pediatric osteosarcoma
Introduction
Introduction to Pediatric Osteosarcoma Osteosarcoma (osteosarcoma) is a malignant bone tumor that occurs in adolescents or children under the age of 20, also known as osteosarcoma, which is more common and is the most common in children with bone malignant tumors, about 5% of pediatric tumors. basic knowledge The proportion of sickness: 0.01% - 0.03% Susceptible people: children Mode of infection: non-infectious Complications: Heart disease Diabetes
Cause
Pediatric osteosarcoma etiology
(1) Causes of the disease
The disease is the most common type of bone malignant tumor. The weight-bearing bone of the lower limb affects the cells by external factors such as virus, which may be related to the formation of osteosarcoma. The osteosarcoma develops from the interstitial cell line, and the rapid growth of the tumor is due to The tumor forms the tumor bone-like tissue and bone tissue directly or indirectly through the cartilage stage.
A typical osteosarcoma originates from the bone. Another completely different type is osteosarcoma juxtaposed with the cortical bone, which originates from the epithelium and nearby connective tissue. The latter is less common, but the prognosis is slightly better.
(two) pathogenesis
The tumor originates from the bone marrow cavity at the end of the long tubular backbone. It can then penetrate the cortical bone and lift the epithelium. The periosteum is perforated. Soft tissue masses can also be found in the muscle. In general, the ossification of the central part of the tumor is better. The circumference is heavy, the ossification part is yellow sand granular, and the area with more cells is more tough and white. The longitudinal scraping surface of the tumor is rich in blood vessels, easy to bleed, and the boundary between the metaphyseal end of the bone and the tumor is unclear. The plate is often inviolable, and the damage to the tarsal plate is also lighter than that of the cortical bone. The articular surface cartilage can also prevent the tumor from invading the joint. Occasionally, two primary tumors appear at different heights of the same bone, so-called jump type. Lesions should be noted when selecting the amputation plane.
The degree of difficulty in pathological diagnosis varies greatly. If the specimen contains a large amount of sarcomatoid matrix, the tumor bone and bone-like tissue are not difficult to distinguish clearly, but some tumors do not see the tumor bone-like tissue, only collagen strips, including Tumor cells, the areas where tumor growth is not very strong are only the interstitial of cells, and some tumors are mainly neonatal cartilage and atypical prismatic cells.
The pathology of osteosarcoma can be divided into 4 types: the first type is mainly bone-like tissue; the second type is composed of bone-like tissue and bone tissue; the third type has no bone-like tissue and bone tissue, only collagen fibers; See, its main components are chondrocytes and tumor cells with different morphological and poorly differentiated tumors. Pathological findings and clinical connections are valuable. The pathological findings alone cannot predict the rate of tumor growth, the pathway of metastasis and the survival of children. At the time, nuclear division is a measure of the speed of tumor growth, but it has little effect on estimating prognosis.
Prevention
Pediatric osteosarcoma prevention
Refer to the general tumor prevention methods, understand the risk factors of tumors, and formulate corresponding prevention and treatment strategies to reduce the risk of tumors. There are two basic clues to prevent tumors. Even if tumors have begun to form in the body, they can help the body to improve resistance. These strategies are as follows:
1. Avoid harmful substances (promoting factors) that can help us avoid or minimize exposure to harmful substances.
Some related factors of tumorigenesis are prevented before the onset, and many cancers can be prevented before they are formed. A report in the United States in 1988 compared the international malignant tumors in detail and proposed many external factors of known malignant tumors. In principle, it can be prevented, that is, about 80% of malignant tumors can be prevented by simple lifestyle changes, and traced back. In 1969, Dr. Higginson's research concluded that 90% of malignant tumors are caused by environmental factors," "Environmental factors", "lifestyle" refers to the air we breathe, the water we drink, the food we choose to make, the habits of activities, and social relationships.
2. Improve the body's immunity against tumors can help improve and strengthen the body's immune system and cancer.
The focus of our current cancer prevention efforts should first focus on and improve those factors that are closely related to our lives, such as quitting smoking, eating properly, exercising regularly, and losing weight. Anyone who follows these simple and reasonable lifestyles can Reduce the chance of cancer.
The most important thing to improve the function of the immune system is: diet, exercise and control troubles. Healthy lifestyle choices can help us stay away from cancer. Maintaining good emotional state and proper physical exercise can keep the body's immune system at its best. Tumors and prevention of other diseases are equally beneficial. Other studies have shown that appropriate activities not only enhance the body's immune system, but also reduce the incidence of colon cancer by increasing the peristalsis of the human intestinal system. Here we mainly understand the diet in preventing tumorigenesis. Some questions.
Human epidemiology and animal studies have shown that vitamin A plays an important role in reducing the risk of cancer. Vitamin A supports normal mucosa and vision. It directly or indirectly participates in most of the body's tissue functions. Vitamin A is present in animal tissues. In the liver, whole eggs and whole milk, the plant is in the form of -carotene and carotenoids, which can be converted into vitamin A in the human body. Excessive intake of vitamin A can cause adverse reactions in the body and -carrot This is not the case with carotenoids, and the low vitamin A content in the blood increases the risk of malignant tumors. Studies have shown that those with low levels of vitamin A intake in the blood increase the likelihood of lung cancer, while those with low blood levels in smokers Levels of vitamin A ingestors have the potential to double lung cancer. Vitamin A and its mixture can help remove free radicals in the body (free radicals can cause damage to genetic material), and secondly stimulate the immune system and help differentiate cells in the body. Ordered tissue (while the tumor is characterized by disorder), some theories suggest that vitamin A can help early carcinogens Invasion mutated cells become reversed the occurrence of the normal growth of cells.
In addition, some studies suggest that supplementation with -carotene alone does not reduce the risk of cancer, but rather increases the incidence of lung cancer. However, when -carotene binds to vitamin C, E and other antitoxin substances, its protective effect. It is shown, because it can increase free radicals in the body when it is consumed by itself. In addition, there are interactions between different vitamins. Both human and mouse studies have shown that the use of -carotene can reduce 40% of vitamins in the body. At E-level, a safer strategy is to eat different foods to maintain a balanced vitamin to protect against cancer, as some protective factors have not been discovered so far.
Vitamin C, E is another anti-tumor substance that prevents the harm of carcinogens such as nitrosamines in food. Vitamin C protects sperm from genetic damage and reduces the risk of leukemia, kidney cancer and brain tumors in their offspring. Vitamin E can reduce the risk of skin cancer. Vitamin E has the same anti-tumor effect as vitamin C. It is a scavenger that protects against toxins and scavenges free radicals. The combination of vitamins A, C and E protects the body against toxins. Better than applying it alone.
At present, research on phytochemistry has attracted widespread attention. Phytochemistry is a chemical found in plants, including vitamins and other substances found in plants. Thousands of plant chemicals have been found, many of which have anticancer properties. The protective mechanism of these chemicals not only reduces the activity of carcinogens but also enhances the body's immunity against carcinogens. Most plants provide antioxidant activity that exceeds the protective effects of vitamins A, C, and E, such as a cup of cabbage. Contains 50mg of vitamin C and 13U of vitamin E, but its antioxidant activity is equivalent to the antioxidant activity of 800mg of vitamin C and 1100u of vitamin E. It can be inferred that the antioxidant effect in fruits and vegetables is far better than what we know. The effect of vitamins is strong, and no doubt natural plant products will help prevent cancer in the future.
Complication
Pediatric osteosarcoma complications Complications, heart disease, diabetes
This disease is the most common type of bone malignant tumor. The lower limb weight-bearing bone causes external mutations such as viruses to cause cell mutation, which may be related to osteosarcoma formation. Due to the doubling of osteosarcoma. Patients can generally live for 15 months to 5 years. Possible complications include heart disease, lung disease and diabetes. 60%-70% of patients with osteosarcoma can continue to survive. Potential complications include the spread of cancer cells to the lungs by surgery.
Symptom
Pediatric osteosarcoma symptoms common symptoms bone mass joint swelling muscle atrophy atrophy dead bone
Pain at the tumor site is a prominent symptom of the disease, which is caused by erosion of the tumor tissue and dissolution of the cortical bone.
Pain
Different degrees of pain in the tumor site are very common and obvious symptoms of osteosarcoma, mainly due to the destruction of the cortical bone by the swollen tumor tissue and the stimulation of the periosteal nerve endings. The pain can develop from the initial intermittent weeks to the persistence. The degree of pain can also be enhanced, and painful lower limb pain can occur.
2. Lump
After the disease develops, local swelling can occur, and the mass can be touched in the painful part of the limb, accompanied by obvious tenderness. The tumor can grow rapidly and the appearance of the mass can be found from the appearance. The skin on the surface of the mass can be increased in temperature and superficial veins are exposed. The surface of the mass and the surrounding soft tissue may have different degrees of tenderness. With the degree of ossification, the hardness of the tumor varies, and the tumor body increases, resulting in limited joint activity and disuse muscle atrophy.
3. Minhang
The pain-relieving lameness caused by limb pain is aggravated as the disease progresses, and those with a slightly longer disease time may have limited joint activity and muscle atrophy.
4. General condition
When the diagnosis is made, the general condition of the child is also poor. The systemic symptoms are fever, discomfort, weight loss, anemia and even depletion. In some cases, the tumor grows rapidly, and the lung metastasis occurs early, causing the systemic condition to deteriorate. The pathological fracture of the body part makes the symptoms more obvious.
X-ray examination: Osteosarcoma has a typical X-ray findings, which is characterized by bone destruction and new bone formation. The tumor is mostly in the center of the metaphyseal end of the long tubular bone, which is characterized by the loss of normal trabecular bone and the unclear state. The damage zone, regardless of new bone, tumor bone or dead bone, increased the density.
The tumor erodes the cortical bone and has obvious damage and new bone. The elongated blood vessels are perpendicular to the backbone after the epithelium is lifted up, and new bones are formed along the blood vessels to form a "sunlight radiation" shadow, and a triangular new bone is formed between the periosteum and the backbone. Called "Caudman sleeve sleeve triangle", this change is not unique to osteosarcoma. It can also be seen in osteomyelitis and Ewing sarcoma. In the late stage of the tumor, soft tissue shadows beyond the cortical bone can be seen on the X-ray film, and pathological fractures can be seen. .
In some cases, alkaline phosphatase is elevated, indicating an enhanced osteogenesis of the tumor bone.
Examine
Pediatric osteosarcoma examination
In cases of osteogenic osteogenic sarcoma, bone-derived alkaline phosphatase is sometimes found in the blood at an early stage, which is related to the large amount of osteogenesis of the tumor. Biopsy: The diagnosis of osteosarcoma is based on clinical and Radiological examination can be clear, but pathological diagnosis is often the necessary basis for treatment. When the diagnosis considers the possibility of the tumor, timely implementation of biopsy, as soon as possible to confirm the pathological examination, has a clear diagnosis and treatment arrangements Extremely important.
X-ray film
The typical X-ray of osteogenic sarcoma is characterized by neoplastic bone formation and bone destruction. The tumor is located at the metaphyseal end of the long tubular bone, the edge is unclear, the trabecular bone is destroyed, and the tumor tissue density is increased. After the osteoclast, the tumor further elevates the periosteum, producing a characteristic X-ray sign of the disease - the Codman sleeve sleeve triangle ("Codman-Triangle"), although this phenomenon is seen in some patients with osteomyelitis and Ewing sarcoma. It can also be seen in the middle, but it is very typical in osteosarcoma. In advanced cases, the shadow of tumor infiltrating soft tissue can be seen, and pathological fracture can also be seen in some cases.
2. CT scan and MRI examination
It is an effective means to judge the nature, extent and presence of surrounding soft tissue infiltration of bone tumors. It can also detect metastatic lesions of the lungs and other organs at an early stage. It is a routine project for clinical examination of osteosarcoma.
3. Radionuclide bone scan
The presence and identification of the presence of osteogenesis can be a common method for early detection and late identification of metastatic lesions.
Diagnosis
Diagnosis and diagnosis of pediatric osteosarcoma
diagnosis
It can be diagnosed based on clinical manifestations and laboratory and auxiliary examination results.
Differential diagnosis
Need to be differentiated from chronic suppurative osteomyelitis, Ewing's sarcoma, metastatic bone tumor.
Chronic suppurative osteomyelitis increased diffuse density in the medullary cavity. The cortex is thickened. However, there is no bone mass destruction or tumor bone formation. Soft tissue swelling is also not obvious. If you see dead bones exist. The diagnosis of osteomyelitis is clearer.
Ewing's sarcoma is characterized by a plaque in the medullary cavity. Rat bite-like bone destruction. The range is longer. More common onion skin-like periosteal reaction.
Metastatic tumors are less likely to invade the bones near the knee joint. Occurs in the pelvis and spine. Most of the bone changes are osteolytic. Most of them have no periosteal reaction and soft tissue mass.
