Hondrosarkoma – one of the most widespread malignant tumors of a skeleton. Comes from cartilaginous tissue. Arises in flat bones of a humeral and pelvic belt more often, however, it can be found also in tubular bones. Can develop on not changed bones or to be formed as a result of regeneration of some benign tumors. It is shown by the progressing pains and a swelling in the field of defeat. Local temperature increase, expansion of network of hypodermic veins over a zone of a tumor and restriction of movements in a nearby joint is in certain cases noted. Possibly several options of a current – from rather favorable, with the slow growth and late metastasis to adverse, with rapid growth and early emergence of metastasises. Treatment is surgical. The forecast depends on option of a current and a possibility of carrying out radical operation.
Hondrosarkoma – a malignant new growth of a skeleton, the second for prevalence. According to various data makes from 7 to 16% of total of malignant tumors of bones. More often bones of a basin, a bone of a humeral belt, an edge, humeral and femurs suffer. Hondrosarkoma is shown by gradually amplifying pains and the increasing swelling in the field of defeat. Treatment surgical – radical operation at which removal of a new growth together with surrounding fabrics is made. Approximately in 60% of cases the disease comes to light at patients of middle and advanced age (40-60 years). However people of all age can have this disease. The earliest emergence of a tumor is noted at the age of 6 years, the latest – at the age of 90 years. It is found in men of a hondrosarkom by 1,5-2 times more often than at women.
Classification by a hondrosarok
Taking into account an origin all hondrosarkoma share on primary and secondary. Primary, in turn, are subdivided on central (growing in a bone) and periostalny or peripheral (the bones growing on an external surface).
Among secondary allocate with a hondrosarok the tumors which resulted from an ozlokachestvleniye at the following processes:
- Hondromiksoidny fibromas
- Bone and cartilaginous ekzostoza
- Hondromatoz of bones (disease of Olye-Maffuchi)
Primary hondrosarkoma come to light in 90% of cases, secondary – 10% of cases. Taking into account features of a structure distinguish the following types a hondrosarok:
Besides, there is a classification of degree of a zlokachestvennost of a hondrosarkoma taking into account the features of a tumor revealed during the histologic research:
- 1 degree of a zlokachestvennost. Intercellular substance mainly consists of hondroidny fabric in which hondrotsita with dense small kernels are located. Multinuclear cages are not enough, figures of a mitosis are absent.
- 2 degree of a zlokachestvennost. Intercellular substance more often miksoidny, is more than cages, than at 1 degree of a zlokachestvennost, congestions of cages on the periphery of segments are noted. Kernels are increased, single figures of a mitosis come to light. There are zones of destruction (necrosis).
- 3 degree of a zlokachestvennost. Intercellular substance miksoidny. Cages settle down in intercellular substance groups or tyazha. A large number of cages of the irregular or star-shaped shape comes to light. It is a lot of multinuclear cages and cages with the increased kernels. Mitosis figures are observed. There are extensive necrotic centers.
Than degree of a zlokachestvennost of a hondrosarkoma, subjects a high probability of early formation of metastasises and emergence of a recurrence during surgical removal of a tumor is higher.
The clinical picture depends on a look and degree of a differentiation of cells of tumor. At the high-differentiated hondrosarkoma the disease can develop within several years. As a rule, such current is observed at patients at the age of 30 years and is more senior. When studying the clinical record it becomes clear that the patient a long time was disturbed at first by unpleasant feelings, and then the weak, slowly progressing pains in the field of defeat. The pain syndrome could amplify at night, weakened under the influence of the anesthetizing medicines, but did not disappear after rest.
The tumor can reach the considerable sizes, cause visually visible deformation or be defined at a palpation. In some cases temperature increase of skin and expansion of hypodermic veins over area of a hondrosarkoma though these symptoms are expressed not so considerably, as is also noted at other malignant tumors of bones. Sometimes restriction of movements in a nearby joint comes to light.
At the low-differentiated forms of a hondrosarkoma more rapid current is observed. As a rule, to the address of the patient to doctors there pass no more than 1-3 months. The main complaint, as well as in the previous case, is the pain in the place of defeat sometimes amplifying at night and not disappearing after rest. However at the low-differentiated forms of a tumor of pain is steadier against action of analgetics.
The pain syndrome differs in constancy and quickly accrues. The swelling also increases quicker, than at rather favorable option of a current. Increase in local temperature, restriction of movements in a nearby joint and expansion of hypodermic veins meets the same frequency, as at the high-differentiated tumors. The low-differentiated hondrosarkoma forms arise at young and youthful age more often and differ in higher frequency of a recurrence.
At all types a hondrosarok of the big size located in basin bones a number of the characteristic symptoms caused by the tumor pressure upon the next bodies and fabrics can be observed. At a sdavleniye of a sciatic texture there are pains giving to a buttock and on the back surface of a hip. At a sdavleniye of a neck of a bladder difficulties of an urination are possible. At a sdavleniye of a podvzdoshny vein unilateral hypostasis of the lower extremity on the party of defeat can develop.
Features of metastasis hondrosarok
The remote metastasises arise at the low-differentiated forms a hondrosarok more often. Malignant cages get to other bodies with blood current (a hematogenic way). Usually regionarny lymph nodes, a liver, lungs and a brain are surprised. For periostalny a hondrosarok the special type of metastasis is characteristic. Around such tumors there is a jet zone – the area separating a new growth from surrounding fabrics. Peripheral hondrosarkoma sprout this zone and form the so-called jumping metastasises (satellite knots) – the centers of malignant cages which do not have a direct connection with the main tumor. Such centers settle down or in the most jet zone, or near it in the thickness of healthy fabrics.
Diagnostics of a hondrosarkoma
Diagnosis of a disease is performed by oncologists to whom patients are usually directed by traumatologists and orthopedists. Clinical symptoms at a hondrosarkoma are not specific therefore the diagnosis is exposed on the basis of additional researches. At the central hondrosarkoma in x-ray pictures the center of destruction of irregular shape with indistinct outlines which is usually located in a metadiaphysis is found. Sometimes the tumor looks speckled because of small ochazhok of calcification. The bone around the center is blown up.
At peripheral hondrosarkoma on roentgenograms the contrast formation of a hilly form with indistinct contours located on the external surface of a bone comes to light. In a transitional zone between a normal bone and the changed tumoral fabric uneven consolidation is noted. The Kortikalny layer of a bone in this zone uneven. As well as at the central hondrosarkoma, the krapchatost because of sites of calcification can come to light.
For specification of the diagnosis carry out a bone trepanobiopsiya. The intake of material is made from several sites of a tumor. In the course of the histologic research hondrosarkoma zlokachestvennost degree is defined. As a rule, the listed researches are enough for exact diagnostics. In some cases additional methods can be necessary: Bone MRT, computer tomography and osteostsintigrafiya. For identification of metastasises in easy for patients with hondrosarkomy the thorax X-ray analysis is appointed.
Treatment of a hondrosarkoma
Patients from hondrosarkomy are hospitalized in office of oncology. The majority a hondrosarok are steady against chemotherapy and radiation therapy therefore the main way of treatment at this disease is surgery. At hondrosarkoma 1 and 2 degrees of a zlokachestvennost removal of a new growth is carried out. Hondrosarkoma is excised the uniform block together with fabrics of a jet zone and some reserve of surrounding healthy fabrics that in a wound there is no tumor cell left. Depending on the size and localization of a tumor either the resection of a part of a bone, or its removal with the subsequent endoprosthesis replacement is carried out.
At hondrosarkoma 3 degrees of a zlokachestvennost can be required radical surgical intervention – amputation or an exarticulation of the affected extremity. If because of the general contraindications or inaccessibility of a tumor its expeditious removal is impossible, also radiation therapy is carried out himio-. However these methods are only palliative, directed to delay of growth of a hondrosarkoma, and do not provide treatment. The forecast depends on neoplasia zlokachestvennost degree. At 1 degree five-year survival makes 90%, at the 2nd degree – 45-60%, at the 3rd degree – about 30%.