Osteoid osteoma is a benign tumor change in the skeleton. Complaints arise from the benign bone tumor rather rarely.
What is an osteoid osteoma?
Osteoid osteoma is the name for a tumor whose origin is in the osteoblasts (special bone cells). The bone tumor brings it to a diameter of up to two centimeters. It occurs particularly frequently in long bones. These include primarily the thigh bone (femur) and the shin bone (tibia). Osteoid osteoma ranks third behind osteoma and nonossifying fibroma in the frequency of benign bone lesions. The bone tumor presents predominantly in adolescence. The upper section of the femur is particularly affected. However, the tibia and spine are also not infrequently affected by the changes. Osteoid osteoma accounts for about 14 percent of all bone tumors. In most cases, it appears in male adolescents between the ages of 10 and 20. Sometimes the tumor appears before the age of 10. After the age of 30, it is very rare.
Causes
Osteoid osteoma takes its origin from the outer hard cortex of bone tissue. It has not yet been possible to find out what causes the benign bone tumor. In some cases, an osteoma is inherited. External physical and chemical influences are under discussion as triggers of the tumor. Injuries as well as nuclear radiation are also considered as conceivable triggering factors. Benign bone tumors often appear when the bones grow too rapidly. Growth hormones are also considered a possible risk factor. Medical science distinguishes bone tumors between osteoid osteomas, osteomas, and osteoblastomas, which originate in bone cells; osteochondromas, chondroblastomas, and chondromas, which originate in cartilage tissue; osteoclastomas and bone fibromas, which originate in connective tissue; and bone hemangiomas, which originate in vascular tissue.
Symptoms, complaints and signs
In many cases, an osteoid osteoma does not cause symptoms. However, some patients may experience pain, which occurs mainly at night. They usually start suddenly and appear at the knee, hip, or back. However, the complaints do not clearly indicate an osteoid osteoma. They occur independently of movement and come from deep within the body. In most cases, the pain improves after taking acetylsalicylic acid (ASA). Occasionally, the benign tumor can even be palpated, which manifests as local swelling.
Diagnosis and course of the disease
If the pain caused by the osteoid osteoma leads the young patient to a physician, the physician first deals with the medical history (anamnesis). In doing so, the physician inquires about how long, how often, and at what location the pain has been occurring. Following the questioning, a physical examination is performed. Occasionally, the doctor can feel the tumor. Imaging techniques are used to obtain further information. This includes, above all, taking X-rays. The images usually show a distension of the cortical bone. Furthermore, there is a connective tissue compression, which has a size of a few centimeters. In the center of the compression, a round, lightening focal point can be seen, which is called a nidus. A computed tomography (CT) scan can be used to determine the extent of the tumor. Another diagnostic method is the bone scintigram. In this procedure, radioactive substances are administered into the bone tissue. This allows the physician to determine the increased uptake of technetium. A bone biopsy (removal of tissue) is performed to confirm the diagnosis. The removed sample is then examined in a laboratory under a microscope for fine tissue analysis. Connective tissue that is well supplied with blood and surrounded by sclerotic bone is considered indicative of an osteoid osteoma. Blood tests are more suitable to exclude other diseases, because the osteoid osteoma does not cause any changes in the blood. An osteoid osteoma takes a positive course. Thus, there is no development of metastases (daughter tumors). Malignant degeneration is also ruled out. If the benign bone tumor is removed by surgery, it is usually cured.
Complications
Osteoid osteoma itself does not usually cause complications. It is a benign bone tumor, which has no tendency to degenerate. However, the disease makes itself felt with pain, which usually occurs at night. Since the pain often becomes chronic, it is essential to treat it. If left untreated, however, it can be the trigger for various complications such as growth disorders, arthrosis or scoliosis. The pain causes postural damage due to constant avoidance behavior. This consequential damage can lead to limited mobility and additional chronic pain. Further consequences can of course be psychological problems such as depression, when the patient feels that he or she can no longer participate in daily life. This is particularly serious for the affected individuals because the disease usually occurs during a particularly sensitive and tumultuous phase of growth between the ages of 11 and 20. In order to avoid these serious effects, an initial attempt is made to alleviate the pain symptoms by administering ASA if an osteoid osteoma is present. In some cases, however, this does not help. Surgical removal of the tumor is then indicated. Ablation of the nidus using toxic substances or radiofrequency therapy is also possible. Curettage, which used to be a common procedure, is no longer performed today because recurrences often occurred here due to incomplete ablation.
When should you go to the doctor?
Bone pain, limited mobility, and sensory disturbances in the arms or legs indicate an osteoid osteoma. Specialist help is needed if the warning signs persist for a long time or rapidly become more severe. A medical professional should also be consulted if other symptoms appear. Osteoid osteoma is a serious disease that must be diagnosed and treated immediately. Otherwise, the tumors can spread and spread to other organs outside the bones or even affect other bones. Anyone who notices increasing pain that cannot be attributed to any particular cause should talk to their doctor immediately. This is particularly necessary if cancer has already occurred in the past. In that case, the sufferer must talk to the doctor in charge. The same applies in the case of genetic predispositions or the presence of any risk factors, for example working in a nuclear power plant or contact with other cancer-causing substances. Affected individuals should speak with their primary care physician, an oncologist, or an orthopedic surgeon. Depending on the severity of the disease, the tumor must then be removed surgically or by means of radiation therapy or chemotherapy. Therapy and aftercare are always carried out under strict medical supervision.
Treatment and therapy
Treatment of osteoid osteoma is not always necessary, provided there are no symptoms and the bone is stable. In addition, the diagnosis must be confirmed. The goal of therapy is to eliminate pain and re-stabilize the bone. The therapy of an osteoid osteoma takes place surgically. Thus, the bone tumor must be completely removed in order to achieve freedom from symptoms. Otherwise, there is a risk that it will form again later. The surgical procedure depends on the location of the tumor. If it is located in an area where there is little physical stress, the surgeon operates it out of the affected bone area in a block-like fashion, removing the rim at the same time. If, on the other hand, the tumor is in an unfavorable position and there is therefore a risk of bone fracture, the bone cortex is first removed until the nidus is visible in the surgical area. The nidus is then removed with a surgical curette. However, this method has the disadvantage that it may not be possible to remove the tumor completely. This is especially true in surgical areas that are difficult to access. On the other hand, an advantage of the procedure is the stress stability of the bone tissue and the lower risk of bone fracture.
Outlook and prognosis
Although osteoid osteoma is a form of bone cancer, the prognosis is positive. For one thing, an osteoblastic tumor is very small. Sometimes it is only the size of a pinhead, sometimes it is the size of a cherry pit. Secondly, osteoid osteoma is a benign bone neoplasm. Metastasis therefore does not occur.Nevertheless, osteoid osteoma is one of the primary tumor types. It mainly affects young people below the age of thirty. As the third most common bone tumor, osteoid osteomas preferentially affect male patients. The prognosis depends on the extent and location of the bone tumor. However, it is very unlikely that osteoid osteomas will become malignant. Often, after diagnosis, patients wait to see how the tumor develops. The reason for this is that 30 percent of osteoid osteomas regress spontaneously. If this is not the case, surgical removal of the tiny tumor may have to be considered after unsuccessful pain therapy. This makes sense if the tumor causes too much pain. These occur preferably at night. They can become chronic. In order to prevent chronicity and the resulting complications, removal of the osteoid osteoma is recommended. In this way, pain-induced restraint, growth problems and other consequences of tumor formation can be prevented. The formerly performed curettage of the tumor often led to tumor recurrences. It is no longer practiced today.
Prevention
It is not possible to prevent osteoid osteoma. Thus, the responsible causes are still unknown.
Aftercare
Follow-up care is an essential part of cancer therapy. Affected individuals are invited to continuous follow-up visits to prevent the symptoms of a neoplasm. Osteoid osteoma is a benign tumor. It also requires follow-up, not only after surgery, but also if surgery is not performed. The last procedure is common in the absence of symptoms. The purpose of observation is precautionary prevention of complications. The doctor and the patient agree on the place and rhythm of the follow-up. Usually, examinations take place in a clinic. Semi-annual appointments are usually sufficient for a check-up. Immediately after a therapy, quarterly check-ups are advisable. Following a surgical intervention, a rehabilitation measure can be useful. Therapists thus accompany the patient’s way back into everyday professional and private life. A follow-up examination consists of a detailed discussion in which possible complaints are investigated. Imaging procedures such as X-rays and a CT scan allow a clear conclusion to be drawn as to whether the tumor has developed further or whether it is new. If movement restrictions have arisen due to an osteoid osteoma, physiotherapy can provide relief if necessary. Many patients receive pain medication for a time after surgery, the effect of which is gradually reduced.
What you can do yourself
Despite the good prognosis and the fact that these tumors are benign and do not cause any discomfort themselves, patients may suffer from pain. For example, if the tumor is located at a joint or presses on a nerve, movement may also be impaired. For this reason and other medical considerations, the attending physicians may then recommend that the osteoid osteoma be surgically removed. The physiotherapy and/or occupational therapy sessions prescribed after surgery should be adhered to, as they are intended to prevent adhesions from forming in the operated areas and thus further restricting movement. The exercises learned there should also be continued after therapy. In any case, the patient should be prepared for several years of medical follow-up, as the osteoid osteoma may return. Patients with an osteoid osteoma that has not been removed must fear that the bone will break more quickly in this area. Therefore, they should be careful to avoid accidents. Abrupt strains and compressions should also be avoided. Less accident-prone sports such as hiking, jogging or cycling are recommended instead of soccer or other team sports. Since the disease most commonly presents between the ages of eleven and eighteen, care must be taken to avoid deforming bones or joints during the growth phase due to the osteoid osteoma. In case of doubt, close medical check-ups are indicated.
