilic granuloma - in the bones of the cranial vault, and dyschondroplasia foci - in the distal extremities. Benign tumors are more often located within the tubular bone, metadiaphyseal region. Cartilaginous tumors in children are almost always associated with the epiphyseal growth cartilage, in the metaphyses of tubular bones they grow in the form of echondromas, while in the elderly they grow centrally, in the form of enchondromas. Dysplasia affects the ends of the bones that form the knee joint, the proximal end of the femur, the upper jaw, etc.

Clinical and laboratory data (general blood and urine tests) with benign tumors and dysplasia do not noticeably change. At the same time, in malignant processes, especially such as osteogenic sarcoma, Ewing's sarcoma and reticulosarcoma, significant changes are detected in the blood in the form of leukocytosis, lymphocytosis, monocytosis, elevated ESR; in multiple myeloma, leukopenia, anemia, thrombocytopenia, and elevated ESR are found.

Biochemical studies are very important for determining the nature and stage of the tumor process. So, in multiple myeloma hyperproteinemia is expressed (up to 100-160 g/l) with an increase in the content α 2 -,β- and γ- globulins. In the urine of such patients, a specific Bens-Jones protein is found. In malignant tumors, the content of total protein usually decreases sharply due to a decrease in the amount of albumins with a slight increase in the content of globulins. The content of sialic acids is one of the indicators of tumor growth. So, with slowly growing it is within the normal range, and with fast-growing benign tumors it increases, with a malignant process it increases sharply, especially with metastasis. The activity of proteolytic enzymes, in particular chymotrypsin, in the blood serum can be of help in the differential diagnosis of malignancy of the process. Increased excretion of total hydroxyproline in the urine indirectly indicates the malignancy of the process.

An important role in the vital activity of bone tissue is played by elements such as calcium, phosphorus and sodium. The study of the state of phosphorus-calcium metabolism (the content of calcium, phosphorus and the activity of alkaline phosphatase in the blood, the content of calcium and phosphorus in the urine) is very important when examining a patient. Alkaline phosphatase activity changes mainly in osteogenic sarcoma, osteoid osteoma, and in some cases in osteoblastoclastoma after a pathological fracture; the content of calcium in the blood increases with a malignant process and with parathyroid osteodystrophy.

X-ray examination allows you to clarify the diagnosis and such indicators as the border of the lesion, its structure; this method is the leading one in the differential diagnosis of malignant, benign and dysplastic processes (Fig. 1). Tomography, radiography with contrast, radionuclide diagnostics and the use of magnetic resonance imaging allow more accurate diagnosis.

Rice. 1.

When differentiating dysplastic processes from inflammatory processes, it is necessary to compare the general signs of changes in bone tissue (Table 1).

Table 1. Differential diagnostic signs of a tumor and a number of other diseases (according to V. D. Chaplin)

sign	Tumor	Chronic osteomyelitis	Tuberculosis	fibrous dysplasia
Destruction
periosteal reaction
Sequester
bone necrosis
bone atrophy

The final diagnosis is made on the basis of clinical, radiological and morphological data.

It should be borne in mind that with age, a transition from one state of bone tissue to another is possible. So, youthful cartilaginous exostosis can turn into a chondroma; cartilaginous dysplasia in adulthood - in chondrosarcoma; fibrous osteodysplasia - in osteogenic sarcoma. Therefore, it is necessary, upon detection of the tumor process, with appropriate indications, to perform a radical operation - resection of the tumor and the mandatory restoration of the weight-bearing capacity and function of the limb. In some cases, a combined treatment is used for a malignant process - surgical in combination with chemotherapy and radiation therapy.

benign tumors

Lipoma- a benign tumor of the subcutaneous adipose tissue, surrounded by a thin connective tissue capsule. Usually, lipomas develop upon reaching puberty, more often in women, they are solitary, less often multiple, located superficially under the skin of the neck, back, and axillary region.

On palpation, a painless formation of a soft-elastic consistency, delimited, often lobulated, is determined. Lipomas associated with nerves (neurolipomas) are painful. Lipomas containing inclusions of fibrous connective tissue (fibrolipomas) are multiple, of various sizes, and are also painful on palpation. There are intermuscular lipomas, which are more often localized in the axillary region, on the thigh, forearm. They have a variety of shapes, grow deep into the bone, up to the bone. On palpation, their elasticity, the absence of sharp boundaries and soreness are felt.

Lipomas in the synovial membranes of the joints are quite rare, but in the mucous bags and tendon sheaths they are relatively common.

There are two forms of lipomas - simple and branched. Clinical symptoms include pain, swelling in the area of ​​location, clicking in the joint during movement. Often there is an effusion in the joint. Their presence in the tendons reduces the strength of the latter and contributes to rupture. Lipomas are located more often in the tendon sheaths of the extensor fingers of the hands, feet and ankle joints.

Macroscopically, a simple lipoma is a solitary rounded formation; branched lipoma has a roughly villous, nodular appearance due to diffuse growth of adipose tissue in the synovial membrane.

Lipoma of the bone itself is extremely rare. It often develops as a peripheral tumor - periosteally. There are no characteristic clinical and radiological signs. In the vertebrae, it occurs in the form of small growths of adipose tissue, sometimes peripheral lipomas located subperiosteally are detected.

Surgical treatment in case of limited function of the joints or in violation of cosmetics.

Hemangioma- a benign tumor growing from blood vessels, often of congenital etiology. It grows in childhood, at the end of the growth of the child, its growth stops. Has a tendency to grow into tissue. There are the following types of hemangiomas: simple, cavernous and branched. A simple hemangioma is an expansion of the skin in the form of a birthmark of red-blue color. When pressed, it decreases until it subsides and disappears, after the cessation of pressure it appears again. The cavernous hemangioma has a nodular structure with developed cavities filled with blood, the size of the nodes is different. When pressing on the tumor, the latter turns pale or disappears. Branched hemangioma is a strongly dilated and thickened pulsating vessels. More often they are located on the hand with the transition to the forearm. When listening, there is a double (arterial-venous) pulsating noise, there are often trophic changes on the skin.

Hemangiomas in the muscles of the extremities (thighs, lower legs) are rare in the form of small dense vascular tumors of a rounded shape (the so-called angiofibromas). They are painful on palpation, have clear boundaries and do not subside.

Hemangiomas of the synovial membranes, tendon bags are also rare, localized in the synovial membrane outside the joint and in the fascia. They are clinically manifested by pain, a test-like swelling is determined by palpation, then increasing, then subsiding when raising and lowering the limb. When hemangiomas are located inside the joints, blockades of the latter often occur.

X-ray hematomas are detected only with the formation of phleboliths or ossification of their stroma.

Surgical treatment is carried out strictly according to indications: with a simple form - more often with blockade of the joint, with a branched form, the operation is much more difficult.

Fibroma- a benign tumor of connective tissue origin, which is based on fascia, aponeuroses and tendons of muscles.

It is rare, grows slowly over a limited area. On palpation, it appears as a smooth elastic mobile formation. Rarely causes compression of blood vessels and dysfunction of the limb.

A tumor of the connective tissue sheaths of nerves is called a neurofibroma. It is located on the skin, which is usually brown, sometimes cyanotic. It is located (for example, with neurofibromatosis) projectively along the intercostal nerves. It has a different shape: round, oblong, can hang on a leg or look like skin folds (folded elephantiasis), located on the nerves of the limbs.

Motor disorders in neurofibroma are not observed, however, there is a disorder of pain sensitivity in the form of anesthesia, hyperesthesia, paresthesia. Palpation and pressure on the neurofibroma are painless, but may cause paresthesia along the nerve.

Benign soft tissue tumors also include fibromatosis, in particular palmar fibromatosis (Dupuytren's contracture), plantar fibromatosis (Lederhose's disease). The first is expressed by the appearance of several nodules and strands in the palmar aponeurosis of the hand, which grow slowly.

It occurs mainly in the elderly, slowly progresses and leads to flexion contracture of the IV and V fingers. The course is long, benign, the process is limited only by the aponeurosis. After surgical removal, relapses are possible.

Lederhose's disease is a fibromatosis lesion of the plantar aponeurosis of the foot, often involving the subcutaneous tissue and skin. It occurs at any age, more often after 30 years.

Treatment is mostly non-surgical. After surgical removal of the altered plantar aponeurosis, relapses are possible.

Ganglion refers to tumor-like cystic diseases of the tendons or joint capsule.

The tumor-like formation has a spherical shape, often the size of a hazelnut, mobile, slightly fluctuating. The most typical location is on the dorsum of the wrist joint (between i.e. extensor indications And t. extensor carpi radialis brevis), less often located at the level of the wrist and the main phalanges. The patient sometimes has neuralgic pain in the hand or throughout the arm, fatigue and aching muscles of the forearm. The skin over the ganglion can be folded, it is mobile, the consistency of the tumor is tight elastic.

Treatment: rest, FTL, limitation of physical activity. In a chronic course, surgical treatment is indicated - removal.

Osteoblastoclastoma(giant cell tumor of the bone) is distinguished by a peculiar clinical course, a polymorphic x-ray picture and a special type of blood circulation, giving a specific histological picture. There are benign and malignant variants. Osteoblastoclastoma was first described in 1818 as a malignant form, and in 1853 by J. Paget as a benign giant cell form.

In accordance with the II edition of the International Classification of Diseases for Oncology (ICD-O), four forms of the disease are distinguished:

1) giant cell tumor of the bone;

2) malignant giant cell tumor of the bone;

3) giant cell tumor of soft tissues;

4) malignant giant cell tumor of soft tissues.

Clinical forms of the disease. Juvenile, or solitary, bone cyst is a form of osteoblastoclast. Depending on the nature of growth and clinical and radiological data, three forms of the tumor are distinguished:

1) lytic, with rapid growth and destruction of a lytic character;

2) active-cystic, with an active increase in the cystic focus;

3) passive cystic - in fact, this is the outcome of the tumor without its obvious growth.

Osteoblastoclastoma is observed in people under 30 years of age, it affects the metaphysis of long tubular bones - the humerus, femur, tibia, etc. Diagnosis of the disease is difficult at an early stage. The onset of the lytic form of osteoblastoclastoma is characterized by rapid bone growth and pain. Later, the local temperature rises, the tumor is palpated, and the saphenous veins expand.

As a result of the thinning of the cortical layer of the bone tumor, pain on palpation joins pain at rest, then pain contracture occurs in the nearest joint.

In the cystic form, the tumor flows asymptomatically, it is detected by chance, after an injury. A pathological fracture in this form is one of the first symptoms of the disease.

Patients with an active cystic form of the disease (Fig. 2) experience pain, gait disturbance due to the reaction of the joint closest to the tumor. Palpation is determined by the fusiform swelling of the bone.

Rice. 2.

X-ray picture. A feature of osteoblastoclastoma is its localization in the metaphyses of long tubular bones in children; in adults with lytic forms, it passes to the epiphysis. Type of tumor - predominantly oval enlightenment with clear boundaries within the bone; with an active cystic form, the boundaries are not clear everywhere, but with a lytic form, they are clear from all sides. Initially, the tumor is located eccentrically, and then centrally. The cortical layer swells up to the periosteum. An important radiological sign of osteoblastoclastoma is the absence of general osteoporosis. An exception is the lytic form of the tumor during prolonged immobilization.

At the moment of rupture of lytic osteoblastoclastoma beyond the periosteum, a bone “peak” is visible on the radiograph, imitating osteogenic sarcoma (Fig. 3).

Rice. 3. Lytic form of osteoblastoclastoma of the femur: a - radiographs in frontal and lateral projections; b - macropreparation of the removed tumor

These tumors behave differently in relation to the epiphyseal cartilage. In the lytic form, the epiphyseal cartilage is damaged, which causes growth retardation, the lesion extends to the articular cartilage, but the latter is not affected. In the active cystic form, osteoblastoclastoma does not penetrate into the epiphysis, but "stops" near it, disrupting nutrition and, as a result, the function of the growth zone, which causes a significant shortening of the limb.

Clinical and radiographic observations of fractures in osteoblastoclastomas indicate good bone fusion, however, with the active cystic form, tumor growth is enhanced, and with the passive cystic form, it is inhibited. Bone deformities that existed before the fracture persist and are difficult to eliminate.

Laboratory research. In lytic forms of the tumor, an increase in ESR, leukocytosis, phosphorus-calcium metabolism changes in the presence of a fracture due to its consolidation. In some cases, the activity of alkaline phosphatase increases.

Morphologically macroscopically, foci of the lytic form of osteoblastoclastoma are visible, which are brown blood clots that fill the tumor; in the active cystic form, the cortical layer is not broken, the bone is as if stretched circularly and contains a significant number of bony septa, inside it contains a jelly-like mass resembling blood. In the passive cystic form, the focus consists of serous fluid enclosed in a dense bone box or fibrous membrane.

Treatment surgical. The tactics of tumor resection in osteoblastoclastoma depends on the form of the disease. So, in the lytic form, it is necessary to remove the tumor while preserving part of the periosteum for osteogenesis. In the cystic form, subperiosteal resection is performed with preservation of the cortical layer along one edge. The tactics of the surgeon in the presence of a pathological fracture due to cystic forms of osteoblastoclastoma should be expectant, but the operation is performed no earlier than a month after the formation of a good callus. It should be especially noted the need to observe ablastics during the operation.

The prognosis for benign osteoblastoclastomas is favorable, with a lytic form, an unfavorable outcome is possible.

Chondroma- a benign tumor of cartilaginous tissue, its frequency is 4% of all primary bone tumors and dysplasia in children. According to the nature of growth, there are: 1) ecchondromas (Fig. 3, a, b), growing exophytically; 2) enchondromas growing inside the bone (Fig. 3c).

Rice. 3. Chondromas: a - chondroma of the upper third of the tibia; b - ecchondroma of the pelvis; c - enchondroma of the main phalanx of the first toe

Along with primary chondromas, secondary ones develop - based on dysplasia or a benign tumor. Chondromas - true tumors, differ from osteocartilaginous exostoses in that the latter have autonomous growth, regardless of the growth of the skeleton.

clinical picture. Chondroma is characterized by a solitary focus in one bone, while multiple chondromas are secondary neoplasms of a dysplastic nature (Fig. 3c).

Most often, the chondroma is localized in the metatarsal, metacarpal, bones of the phalanges of the fingers and toes, then in the ribs and sternum, i.e., in the bones with the largest amount of cartilaginous tissue. Pain in ecchondroma is usually caused by swelling of the tumor of the bone tissue and periosteum. Enchondroma is asymptomatic for a long time. Deformities as a result of the growth of chondroma develop mainly on the fingers and toes.

Radiologically, ecchondromas are characterized by clear boundaries in the form of a cortical "shell", clearly visible at the base of the bone. Echondroma cartilage is oval and spherical accumulations with bone inclusions.

Enchondromas are located centrally in the metaphysis and diaphysis. On the radiograph, they look like a cyst - an oval or round rarefied space with calcareous inclusions in the center and a small area of ​​sclerosis around.

Morphological picture. Chondroma in macroscopic examination is a dense tumor with a bumpy surface of pearly color.

Treatment surgical - partial marginal resection of the bone; only in doubtful cases, a segmental resection is performed. Tumor recurrences are extremely rare.

Malignant tumors

An exceptionally malignant tumor, its frequency is 18% of all tumors and 62% of malignant bone tumors in children.

The term "osteogenic sarcoma" was proposed in 1920 by I. Ewing. This primary neoplasm originates from the bone itself and consists of undifferentiated mesenchymal cells.

According to the histological picture (by the predominance of one or another tissue), osteoblastic, chondroblastic and fibroblastic sarcomas are distinguished. Osteogenic sarcomas are localized mainly in long tubular bones (Fig. 4), especially those forming the knee joint (75% of cases).

Rice. 4.

Osteogenic sarcomas typically involve only one bone, even with metastasis. Metastases can be in the lungs, liver, lymph nodes.

The clinical picture at the onset of the disease is uncertain. In the first place is the pain syndrome. These are intense independent pains, even at rest. The growth of the tumor is rapid, with swelling of the soft tissues and skin. The cyanosis of the skin due to venous stasis is determined, the subcutaneous veins expand, the skin over the tumor becomes thinner.

By the 3-4th month from the onset of the disease, pain contracture occurs in the nearest joint, due to which the limb becomes unsupported.

On palpation, the tumor has a dense texture, in some places there are areas of softening as a result of tissue breakdown. The crunch of the tumor with pressure on it is a late symptom of the disease. Regional lymph nodes are not enlarged. The general condition of a patient with osteogenic sarcoma does not change, and by the 3rd-4th month, when the tumor becomes large, the body temperature rises to 38...39 °C.

Laboratory research. Changes in the blood are revealed in the form of leukocytosis, elevated ESR, anemia in the advanced stage.

Increased activity of alkaline phosphatase in the blood and urine indicates a malignant course of the process.

X-ray picture the initial stage of sarcoma is characterized by focal osteoporosis, blurring and indistinct contours of the tumor, which usually do not pass to the epiphysis; the destruction of the bone structure is determined in the form of a defect (Fig. 5, a-d). When the tumor reaches the periosteum and exfoliates it, the pain increases dramatically. With the destruction of the detached periosteum, a typical “visor” is visible on the radiograph. In the first months, the "visor" and periostitis are small, then the tumor spreads along the medullary canal to the center of the diaphysis, and the exfoliated periosteum is defined as a "swollen" periostitis. Areas of diffuse osteoporosis of the bone can be combined with sclerotic foci, the so-called osteoid bundles. A characteristic radiological sign appears - a symptom of needle periostitis.

Rice. 5. Osteogenic sarcoma: a - osteogenic sarcoma of the lower third of the femur; b - appearance of the removed tumor; c - osteogenic sarcoma of the fibula; d - osteogenic sarcoma of the femur

According to M. V. Volkov, there are three stages in the course of osteogenic sarcoma.

I stage characterized by pain without external manifestations of the tumor. On x-ray, it is defined as an indistinct focus of osteoporosis with sclerotic bone inclusions within the normal boundaries of the bone.

II stage - swelling of soft tissues in the area of ​​the tumor, some expansion of the saphenous vein network, the first radiographic signs of sarcoma in the form of destruction of the periosteum exfoliated by the tumor (symptom of the "visor") appear.

III stage- visible and palpable tumor. The skin above it is thinned, the venous pattern is expanded. On the radiograph - a large "visor" and spiculate spotted deposition of bone substance in the soft tissues. The pain is unbearable. Limb function is impaired (statics and dynamics).

The examination should include radiography and magnetic resonance or computed tomography of the affected segment, radiography and computed tomography of the chest, scintigraphy of the skeleton and liver, ultrasound of the abdominal cavity and retroperitoneal space, trepanobiopsy of the tumor with cyto- and histological verification of the diagnosis.

Treatment Osteogenic sarcoma remains one of the most difficult problems in bone oncology. Currently, the method of choice is combined treatment, including a combination of cyclic polychemotherapy and surgical support (in case of lesions of long tubular bones). Most of the used schemes of neoadjuvant (preoperative) and adjuvant (postoperative) drug therapy contain various combinations of methotrexate, phosphamide, cisplatin, doxorubicin. Operative organ-preserving treatment consists in ablastic removal of the tumor within healthy tissues, followed by replacement of the resulting defect (endoprosthetics, bone grafting, arthrodesis). If it is impossible to perform an organ-preserving operation, an amputation or disarticulation of the limb is performed, followed by its prosthetics. The survival rate of patients after combined treatment is 60-70%, and the frequency of local tumor recurrence after organ-preserving operations is 5-8%.

Bone hemangioma. Bone hemangioma is a tumor of non-osteogenic origin. Primary bone hemangioma originates from the vascular elements of the red bone marrow.

Pathogenesis. The blood sinuses in the bone communicate with the bone capillaries, move apart the bone elements and thereby cause osteoporosis, atrophy of the bone beams, and the elements of the bone tissue themselves become calcified. A frequent localization of hemangioma is the spine, then - the bones of the skull, the humerus (Fig. 6). It is observed at any age.

Rice. 6.

Clinical picture hemangiomas of a long tubular bone, indeterminate. The first sign of a tumor is pain, constant in intensity. Swelling occurs quite late, when the hemangioma extends beyond the bone. The diagnosis is difficult to make even radiographically; most informative X-ray. Radiographically, with spinal hemangioma, a fine-mesh pattern of the affected vertebra and a radiant structure of protruding bone bars are revealed.

An early sign of vertebral hemangioma is osteoporosis, local, without destruction. The second sign is the absence of changes in the intervertebral discs.

With hemangioma of a long tubular bone, there are no characteristic radiological signs. The primary hemangioma growing from the vessels of the bone has a delineated appearance, while the cortical layer of the bone can be usurated, the bone itself is thinned. In secondary hemangioma, the borders of the tumor are fringed.

Treatment with hemangioma of the spine - X-ray therapy. With tubular bone hemangioma - marginal or complete resection of the bone with plastic replacement of the defect.

Myeloma. Myeloma is a malignant bone tumor of non-osteogenic origin that develops from proliferating bone marrow plasma cells. Myeloma was described in 1873 by O. A. Rustitsky. There are four forms of the disease:

1) multifocal;

2) diffuse osteoporotic without localized tumor nodes - generalized myelomatosis of the red bone marrow;

3) osteosclerotic;

4) solitary.

The disease is more often observed at the age of 50-60 years and is extremely rare in children. Mostly flat bones are affected - ribs, skull, pelvis.

clinical picture. Manifestations of the disease begin with a general decline in strength, disability, aching pain in the bones such as rheumatic, weight loss. Quite often, pathological fractures occur, especially of the ribs, and radicular disorders are possible. Patients may have low blood pressure.

Laboratory data: in the urine in 70% of cases, Bence-Jones protein is detected, while the calcium content in the urine increases. In the blood - hyperproteinemia, often anemia.

X-ray in the initial stage - disseminated osteoporosis, then multiple foci of osteolysis are determined with the absence of periosteal and endosteal reactions (Fig. 7).

Rice. 7.

In the future, the process spreads to other bones, pathological fractures, compression of the vertebral bodies, cachexia occur. Myeloma metastasizes to parenchymal organs: the spleen, liver, and rarely to the lungs.

Treatment. Patients with single and multiple myeloma need radiotherapy; shown chemotherapy, the introduction of corticosteroids. The effect of the treatment is short-lived.

The prognosis for life is unfavorable.

Traumatology and orthopedics. N. V. Kornilov