pediatric osteochondroma
Introduction
Introduction to pediatric osteochondroma Osteochondroma, also known as exostosis, is the most common benign bone tumor in childhood. The tumor is usually located on the side of the metaphysis of the metaphysis, which grows to the surface of the bone and can be divided into single and multiple osteochondroma. The latter has a genetic predisposition and affects the development of the epiphysis or the development of limb malformations, known as multiple hereditary osteochondromatosis, or continuation of the backbone. basic knowledge Sickness ratio: 0.1% Susceptible people: children Mode of infection: non-infectious Complications: chondroma
Cause
Pediatric osteochondroma etiology
Causes:
Osteochondroma is strictly not a tumor, but an abnormality in growth, or a hamartoma. The tumor has a cartilage cap and a bone tissue protruding from the side of the bone. This disease is also called osteophytes. The cause may be from A small cartilage island near the periosteum grows, or comes from the epiphyseal cartilage.
Where the cartilage bone can occur, but the long bones of the lower limbs account for 1/2, the lower end of the femur and the upper end of the tibia, followed by the upper end of the humerus, the lower end of the tibia and fibula and the ends of the tibia, the lesion is located at the metaphysis, with growth The development gradually moves away from the tarsal plate. The bone marrow in the epiphysis is rich in adipose tissue. The growth of the epiphysis is caused by the deep cartilage of the cartilage cap. After the diseased child matures, the epiphysis stops growing.
After adulthood, the cartilage cap gradually degenerates and disappears, and is persistent and can be secondary to chondrosarcoma.
Pathogenesis:
At present, there are two main theories. Virchow proposed the separation of the epiphyseal cells in 1891. It is believed that the chondrocytes of the tarsal plate are separated from the tarsal plate and rotated 90° and then grow along the long axis of the long bone, that is, lateral growth to form a tumor. One theory believes that the chondrocyte nest originating from the periosteum continues to proliferate, the ossified tumor, and later D. Ambrosia and Ferguson successfully transplanted the osteochondroma model through the epiphyseal chondrocyte transplantation, thereby supporting the theory of the development of the epiphyseal plate. .
Pathological anatomy shows that the tumor is cauliflower-like, composed of perichondrium, cartilage cap and bony tumor. The osseous part can be directly or with a fine pedicle and bone cortex. The diameter of the tumor is more than 1~10cm, and the shape is different. The cartilage cells in the cartilage cap are arranged in the shape of osteochondral cells, and the proliferating chondrocytes are located in the deep layer of the cartilage cap. When the tumor grows actively, the chondrocytes proliferate significantly, and when the tumor growth stops, the chondrocytes also stop proliferating. Degenerative changes occur, calcification can be seen in the chondrocyte stroma, multiple osteochondroma is a chromosomal dominant genetic disease, the age of onset is small, about 1/3 is less than 10 years old, X-ray findings and pathological changes are similar to single-shot However, its malignant rate is as high as 5% to 10%.
Prevention
Pediatric osteochondroma 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).
Secondly, it can stimulate the immune system and help the body to differentiate cells, and develop into ordered tissues (and the characteristics of the tumors are disordered). Some theories suggest that vitamin A can help cells that are early affected by carcinogen invasion to reverse and become normal growth. Cell.
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 alone.
For example, a cup of cabbage contains only 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 much better than that. The vitamins we know are more effective, and no doubt natural plant products will help prevent cancer in the future.
Complication
Pediatric osteochondroma complications Complications chondroma
Complications of osteochondromas Chondromas are more common in adolescents. The onset is slow, and there are no obvious symptoms in the early stage. The local swells gradually, especially in the (toe) part, which can be deformed and accompanied by a feeling of soreness. An enlargement of the tumor will force the nearby blood vessels, causing ischemia in the part of the blood vessel. And symptoms of local hyperplasia, pathological fractures, or no symptoms of discomfort.
Symptom
Pediatric osteochondroma symptoms common symptoms cartilage dysplasia and... limb shortening deformity bone mass
Although any osteochondroma can be grown from the bone of the cartilage bone, the long tubular bone is more common than the flat bone and short bone. The distal femur, the proximal humerus and the proximal humerus are the most common, because the tumor does not produce Pain, mostly due to accidental touch of the tumor, or X-ray examination found that the tumor, local painless, some due to compression of blood vessels, nerves and internal organs, produce the corresponding symptoms, often accidentally touched the mass or on the X-ray photos Occasionally found abnormalities, most of them have no symptoms. The medial epiphysis of the lower end of the femur or the upper end of the humerus may have a sense of tendon sliding. The mass may be directly impacted or the pedicle may have a pain after it has a fracture. When the tumor is large, the nerve may be compressed. The osteophytes of the lumbar vertebrae may have compression symptoms of the cauda equina, and the foot and ankle mass may make walking and wearing shoes difficult, and some may be complicated by bursae or bursitis.
Examine
Pediatric osteochondroma examination
Pathological changes:
1. Macroscopic morphology: The mass is 1~10cm, the surface is smooth, gray-blue cartilage-like, and the thickness of the cartilage cap is no more than 1cm.
2. Histomorphology: The surface of the lesion is thin fibrous tissue, the lower is the cartilage cap, the chondrocytes are small, the nucleus is deeply stained, the rules are arranged, and then the chondrocyte hypertrophy, calcification and spongy trabecular formation, trabecular bone There is red bone marrow and fatty bone marrow.
X-ray examination showed that the tumor was located on the cortical surface of the metaphysis of the long bone. The shape was cauliflower-like, overhanging bony bone, and its tip was opposite to the adjacent joint. The base was directly or has a fine pedicle and the cortical bone was continuous. Although the cartilage cap on the surface is not developed on the X-ray, it is often calcified and ossified. It is located in the forearm. Large tumors in the calf can compress adjacent bones, resulting in compression bone defects or deformities. Multiples often have skeletal deformities.
Diagnosis
Diagnosis and diagnosis of osteochondroma in children
According to the above performance and laboratory, the auxiliary examination features diagnosis.
Identification of benign osteochondromas and osteochondromas that develop sarcoma, mainly the diagnosis and differentiation of benign and malignant, local blood vessels and skin temperature are also the case of metastasis. Other diseases mainly include inflammation or local abscess and the identification of proliferative hyperplasia, as well as the condition of deformed healing after fracture needs to be differentiated. X-ray can confirm the lesion.
