Chondroma, enchondroma, osteochondroma: treatment, causes
Chondroma is a benign neoplasm, which is based on a Mature cartilage tissue. The share of hondros accounts for about 10% of all tumors of the skeleton, and in the practice of traumatologists and orthopedists it quite often.
Usually the tumor is benign, is characterized by relatively slow growth and the absence of pain, but in some localizations chondroma the risk of malignancy is quite large. In addition, chondroma tend to recur, especially in its non-radical removal.
Chondroma affects the bones of the extremities (foot, hand, thigh), but it is possible its detection and in the soft tissues (larynx, trachea). The growth of the tumor begins to deform the affected area and may cause fracture. The disease is diagnosed in young individuals up to 30 years, with the same frequency in humans, male and female, and the peak of it is at 11-16 years, i.e. the period of intensive growth of bones.
Chondroma – the tumor is benign and the danger it presents, and timely removal allows once and for all get rid of the disease. However, some localization can pose a serious health threat. So, from the cartilage bones of the skull, the bony sinuses are formed chondroma that if you increase the size capable to compress surrounding structures and nerve tissue, destroy bone.
The tumor is built of Mature chondrocytes which, in contrast to normal cartilage, messy and surrounded by small amount of fibrous tissue. Sometimes tumors appear in areas of osoznanie, and in the case of the formation of Islands of bone tissue it is called osteochondromas, which usually affects the tubular bones of the hands and feet. In osteochondroma can be formed and the bone marrow. Source of chondroma becomes cartilage proper bone, cartilage, atypical localization, and embryonic remnants.
Most patients revealed a solitary tumor of the humerus or femur, ribs, sternum, hands and feet, and multiple growth is more characteristic for hereditary disorders and malformations. The tumor grows slowly, sometimes reaching large sizes and obrazujas of several merging together nodes.
A special group of patients are children, including newborns. Children chondroma can be purchased on the background of injuries, improper treatment of injuries of the bones, or as a result of violations of fetal development, when the mother there are errors in diet, or she suffered an acute infection.
Causes and types of hondros
The exact causes that give rise to tumors of cartilage are unknown, but a role to play:
- Inflammatory process;
- Hereditary predisposition;
- Disturbance of ossification in the area of bone growth.
The peak incidence, as mentioned above, accounts for childhood and adolescence. This is probably due to intensive growth of bones in length when there is increased proliferation of cartilage cells, through which the bone can grow. At some point, may fail, cells begin to divide more rapidly, placed randomly, and the cartilage loses its structure.
Injuries, fractures, cartilage is Central to the process of regeneration, so intense multiplication of its cells can lead to tumor growth.
Depending on the location of the tumor relative to the surface of bone are usually distinguished:
Chondroma grows outwards, in the direction of the soft tissues. The tumor is usually of small size, striking the ribs, vertebrae, pelvis. Enchondroma is formed inside the bones, with increase in the size of «bursting» inside of the bone, causing its deformation.
Chondroma tend to affect the small bones of hands and feet, rarely diagnosed neoplasm of long bones of the limbs (femur, tibia, humerus), shoulder blades or ribs.
The possible growth of the tumor beyond the bone – the cartilage of the larynx, trachea, and ear. If in the process of embryonic development, there has been a violation of the displacement of the rudiments of cartilage, neoplasia can be detected even in parenchymal organs (lung, salivary gland).
Chondroma growing near the articular surfaces of the femur or humerus, tumors of the scapula, sternum and pelvic bones have a special propensity for malignant transformation (eg. in a chondrosarcoma). Bone lesions of the skull and paranasal sinuses is fraught with compression of the nervous tissue, a violation of nasal breathing and growth chondroma near the joint can cause the inflammation (synovitis).
Manifestations of hondros
Symptoms of chondroma of bones not a great variety. The tumor grows very slowly for a long period of time without letting themselves known to any manifestations. Until the occurrence of at least some of the symptoms may take years and even decades, but it concerns formations, located on the limbs. In the case of hondros of the skull base, nasal cavity, trachea or larynx clinical signs appear much earlier.
With increasing size of the tumor, possible compression of the soft tissues, nerves, bone destruction, leading to the appearance of the first symptoms tumors – deformity, pain, fracture.
If chondroma located on the finger of the hand or the foot, to probe or even see it can the patient. The growth of the tumor, the finger may increase in size, deformed and pinched nerves lead to pain.
When chondroma large bones of the limbs the first symptoms can be a strain, the presence of palpable education and pain, which appear with a significant size of the tumor. Involvement of the synovial lining of the joint is expressed in synovitis (inflammation), which is manifested by pain during movement, swelling, local rise of skin temperature.
Chondroma ribs and chest
Lose chest most commonly affects the ribs and the tumor is formed at the border of bone and cartilage of the bones. The first sign of becoming a cosmetic defect, especially in subjects of subtle body. When you increase the size, chondroma rib shows a tendency to ingrowth into the periosteum on the inner side of the ribs and even the pleura that is accompanied by pretty intense pain.
Chondroma clavicle represents only 15% of tumors of the bony framework of the thorax, but it is a very dangerous possibility of the growth of internal organs and compression of the major blood vessels, nerves, lung or heart. Symptoms can be shortness of breath, palpitations, signs of impaired blood flow in the head.
Chondroma bone and cartilage framework of the nose may cause a violation of nasal breathing, pain, deformation, and the defeat of the larynx – voice problems and asthma. Manifestations of hondros growing in the bones of the skull depend on the nerve or of the brain, which undergoes compression.
Among the possible signs:
- Headaches and dizziness;
- Movement disorders up to paralysis and paresis;
- The change of coordination of movements;
- Vision disturbances with compression of the optic nerves or chiasm.
Cartilaginous tumor of the ear to the ear is what gives cosmetic inconvenience, and being in the middle or inner ear can lead to hearing loss and pain. Chondroma ear slope to relapse after removal.
In addition to small bones and joints of the hands and feet may lose bone and major joints, particularly the knee joint. Chondroma this localization often occurs in athletes who have knee experiences considerable loads and frequent injuries, provoke the reproduction of cartilage cells. Chondroma of the knee joint accompanied by pain and limitation of motion of the limb. Possible synovitis, in which the pain becomes more intense and there is swelling of the entire joint.
Chondroma internal organs are the result of violations of fetal development, when the islets of cartilaginous embryonic tissue remains, where in an adult it shouldn’t be. So, chondroma light is a kind of malformation is asymptomatic and often found incidentally. In addition to the lung, these tumors can be detected in the ovaries, salivary glands and even the brain.
If you suspect the presence of chondroma the patient must undergo some tests to confirm the diagnosis.
When enchondral possible tumors, conventional radiography, and when chondrules embodiment, it will be uninformative. In this case, a computer or magnetic-resonant tomography. The most accurate method of diagnosis is biopsy, allowing not only to establish the type of tumor, but also to exclude a possible malignancy. For tumors of the skull bones may need to consult other specialists – a neurosurgeon, neurologist, ophthalmologist, Laura.
Methods of treatment of hondros
Treatment chondroma implies:
Surgical treatment is considered the standard approach for benign tumors of cartilage. The method of its implementation is determined by the size, localization of the neoplasia and the patient’s condition. When tumors of the foot and brush make removal of the affected fragment within the limits of healthy tissues. If necessary, the operation is complemented by the plasticity of bone defect due to its own tissues or synthetic materials.
When chondroma long bones, ribs or pelvic bones are a radical intervention in accordance with the principles of removal of malignant neoplasias, as the risk of malignancy in such tumors is quite high. Amputation is performed only rarely, when the tumor is too large or there are signs of malignancy.
Deletion of chondroma may be in the form of excelasia when the doctor «will draw» the contents of the tumor cavity without touching its walls, or a resection – removal of fragment of bone with tumor.
A special approach require chondroma the base of the skull or inside it. Surgery in these patients can be traumatic and carry a great risk of dangerous complications. Depending on the characteristics of the tumors and the technical possibilities to remove it as a possible open surgery on the skull (trephination) and endoscopic treatment. When craniotomy, the doctor gets direct access to tumor tissue, however, there is the possibility of infection of the surgical wound and bleeding, so the currently preferred minimally invasive techniques, endoscopic removal.
Endoscopic removal of chondroma is carried through the nasal passage with the help of special tools. The operation is less traumatic, so the chance of complications is minimal and the patient does not require long-term rehabilitation. Method is good, but has limitations when large tumor size and location in those areas of the skull, cannot be accessed with an endoscope.
Radiation therapy is indicated for the treatment of hondros skull base as the primary method of removing education or in addition to surgery to reduce tumor volume before surgery, or destroy the remaining tumor of chondrocytes after it. If there are contraindications to surgery when a serious condition of the patient, comorbidity, radiation therapy becomes the primary method of tumor removal. Typically, the irradiation is performed up to five times a week, and the therapy takes several weeks. Complications are often associated with skin reactions to radiation burns and radiation dermatitis. Possible hair loss in the irradiated area.
A new approach in the treatment of various types of tumors is the so-called stereotactic surgery (gamma knife, CyberKnife, NOVALIS). The effect of this impact is similar to surgical procedure, so the method relates to radiosurgery. The method consists in a directed impact on the tumor focused beam of radiation, the maximum of which is at the tumor, while surrounding tissue is not affected. The accuracy of the operation is achieved by using during it computer or magnetic-resonant tomography.
Using radiologa can’t remove difficult to reach tumors of the skull bones, and the organs of the head and neck where the risk from normal operations high due to the possibility of damage to major blood vessels, nerves, or when the patient’s condition.
The benefits of radiosurgical removal of gondrom can be considered the action, painless, low rate of complications. After the procedure the patient goes home, hospitalization is not required. The disadvantage is the inability to remove large tumors, as well as the fact that the destruction of tumor tissue is not immediate, and within a few weeks or months, but the process is painless for the patient and requires no further treatment.
In the treatment of hondros bones of the limbs is often necessary in the generated defect. For this purpose successfully used synthetic materials such as calcium sulphate (osteoset). The drug creates a basis on which to form new bone tissue. For healing takes 4 to 8 weeks, during this time, the drug is completely absorbed, and in its place there is newly formed bone tissue.
Ways to prevent the formation of chondron does not exist, but the risk can be reduced by avoiding injuries, fractures and other injuries to bones and joints. With timely treatment the prognosis is favorable.