osteosarcoma - a form of primary malignant tumor of bone.Osteosarcoma is in sixth place among all malignant pathologies and is almost 70% of all skeletal sarcomas.The tumor originates in bone-forming mesenchyme, which later can turn into bone, cartilage or fibrous tissue.
Osteosarcoma mostly suffer in the second decade of life, from the age of ten to twenty years.In addition, among the boys it is a malignant neoplasm is more common than among girls in the ratio of 1.3: 1.After thirty years of osteosarcoma acts as a secondary pathology on the background of tumor processes, such as Paget's disease, diskhondroplaziya, giant cell tumor, fibrosarcoma.
When diagnosing the disease is an important condition for the formation of malignant bone.Osteosarcoma can affect any part of the skeleton, but mostly it occurs in long bones of the limbs.In 80-90% of the tumor site have limbs which are at the bottom and 10% Osteosarcoma affects humerus.Malignant neoplasm of the etiology of these bones
Moments etiologic osteosarcoma bone formation is not fully known, although there are several factors that contribute to their occurrence.
Osteosarcoma can develop in the bones, which had previously received exposure to ionizing radiation in the treatment of malignant or benign tumors.Radioindutsirovannyh bone disease usually manifests itself in three years from the end of irradiation, as osteosarcoma.
a role in certain cases, the causes of cancer is given ankiliruyuschim carcinogenic agents and anthracyclines.Furthermore, as osteosarcoma develops in those bones which are relatively quick growing and subjected to physical stress, it does not exclude a role such as the intended load factor in the formation of osteosarcoma.
Sometimes patients with a history of osteosarcoma clarified existing injury.However, they are not considered a direct cause of today in the development of this disease.Although there are assumptions about their provoking abnormalities, cells that already exist in the body.
also believed that many diseases, such as fibrous dystrophy, chondroma, deforming osteoz, osteochondral exostosis can be transformed into osteosarcoma.
This disease is an extremely malignant tumors, which tend to spread via hematogenous metastasis.The most common metastases penetrate into the lungs, but does not exclude other parts of the defeat, lymph nodes, and physical bodies.Metastases generally can occur from two months to three years, and on average - it is up to nine months from the start of the therapeutic treatment.In the main number of patients with osteosarcoma observed multiple metastases in the lungs and only 11% with a solitary lesion.
for osteosarcoma is characterized by the classic triad of symptoms, which include: impaired function of the limb, swelling and pain.That explains why the erroneous diagnosis of the disease, as these symptoms are many pathologies of the locomotor system.
Clinically distinguish two forms of osteosarcoma.The first form - is a fast growing tumor, which is characterized by acute onset, acute pain, a quick death.The second form - is slowly growing tumor, which is characterized by less bright clinical manifestations.The fast-growing osteosarcoma can produce lung metastases, which are found even in the initial evaluation of patients.This type of osteosarcoma, usually diagnosed in children.
Also for osteosarcoma is characterized by an aggressive course of the disease.In addition, the disease may start spontaneously, or 50% in a history may be transferred earlier indication of injury.
cardinal symptom of the disease are pain symptoms.In the early stages of osteosarcoma may be moderate, occur periodically, especially after exercise.These pains are the result of joining in the pathological process of the periosteum, but gradually they become permanent.Particularly intense expression of pain related to bone loss in the lower leg, which is due to its anatomical structure.Very often the pain appear at night, although somatic condition of the patients remains positive.Only some patients subfebrile temperature reaches indicators.
characteristic feature of the disease is the appearance of the tumor in the form of swelling.The rapid growth of osteosarcoma is considered the primary diagnostic indicators.As the tumor continues to progress in growth, soft tissue above it becomes intense, the skin becomes a kind of shine and appear enlarged subcutaneous veins.As a result, patients with limited motor function of limbs in the form of flexion contracture, and lameness.Thus, developing muscle atrophy.
Common symptoms osteosarcoma occurs in the later stages of the disease and is characterized by symptoms such as malaise, weakness, weight loss, sleep disturbance.
observed in 10% of pathological fractures of nature that characterized osteolytic sarcoma.
Very often this disease in the early stages of progression is diagnosed as an inflammatory disease, and this in turn leads to an erroneous treatment assignment.
In laboratory studies, the analysis of the blood is determined increase in erythrocyte sedimentation rate, serum alkaline phosphatase, and leukocytosis almost half of the patients.For the later stages of osteosarcoma characteristic feature of the disease is anemia developing.
X-ray examination gives an extremely varied picture of lesions, localization and tumor growth and structural change elements of bones.Important features are osteosarcoma visor or triangular spur, long thread-like spicules and amorphous calcifications oblakovidnye.
As a result, the destructive process and osteoplastic, osteosarcoma is divided into osteolytic type, osteoblastic and mixed.
Osteosarcoma frontal bone
is a malignant disease that has osteogenic origin and affects the flat bones of the skull.Osteosarcoma of the frontal bone is developing rapidly, so it soon becomes noticeable visually.It forms a kind of bulge in the skull and bone tumor processes.Such pathological tumor is extremely rare that distinguishes it from other lesions of the skeleton.
Osteosarcoma can affect a set and base of the skull.In the vault often changes the tumors were: temporal bone, parietal and occipital.But sometimes Osteosarcoma affects the frontal bone.This disease can be found in patients of all ages, but more frequent observed pathology of the newly-formed at a young age.Typically, the tumor is localized to the frontal bone, but it can then grow outward and into the cranial cavity.For frontal bone osteosarcoma cell round shape and are characterized by fusiform cell shape.
clinically malignant disease is manifested painless flat and solid elevation of the skin is visible veins.Osteosarcoma frontal bone begins to grow rapidly increase and sometimes reach a considerable size compared to the size of the skull.In the future, the tumor spreads outward and gives ulceration.Upon germination osteosarcoma inside the skull, there are characteristic symptoms as pain head of pressure within the skull and other phenomena in the hearth, which are dependent on the tumor.Sometimes osteosarcoma frontal bone palpation pulses, but the lymph nodes in the neck are affected very rarely.
Generally the prognosis of this disease is extremely poor, even after surgery.The best results possible to reach the combined treatment with radiation exposure.When unresectable osteosarcoma frontal bone radiotherapy administered as an independent kind of treatment.
There are three forms of the disease: osteoblastic, osteolytic and mixed.
first clinical manifestation of osteosarcoma are pain in the jaw intact tooth, unpleasant itching in the edge region of the gums, loosening of teeth of individual groups.
Painful symptoms of the upper jaw otseosarkome appear much later than in the disease of the lower jaw.They are late signs of symptoms of cancer.In some cases, until the pain is marked characteristic of paresthesia at the site of branching or chin infraorbital nerve.In addition, sensory loss occurs in the form of volatile and transient one paresthesia.
In place of localization of osteosarcoma of the jaw swelling formed with different density, size, and tenderness to palpation moderate.With significant anti-inflammatory therapies detect tumors of soft tissues, increased congestion of veins under the skin and mucosa with istonchёnnoy skin above the tumor process.
When localization osteosarcoma chewing muscles near the temporomandibular joint occurs early reduction of both jaws.Very rarely, in the development of osteosarcoma of the jaw can be found pathological fracture of the character and then the later stages of the disease.
overall clinical condition of patients at the beginning of malignant disease remains unchanged.But when osteosarcoma reach larger and breaks, the rise in temperature is observed to increase 39-40˚S and accelerated ESR.Osteosarcoma jaw starts to metastasize, and generally affects the lungs, and then enters the other organs, a part of the skeleton and promotes example ostesarkomy rib.
Osteosarcoma jaw osteolytic type manifested as a significant bone destruction and degradation of the characteristic X-ray diffraction shows a certain portion of bone, which has a structural form.This defect is irregular, jagged, eroded contours.And the outer edges are completely absent, so the changes are merged with the nearby soft tissues.
for osteoblastic osteosarcoma of the jaw bone formation characterized by the prevalence of disease.In the beginning of the development of tumors in the chest radiograph resembles a small, fuzzy contoured, compacted fireplace bone, which is characterized by marked changes in the periosteum with the needle periostitis.With the progression of the tumor stunned by the jaw bone continues to grow, sclerotic, and then becomes almost opaque to X-rays.
diagnosis of osteosarcoma of the jaw is carried out on the basis of symptoms, X-ray examination and biopsy tests.Be sure to have resorted to the differentiation of malignant disease sarcomas such as fibrosarcoma, chondrosarcoma, who can be expected periosteal reactions.
For the treatment of osteosarcoma of the jaw beam radiation used in the preoperative period.Then perform radical surgery to remove tumors, followed by chemotherapy using Andriamitsinom.
treatment of osteosarcoma
earlier for the primary treatment of limb osteosarcoma, which had no distant metastasis was used to remove the tumor in the form of amputation or irradiation of a large area of the main lesion.Also, the first method of chemotherapy for osteosarcoma gave disappointing results, so malignant pathology belonged to chemoresistance.
Only since the 80's, were effective schemes of chemotherapy, which have been used successfully Adriamycin, large doses of methotrexate, supported by leucovorin, and platinum drugs ifosfamide.It was found that these chemotherapeutic drugs may eliminate hidden metastasis, as well as microscopically small tumor dissemination and improve survival.
proposed chemotherapy in the preoperative period, performs the main function, which is characterized by the suppression of micrometastases and Redistribute primary osteosarcoma.The reaction of a malignant tumor in the combination chemotherapy before surgery is evaluated clinical, laboratory, radiologic and pathologic characteristics.
Efficacy osteosarcoma manifest clinical signs such as a decrease in pain symptoms and swelling.A laboratory diagnostics evidence of the positive results of treatment of osteosarcoma in the form of reduced levels of alkaline phosphatase.After the MRI, bone scan determined reduced soft tissue components of tumor or their absolute disappearance, restore intermuscular intervals, pathological fractures, and healing kaltsifitsiruemaya periosteum.
Angiography presented in the form of subjective evaluation method for severe reactions to combination chemotherapy for osteosarcoma.To the gold standard assessment and identification of response to the therapy include histological parameters that have been discovered in a remote tumor after chemotherapy before surgery.Expressed in osteosarcoma drug pathomorphosis recognized as the main factor in predicting disease.
Until recently, no effective chemotherapy drugs, radiation therapy was considered necessary in the treatment of the primary disease in order to avoid, for example, amputation of limbs affected with osteosarcoma metastases initially determined.Although five or six months in these patients after radiation exposure, distant metastases were detected.So many cancer clinics refuse this method of treatment, as osteosarcoma refers to vysokoradiorezistentnoy pathology.
Typically, radiation irradiation is administered as a symptomatic treatment for pain, as well as in inoperable osteosarcomas, which are located in the pelvis or spine.Furthermore, the question of holding beam irradiation is achieved if the neoplasm pathological localized unresectable in part, despite the fact that osteosarcoma sensitive to radiotherapy exposure.With the defeat of the solitary nature of the tumor, radiotherapy controls the size of tumors.
most important condition for successful resection of primary osteosarcoma is the careful selection of patients and proper planning of surgical intervention.Mainly from the localization of the tumor process will depend surgical technique.Today, many leading centers that treat osteosarcoma, proved that the preservation of organs from children during operations are considered to be adequate and appropriate method of therapy in some patients who have gone through all the proper conditions for selection.The most important decision
cancer surgeon is to determine the specific boundaries of removal of the tumor and the desire to conduct cost-effective operation that will maximize the patient's rehabilitation.Studies show that patients who have undergone amputation, physiologically adapt the same as patients who underwent conserving surgery.
to determine the level of removal of osteosarcoma central role given to two factors.The first component relates extent of soft tissue that are associated with blood vessels and nerves.The second factor is length of the affected bone and intramedullary extent of osteosarcoma.This spread intramedullary nature manifests the vastness that makes it different from soft-tissue component.Classically amputation spend about seven - eight centimeters above the boundaries of the soft tissue and intramedullary component of the tumor.