Bone osteoma: causes, surgical removal

A benign tumor process that develops in bone tissue is called bone osteoma. This tumor grows slowly, in the course of its growth nearby tissues move apart, sprouting does not occur in them. Osteoma is not capable of producing metastases, can grow to large sizes and often has a peculiar capsule.

As a rule, bone osteoma can be treated well, the outcome of which can be classified as favorable.

[1], [2], [3]

Epidemiology

Bone osteoma is found most often in childhood and adolescence, as well as in young people 20-25 years. Mostly men are ill, but lesions of facial bones are more often diagnosed in women.

Osteomas account for about 10% of all tumoral bone tumors.

Most often the disease affects the flat cranial bones, subordinate sinuses, tibial, femoral, humerus, rarely - vertebrae and ribs.

[4], [5], [6], [7], [8], [9]

Causes of the bone osteoma

The exact causes of the appearance and growth of osteoma are not completely defined. Presumably, the pathological process may be associated with mechanical damage to the bone site, or with hereditary predisposition. His contribution to the development of the disease also makes such pathologies as gout, rheumatism, syphilis. But in similar situations in the bone tissue exostoses are formed - bone outgrowths, which are not tumors as such.

A significant role in the development of osteoma is played by inflammatory processes and trauma. For example, with the defeat of the bones of the nasal sinuses, the inflammatory ENT diseases, as well as the sinus puncture itself, can be provoking factors in the treatment of chronic sinusitis.

Specialists do not exclude also a certain role of peculiarities of intrauterine development, violation of calcium metabolism, negative ecological background.

[10], [11], [12], [13], [14], [15], [16]

Risk factors

The onset of the pathological process associated with osteoma of the bone can be provoked by such factors:

• processes of metaplasia with the replacement of healthy cells with pathological structures;
• adverse heredity;
• pathologies of embryonic development;
• inflammatory processes, infectious diseases;
• chronic systemic pathologies;
• gout;
• violation of calcium metabolism;
• post-inflammatory complications.

[17], [18], [19], [20]

Pathogenesis

More recently, osteoma has been considered one of the signs of chronic sclerosing osteomyelitis and did not consider the tumor as a separate pathology. The first bone formation, which was considered an independent disease, was osteoid bone osteoma. This tumor develops in tubular structures and looks like a small-sized site with a rarefied bone tissue, with a diameter of up to 20 mm. At more detailed visualization it is possible to pay attention to the obvious sclerotic reaction along the edge of the tumor focus. Such osteomas can be cortical or spongy. When carrying out histology, many osteoblasts and osteoclasts are found.

Examination of pathology with the help of a microscope allows you to notice the clear contours separating the sparse tissue, permeated with blood vessels. In the central part of the osteome there are osteoid trabeculae and strands, as if entangled with each other. In the altered tissue, there are large osteoblasts with a large nucleus.

In the structure of osteoma there are no hemocytoblasts and lipid tissue. In some zones, osteoclasts can be identified, with a single or group location. If there is a breach of the integrity of the bone at the site of the osteoma, then inside it you can see the cartilaginous tissue, which is also present in the formations developing below the articular cartilage. This is the structure of the central part of the tumor. On the perimeter there is a fibrous connective tissue, which has the form of bands, widths reaching two millimeters. Further, a thin layer of the dilated cortical plate may be noticeable - but this does not always happen.

[21], [22], [23], [24], [25]

Symptoms of the bone osteoma

Osteoma most often develops at a slow pace, without certain signs and manifestations. The predominant location of the osteoma is the outer surface of the bone. A tumor can occur on any part of the skeletal system (except for the bone of the sternum). The most common localization is the bony surfaces of the paranasal sinuses, the bones of the skull, shoulder and thigh.

Osteoma often has the appearance of a firm and smooth elevation on the outer part of the bone, which is characterized by immobility and painlessness. With the development of education on the inner surface of the skull, the first signs manifest themselves particularly clearly, in the form of headaches, increased intracranial pressure, memory disorders, seizures. If the osteoma appears in the "Turkish saddle" zone, then it can manifest as hormonal failures.

Osteoma of the paranasal sinuses is often accompanied by such signs:

• protrusion of the eye (by the type of exophthalmos );
• deterioration of vision;
• double vision in the eyes ;
• omission of the eyelid ;
• differences in the size of the pupils.

If the osteoma is localized in the vertebrae, the patient will complain of pain. Diagnosis determines the compression of the spinal cord, deformation of the spine.

[26], [27]

Forms

The pathogenetic division of osteomas is as follows:

• solid osteomas, which are particularly strong and dense;
• spongy osteomas with a corresponding spongy structure;
• Brain-like osteomas, consisting of relatively large cavities, with a medullary component inside.

Solid formations include osteophytes - these are specific bone layers located along the circumference (hyperostosis), on one convex part of the bone (exostosis) or inside the bone tissue (endostosis).

Solid formations are often found in the area of the skull, on the pelvic bones.

According to the etiologic factor, these types are distinguished by osteome:

• Hyperplastic, which arise directly from bone tissue (osteoid osteoma, simple osteoma of bone);
• heteroplastic, which arise from connective tissue (osteophytes).

Osteomas are always single. Multiple formations are typical of Gardner's syndrome, a disease in which adenomatous polyps combine with osteoma of the cranial bones and cutaneous neoplasms. The syndrome belongs to the group of family polyposis with an autosomal dominant type of inheritance.

• Osteoid osteoma of bone  occurs in the zone of diaphysis of long tubular bones. Most often, the tibia suffers, less often - flat bones, vertebrae. If the pathology is localized near the growth zone, bone growth can be stimulated, which in childhood can cause asymmetry in the support apparatus. In addition, the symptomatology associated with the compression of the peripheral nerves is often manifested.
• Spongy bone osteoma has a porous structure resembling a sponge. Neoplasm is permeated with a network of vessels and contains a lot of lipid and connective tissue. The primary localization of spongy osteoma is tubular bone. A distinctive feature of this pathology is the ability to separate from the bone element with a strong growth.
• The osteoma of the skull bone in many cases develops in the region of the lower jaw - on the posterior surface, or on the jaw branch, below the molars. Such a tumor is round or oval, with a smooth surface and distinct cortical contours. The sizes of education can be different: in neglected cases, the osteoma displaces nearby tissues, causing asymmetry and violation of muscle function.
• The osteoma of the frontal bone  is most common. With a significant increase in the tumor, the person swells (without pain), breathing may become difficult. Patients are often concerned about headaches and visual impairments. The tumor usually has sizes from 2 to 30 mm, sometimes - more. Affected bone tissue can become inflamed, which becomes a direct indication for surgical intervention.
• Osteoma of the occipital bone is considered a rare pathology. The disease is not accompanied by painful symptoms and is detected mainly by accident - using an X-ray. In some patients, the tumor manifests itself by increasing sensitivity to external irritants, dizziness and general discomfort associated with the creation of pressure on the inner ear. Occipital osteoma does not break the structure of bone tissue, developing from the cranial arch.
• Osteoma of the parietal bone can be represented by osteoid osteoma or osteoblastoma. Osteoblastoma is large in size and prone to further enlargement. The dark bone is more often affected in children, not accompanied by a certain symptomatology. However, tumors with a similar location must be removed, in view of the danger of their localization.
• Osteoma of the temporal bone in most cases is concerned only because of the existing aesthetic defect, since other signs of pathology usually do not appear. With large sizes of education, patients can complain of constant headaches.
• The osteoma of the latticed bone refers to benign diseases of the cranial bones. It is located at the center between the facial bones and comes into contact with many of them. The trellis bone itself participates in the formation of the nasal cavity and orbits, therefore, when the size of the formation is large, difficulties can arise not only with nasal breathing, but also with visual function.
• The osteoma of the femur is most often an osteoid tumor consisting of osteoblasts, the vasculature and directly the bone tissue. Such a tumor has a central zone of mineralization, or vascular-fibrous boundaries, and can appear on any part of the hip bone.
• The osteoma of the tibia may have a hard, spongy or combined structure, but most often this tumor is dense, like an ivory. In its structure there are no bone marrow cells. Among all tumors affecting long tubular bones, the most common tumor is the femur. The second place in the frequency of incidence is osteoma of the tibia, and the third - the osteoma of the fibula. The listed pathologies are often manifested by lameness, painful sensations in a state of rest (for example, during a night rest), muscular atrophy. Some patients experience repeated fractures of the extremities.
• Osteoma of the ilium is diagnosed relatively rarely, since at small sizes it does not show itself as a clinical symptomatology. Pelvic bone tumors in women can significantly complicate the course of labor.
• Osteoma of the calcaneus can develop at almost any age. This is one of the varieties of osteoma, which, in view of the specific localization, almost immediately reveal themselves as a marked symptomatology. Patients complain of severe pain while walking and standing, which often significantly worsens the quality of life. Education on the heel includes cartilaginous cells and grows on the bone surface.
• Osteoma of the metatarsal bone in most patients occurs without symptoms, and only when the size of the pathological focus is significant, pain can be disturbed after or during exercise. Also there is a deformation of the metatarsal bone, which can to some extent create discomfort to the patient.
• The osteoma of the pubic bone refers to the pelvic formations and is relatively rare. Pathology is not characterized by a clear symptomatology and is found by accident - with radiography or computed tomography.
• The osteomal of the ischium is a center of rounded configuration with even, clearly defined sclerotized borders. A dense zone of rounded shape is found along the lower margin, as well as thin banded periosteal stratifications. A similar bone defect refers to rare benign pathologies.
• Osteoma of the humerus is common, but it has some difficulties with identification. So, on the roentgenogram the formation has a similarity to a healthy ordinary bone, or it appears as a small thickening. The accuracy of the diagnosis depends on the qualifications of the medical specialist.
• The osteoma of the head of the humerus with a relatively large size can be accompanied by pain in the upper part of the shoulder - for example, with passive movements. On examination, the broken configuration of the shoulder joint can be detected. To clarify the diagnosis, x-rays are prescribed in two projections: in the anteroposterior direction, and also in the axial direction, in which the rays pass from the top downwards through the axillary fossa.
• The osteoma of the radius can be located on any part of the bone tissue, but most often this pathology is represented by osteoid osteoma. In most cases, the disease has no clear symptoms and does not bother the patient with pain or other uncomfortable sensations.

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Complications and consequences

The most unfavorable complication of the osteoma of the inner bone surface of the skull is a visual impairment in the form of loss of the ability to separate perception of two points that are at a distance from each other. If the osteoma continues to increase in size, then there may be such problems:

• strong and frequent migraine attacks;
• convulsive attacks, sometimes with loss of consciousness;
• uncontrolled muscle contractions;
• a disturbance of nervous activity, a change in the body's response to external or internal factors;
• violation of bioelectrical activity and, as a result, violation of respiration and cardiac activity.

The listed negative consequences can arise only at a tumoral defeat of bones of a head. When the vertebral column is affected, paresis, impaired innervation, impaired motor capacity of the limbs can be observed.

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Diagnostics of the bone osteoma

Osteoma is determined when examining an x-ray photograph. Since the symptomatology of the disease has much in common with osteogenic sarcoma and the chronic course of osteomyelitis, an X-ray diffraction is mandatory, since it allows one to accurately differentiate the disease.

Additional instrumental diagnostics can be represented by computed tomography. Histologically, a discrepancy is found between the typical composition of bone marrow substance. Channels are located chaotically, their relatively small. Spongy osteoma is devoid of channels, visualized chaotically located bone beams. The layers of fibrous tissue are enlarged against the background of an increase in brain spaces.

Less often, diagnostics is supplemented with ultrasound scanning, thermography, angiography, radioisotope investigation. The listed diagnostic procedures can help with the detection of compact or spongy bone osteoma, which occur with almost the same frequency.

A compact tumor grows inside the bone formation and does not appear as a protrusion. The formation has a hemispherical or spherical configuration, and an X-ray photograph shows an unstructured obscuration. Such a pathology in most patients is detected by chance.

With spongy osteoma, the focus is large: a convex swelling of the layer of bone tissue on the outside of the bone is observed. The cortical layer remains intact.

Analyzes are in addition to a comprehensive diagnostic examination:

• a blood test to assess the level of alkaline enzyme phosphatase;
• a general blood test to assess the general condition of the body.

[35], [36]

Differential diagnosis

Differential diagnosis is carried out:

• with sclerosing processes in the bone (pay attention to the absence of a contour between the affected and normal tissue);
• with exostases (almost do not cause pain and function disorders);
• with osteoid osteoma (painful sensations of a noisy character are typical, amplifying at night).

Treatment of the bone osteoma

If, during diagnostic activities, bone osteoma is detected without indications for surgical treatment, then conservative therapy may be prescribed. With a large size of education, the only treatment is considered to be surgical intervention, which is also indicated when a number of located organs are malfunctioning, or with visible changes in bone configuration.

Medications are prescribed primarily for symptomatic effects - for example, to get rid of pain, to improve overall well-being and strengthen immunity.

	Dosing and Administration	Side effects	Caveats
Orthophenia	Take 100-150 mg per day.	Hypersensitivity, drowsiness, ringing in the ears, abdominal pain, irritability.	Do not take the drug for a long time. Optimum - 3-4 days in a row.
Ibuprofen	Take the calculation of 20-30 mg per kg of weight per day.	Nausea, dizziness, hypersensitivity reactions.	Do not appoint children under six years.
Calcemin	Take one tablet 1-2 times a day, but not more than 4 tablets per day.	Rarely - allergies, nausea.	Do not administer to children under 5 years of age.
Calcium D 3  Nycomed	Take one tablet twice a day.	Rarely - dyspepsia, allergic reaction.	Do not appoint patients with phenylketonuria, sarcoidosis, and children under 5 years.
Chondroitin Complex	Take one capsule twice a day, half an hour before meals.	Rarely - allergies, dizziness, nausea.	The recommended duration of treatment is at least six months.

Surgery

The method of surgical intervention is chosen by the doctor, taking into account the symptoms of osteoma, complaints of the patient, the degree of tumor growth and its localization. As a rule, bone osteoma removal is performed after the results of histological analysis are obtained.

Location pathological education - this is the main point that affects the choice of type of operation. For example, with the localization of osteoma on the skull bones, the intervention is most often entrusted to neurosurgeons, and if the tumor hits the bones of the limb, then the surgeon-traumatologist.

Technical features of the operation are discussed by doctors in advance and depend on the presence of symptoms, the stage of development of pathology and the presence of complications from neighboring organs. In recent years, laser is widely used to remove osteoma.

The use of the laser is particularly in demand in the defeat of flat cranial bones. The operation is performed under general anesthesia. The doctor makes a cut of skin. If it is necessary - trepanizes the skull and performs a thorough resection of the tumor tissue. Removed and damaged blood vessels.

However, laser removal is not yet the most modern surgical method. A more effective intervention is the excision of the tumor focus by radiofrequency irradiation with computer tomography guidance. This procedure avoids possible repetition of the disease, bleeding and infection complications. Treatment can be carried out even with local anesthesia. To detect the tumor focus, use thin computer tomography sections, after which a radio-frequency transmitting device is introduced into the affected tissues. The formation is heated to 90 ° C - at this temperature, the tumor is destroyed, and adjacent normal tissues do not suffer. The operation is done on an outpatient basis. The rehabilitation period is short: in a week the patient can go to work.

Prevention

Specialists do not have specific recommendations for the prevention of osteoma of the bone - first of all, because the exact causes of the development of the disease are unknown. Among the general recommendations are the following:

• avoid injuries and damage to the musculoskeletal system;
• for any inflammatory diseases and injuries, consult a doctor;
• if the doctor has prescribed treatment, follow all the appointments exactly and bring the course to the end;
• Eat fully, watch for the constant intake of important mineral and vitamin substances into the body.

Timely appeal for medical help and thorough diagnosis will avoid the development of unpleasant consequences of osteoma.

[37], [38], [39], [40]

Forecast

Prognostic data on the disease are favorable. The tumor develops gradually, without intensive aggressive growth. To date, there have been no recorded cases of its transformation into malignant formation: bone osteoma does not give metastases and is not prone to germination in a number of located tissues

Do not engage in independent treatment of osteoma: the only possible solution to this problem is surgical. In no case should you apply to a heating tumor, put compresses, or act in any other physical ways - it can only increase the growth of the tumor. It should be noted that in the vast majority of cases, bone osteoma lends itself to successful treatment and does not pose a threat to human life.

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