Hondroma – the good-quality new growth consisting of cells of a mature cartilage (as a rule, hyaline). Can develop on any bones, however tubular bones of a brush most often are surprised. Sometimes arises on cartilages of a throat or in soft fabrics. It is inclined to slow growth, a current favorable. In certain cases perhaps ozlokachestvleny with regeneration in hondrosarky. Symptoms appear gradually. At the initial stages the clinic poor or is absent therefore small hondroma often become a casual find when carrying out a X-ray analysis in other occasion. In process of growth there is a deformation, at an arrangement in a joint artralgiya are possible, is more rare – sinovit. The diagnosis is exposed on the basis of a radiological research and data of a biopsy. Treatment quick in a planned order. The forecast is favorable.
Hondroma is the benign tumor consisting of mature cartilaginous cages. Usually grows slowly, and long time can remain asymptomatic. Symptoms usually appear at a sdavleniye of the anatomical structures located nearby. The current favorable, however, is possible regeneration in a malignant tumor (hondrosarky) therefore surgical removal is required. Treatment is performed in a planned order in the conditions of a hospital. Tumors are inclined to a retsidivirovaniye.
In practice of experts in the sphere of orthopedics and traumatology of a hondroma meet rather often. They make about 10-12% of total number of new growths of a skeleton. Patients of young age (from 10 to 30 years) suffer mainly, the peak of incidence falls on 11-16 years. The reasons of development are unknown. Usually hondroma happen solitary (single). In the presence of displastichesky processes formation of multiple secondary tumors is possible. The normal cartilage (rostkovy, articulate), sites dihundred-pyrobathing (located in the atypical place) a cartilage or the centers of the embryonic neogrowing stiff cartilage can be a source of a hondroma.
Classification and features of localization hondry
Depending on a hondroma arrangement in relation to a bone allocate two types of tumors:
- Enkhondroma. It is formed in a bone. In the course of growth of an enkhondrom deforms a bone, as if holding apart it from within.
- Ekhondroma. It is formed on the external surface of a bone, grows towards soft fabrics.
Most often the hondroma arises on bones of phalanxes of fingers, pyastny bones of a brush and metatarsal bones of foot. From long tubular bones the femur most often is surprised, is more rare – a humeral bone and bones of a shin. Can also develop on flat bones, in soft tissues, cartilages of a throat and okolonosovy bosoms. Constitutes special danger at education in the field of the skull basis as at an intrakranialny arrangement squeezes brain structures.
At localization in nasal bosoms causes difficulty of nasal breath, at education in the field of epifiz of tubular bones can become the reason of a sinovit. Pathological changes are in some cases possible. Hondroma of proximal departments of humeral and femoral bones, and also hondroma of a breast, a shovel and a basin rather often are exposed to malignant regeneration. At the same time the ozlokachestvleniye hondry short tubular bones (foot, a brush) meets extremely seldom and it is considered a casuistic case.
The clinical current of a hondroma substantially depends on its localization. As a rule, at initial stages the disease proceeds asymptomatically. Extremely slow growth characteristic of this new growth leads to what from the moment of formation of a hondroma before emergence of the first symptoms of a disease can pass several years or even decades. However, also exceptions (are possible at an arrangement in a trachea, okolonosovy bosoms, the skull basis etc.) as they at such localization of a hondroma early begin to squeeze nearby anatomic educations.
At localization in small tubular bones (a brush, foot) during a palpation the small painless thickening in certain cases comes to light. Pains can arise when the new growth reaches the considerable sizes and begins to squeeze the nervous trunks located on the side surfaces of fingers. At formation of a hondroma in metafizo-diafizarny and metafizo-epifizarny areas of long tubular bones symptoms at initial stages are also absent. In process of growth of a tumor there are passing artralgiya (joint pains without inflammation signs). If the hondroma reaches enough large sizes, development of a sinovit is possible.
At localization of a hondroma in a thorax in 90% edges are surprised. In overwhelming number of cases of a hondrom it is formed in the place of transition of a bone part of an edge in cartilaginous and most often it is found in the area II-IV of an edge. At initial stages a current asymptomatic. In process of growth of a tumor there is a cosmetic defect in the beginning, and already after a while (sometimes – several years) the pain syndrome joins. In spite of the fact that the hondroma is a benign tumor, she shows a tendency to germination of an internal leaf of a periosteum and pleura. When involving in process of a pleura the patient has a thorax pain amplifying at breath.
Increasing in a size, the hondroma can sprout a considerable part of diameter of a bone. At the same time the strong bone tissue is replaced softer and gentle cartilaginous therefore tumors of the big sizes, regardless of their localization, can become the reason of pathological changes. Characteristic symptoms of such fractures are sharp pain, a krepitation and pathological mobility in the field of damage in the absence of a trauma or after an insignificant trauma.
Hondroma, the skulls growing from the basis and located in his cavity early begin to squeeze a brain. The tumor increases slowly therefore symptoms of a sdavleniye arise gradually. Dizzinesses, headaches, an incoordination of movements (a vestibular ataxy), paralyzes and paresis of extremities are possible. Growth of a hondroma in okolonosovy bosoms becomes the reason of the complicated breath through a nose.
Diagnostics and differential diagnostics hondry
Diagnostics is performed by oncologists and orthopedists. Because of poor and nonspecific symptomatology the main method of diagnostics hondry are additional tool researches. Endokhondroma in skeleton bones (except the skull basis) it is possible to find during the ordinary radiological research. As a rule, it is necessary to apply other techniques as the cartilaginous tumor not a rentgenokontrastna and is not visible against the background of soft fabrics to diagnosis of an ekzokhondroma.
The limited homogeneous enlightenment which often occupies all diameter of a bone is characteristic of an endokhondroma in short tubular bones (a brush, foot). On roentgenograms of long tubular bones of a hondroma look as oblakovidny enlightenments of irregular shape, sometimes – with calcification shadows. The radiological picture of a hondroma in some cases can remind a single-chamber bone cyst, the localized center of a fibrous dysplasia and a gigantokletochny cystous tumor. It is necessary to exclude hondroma ozlokachestvleniye signs also. For specification of the diagnosis carry out a biopsy with the subsequent histologic research of material.
The typical hondroma from gialinozny cartilaginous tissue represents lacunas in which center the single cages divided by normal, miksomatozny or edematous substance lie. At change of intercellular substance of a cage often have the star-shaped or spindle-shaped form. In intercellular substance the kaltsifikation centers usually are found.
Kernels of cells of benign tumor small, slightly rounded. One cage usually contains one kernel. At malignant regeneration of a kernel become larger, "chubby", round or gain irregular shape. The quantity of two-nuclear cages increases. At initial stages of an ozlokachestvleniye in a hondroma the centers of not changed cartilaginous cages therefore at suspicion on malignant regeneration of a tumor it is recommended to take in several sites remain. The magnetic and resonant tomography and a computer tomography with a tumor biopsy is applied to detection ekzokhondry.
At identification hondry the bases of a skull and okolonazalny sine a X-ray analysis also a maloinformativna therefore in such cases KT or MPT is used. Before tool diagnostics the neurologist or the neurosurgeon conducts neurologic examination for defeat localization specification. During KT of a skull and MRT of a brain exact determination of location of a hondroma, its form, the sizes and the relation to the next bodies and fabrics is carried out. In conclusion for specification of the diagnosis the biopsy is carried out (if it is possible at this location of a hondroma).
Treatment of a hondroma quick, is performed in a planned order in the conditions of specialized office (usually oncological). Tactics and volume of surgical intervention are defined with localization of a tumor and its influence on the next bodies and fabrics. Hondroma, the feet located in short tubular bones and a wrist, are removed within healthy fabrics. If necessary plasticity of bone defect gomo-or allotransplantaty is carried out. Hondroma in long tubular bones, and also a breast, a shovel and a basin it is necessary to delete considerably, following the principles of expeditious treatment of patients with malignant new growths (hondrosarkoma) as in this case the risk of an ozlokachestvleniye of a tumor is rather high.
Tactics of treatment of a hondroma in the field of the basis of a skull is chosen taking into account its localization, the sizes, the relation to the next fabrics, existence of associated diseases, the general condition of the patient and risk of development of complications. The standard is surgical treatment. Perhaps traditional surgical removal of a tumor of bones of a skull, low-invasive surgery (with use of the endoscope entered through the nasal courses) or radio surgery.
At treatment hondry the skull bases radiation therapy can be also used. Usually it is applied at a stage of preparation for surgery to reduction of the size of a new growth or in the postoperative period to elimination of cells of tumor which could remain after operation. At the same time, in some cases radiation therapy becomes the main method of treatment hondry the skull bases. It occurs in the presence of contraindications and to carrying out surgical intervention, for example, in the presence of serious somatic diseases or a serious general condition of the patient.