Tumors of bones – group of the malignant and good-quality new growths arising from bone or cartilaginous tissue. More often in this group carry primary tumors, but a number of researchers calls tumors of bones and secondary processes which develop in bones at metastasis of the malignant new growths located in other bodies. For specification of the diagnosis the X-ray analysis, KT, MPT, ultrasonography, radio nuclide methods and a biopsy of fabrics is used. Treatment of benign and primary malignant tumors of bones usually quick. At metastasises conservative techniques are more often used.
Tumors of bones
Tumors of bones – malignant or good-quality regeneration of bone or cartilaginous tissue. Primary malignant new growths of bones meet seldom and make about 0,2-1% of total number of tumors. Secondary (metastatic) bone tumors are a widespread complication of other malignant new growths, for example, of lung cancer or a breast cancer. At children primary tumors of bones, at adults – secondary come to light more often.
Benign tumors of bones are found less often malignant. The majority of new growths is localized in tubular bones (in 40-70% of cases). The lower extremities are surprised twice more often than top. Proximal localization is considered predictively an adverse sign – such tumors proceed more zlokachestvenno and are followed by a frequent recurrence. The first peak of incidence falls on 10-40 years (in this period Ewing's sarcoma and osteosarcoma develops more often), the second – on age after 60 years (there are fibrosarkoma, retikulosarkoma and hondrosarkoma more often). Orthopedists, traumatologists and oncologists, malignant – only oncologists are engaged in treatment of benign tumors of bones.
Benign tumors of bones
Osteoma – one of the most favorably current benign tumors of bones. Represents a normal spongy or compact bone with reorganization elements. More often the osteoma comes to light at teenage and youthful age. Grows very slowly, can proceed for years asymptomatically. It is usually localized in skull bones (a compact osteoma), humeral and femurs (the mixed and spongy osteoma). The only dangerous localization – on an internal plate of bones of a skull as the tumor can squeeze a brain, causing increase in intra cranial pressure, an epipripadka, disorder of memory and headaches.
Represents motionless, smooth, dense painless education. On the roentgenogram of bones of a skull the compact osteoma is displayed in the form of oval or roundish dense homogeneous education with the wide basis, a clear boundary and equal contours. On roentgenograms of tubular bones the spongy and mixed osteoma come to light as the educations having homogeneous structure and accurate contours. Treatment – removal of an osteoma in combination with a resection of an adjacent plate. At an asymptomatic current perhaps dynamic observation.
Osteoid-osteoma – the bone tumor consisting of an osteoid and also an unripe bone tissue. The small sizes, well noticeable zone of a jet kosteobrazovaniye and a clear boundary are characteristic. Comes to light at young men more often and it is localized in tubular bones of the lower extremities, is more rare – in humeral bones, a basin, bones of a wrist and phalanxes of fingers. As a rule, perhaps asymptomatic current is shown by sharp pains, in some cases. On roentgenograms comes to light in the form of the oval or roundish defect with accurate contours surrounded with a zone of sklerozirovanny fabric. Treatment – a resection together with the sclerosis center. The forecast is favorable.
Osteoblastoma – a bone tumor, on a structure similar on osteoides-osteomu, but differing from it in the big sizes. Usually affects a backbone, femoral, tibial and pelvic bones. It is shown by the expressed pain syndrome. In case of a superficial arrangement the atrophy, hyperaemia and hypostasis of soft fabrics can come to light. Radiological the oval or roundish site of an osteoliz with indistinct contours surrounded with a zone of an insignificant perifokalny sclerosis is defined. Treatment – a resection together with the sklerozirovanny site located around a tumor. During full removal the forecast favorable.
Osteokhondroma (other name bone and cartilaginous ) – a tumor of a bone which is localized in a zone of a cartilage of long tubular bones. Consists of the bone basis covered with a cartilaginous cover. In 30% of cases of an osteokhondrom comes to light in a knee. Can develop in a proximal part of a humeral bone, a head of a low-tibial bone, a backbone and bones of a basin. Because of an arrangement near a joint it becomes frequent the reason of jet arthritis, dysfunction of an extremity. When carrying out a X-ray analysis accurately outlined hilly tumor with not homogeneous structure on a wide leg comes to light. Treatment – a resection, at formation of a major defect – bone plasticity. At multiple ekzostoza dynamic observation is conducted, operation is shown at rapid growth or a sdavleniye of the next anatomic educations. The forecast is favorable.
Hondroma – the benign tumor of a bone developing from cartilaginous tissue. Can be single or multiple. The hondroma in bones of foot and brush is localized, is more rare – in edges and tubular bones. Can settle down in the marrowy channel (enkhondrom) or on the external surface of bones (ekhondrom). It Ozlokachestvlyatsya in 5-8% of cases. Usually flows asymptomatically, not intensive pains are possible. In x-ray pictures the roundish or oval center of destruction decides on accurate contours. Uneven expansion of a bone is noted, at children deformation and lag of growth of a segment of an extremity is possible. Treatment is surgical: the resection (if necessary with endoprosthesis replacement or bone plasticity), at damage of bones of foot and brush sometimes is required amputation of fingers. The forecast is favorable.
Malignant tumors of bones
Osteogene sarcoma – the bone tumor arising from a bone tissue inclined to a rapid current, bystry formation of metastasises. Develops mainly at the age of 10-30 years, men suffer twice more often than women. It is usually localized in metaepifiza of bones of the lower extremities, in 50% of cases affects a hip, then tibial, low-tibial, humeral, elbow bones, bones of a humeral belt and a basin follow. At initial stages it is shown by dull not clear aches. Then the metaepifizarny end of a bone is thickened, fabrics become pastose, the visible venous network is formed, contractures are formed, pains amplify, become intolerable.
On roentgenograms of a hip, shin and other affected bones at initial stages the osteoporosis center with the greased contours comes to light. In the subsequent defect of a bone tissue is formed, spindle-shaped swelling of a periosteum is defined and needle periostit. Treatment – expeditious removal of a tumor. Applied amputation earlier and an exarticulation, carry out organ-preserving operations against the background of before more often now - and postoperative chemotherapy. Defect of a bone is replaced alloprotezy, an implant from metal or plastic. Five-year survival – about 70% at the localized tumors.
Hondrosarkoma – the malignant tumor of a bone which is formed of cartilaginous tissue. Occurs seldom, as a rule – at elderly men. It is usually localized in edges, bones of a humeral belt, bones of a basin and proximal departments of bones of the lower extremities. In 10-15% formation of a hondrosarkoma is preceded by ekhondroma, enkhondroma, , solitary osteokhondroma, Pedzhet's disease and Olye's disease.
It is shown by intensive pains, difficulty of movements in an adjacent joint and puffiness of soft fabrics. At an arrangement in vertebras lumbar and sacral radiculitis develops. The current is usually slow. On roentgenograms the destruction center is found. The Kortikalny layer is destroyed, periostalny imposings are expressed unsharply, have an appearance or a peak. For specification of the diagnosis MPT, KT, an osteostsintigrafiya opened and the getting needle biopsy can be appointed. Treatment is more often complex – himiokhirurgichesky or radio surgical.
Ewing's sarcoma – a malignant tumor of a bone, the third on prevalence. Strikes disteel departments of long tubular bones of the lower extremities more often, comes to light in bones of a humeral belt, edges, a basin and a backbone less often. It is described in 1921 by James Ewing. It is usually diagnosed for teenagers, boys suffer one and a half times more often than girls. Is extremely aggressive tumor – at a diagnosis stage the metastasises revealed by means of usual methods of a research are found in a half of patients. Frequency of micrometastasis is even higher.
At early stages it is shown by not clear pains amplifying at night and not abating at rest. In the subsequent the pain syndrome becomes intensive, interrupts a sleep, interferes with daily activity, causes restriction of movements. At late stages pathological changes are possible. Also general symptoms are characteristic: loss of appetite, kakheksiya, temperature increase, anemia. At survey expansion of hypodermic veins, pastosity of soft fabrics, a local hyperthermia and hyperaemia comes to light.
For specification of the diagnosis the X-ray analysis, KT, MPT, a positron and issue tomography, an angiography, an osteostsintigrafiya, ultrasonography, a trepanobiopsiya, a tumor biopsy, molecular and genetic and immunohistochemical researches can be appointed. In x-ray pictures the zone decides on sites of destruction and an osteosclerosis. The Kortikalny layer indistinct, is stratified and . Needle comes to light periostit also the expressed myagkotkanny component with uniform structure.
Treatment – multicomponent chemotherapy, radiation therapy, at an opportunity is performed radical removal of a tumor (including a myagkotkanny component), at the same time organ-preserving operations are often applied in recent years. At impossibility to remove a new growth not radical intervention completely is carried out. All operations are performed against the background of before - and postoperative beam and chemotherapy. Five-year survival at Ewing's sarcoma – about 50%.