Classification of bone tumors
According to the WHO classification ICG (series №6) primary bone tumors and
tumor-like lesions are divided into the following groups and individual species.
1.Kosteobrazuyuschie tumors: benign - osteoma, osteoid osteoma, malignant,
osteogenic sarcoma, osteosarcoma parostalnaya.
2.Hryascheobrazuyuschie tumors: benign -hondroma, osteochondroma,
hondrroblastoma, hondromiksoidnaya fibroma, malignant - chondrosarcoma,
yukstakortikalnaya chondrosarcoma, mesenchymal chondrosarcoma.
3.Gigantokletochnaya tumor (osteoclastoma)
4.Kostnomozgovye tumors (all malignant) - Ewing's sarcoma, clasmocytoma
bones, lymph bone sarcoma, myeloma.
5.Sosudistye bone tumors: benign hemangioma, Lim fangioma, intermediate or
indeterminate (aggressive with signs of malignancy) - hemangioendothelioma,
hemangiopericytoma, zloka-tative - angiosarcoma.
6. Other connective tissue bone tumors: benign, desmoplastic fibroma,
fibrosarcoma, malignant, liposarcoma, malignant mezenhimoma, undifferentiated
sarcoma.
7.Prochie bone tumors: benign, chordoma, adamantinoma of long bones,
nevrilemmoma (shvanoma, neuroma), neurofibroma.
8.Neklassifitsiruemye tumor.
9.Opuholepodobnye bone disease - a solitary bone cyst, aneurysmal bone cyst,
periarticular bone cyst, neossifitsiruyuschaya fibroma, eosinophilic granuloma,
fibrous dysplasia, "myositis ossificans", "brown tumor" hyperparathyroidism.
The WHO classification is based only on the principle of differentiation
histological tumor cells with regard to the nature of the intercellular substance.
Classification has shortcomings when applied in clinical practice the dentist.
Therefore we use in clinical practice classification of primary tumors and tumorlike formations on the bones of the face A.A.Kolesovu, which includes primary
benign and malignant bone formation, as well as a number of tumor lesions.
Tumors
benign
osteogenic group
chondroma
Osteoblastoklastoma
osteoma
Neosteogennaya group
Myxoma
fibroma
Hemangioma
Neurofibroma
Nevrilemmona
Cholesteatoma
odontogenic group
Adamantinoma
odontoma soft
tumor-like formations
malignant
chondrosarcoma
Osteoblastoklastoma
osteosarcoma
Fibr.displaziya (single
bone, a lot of bone).
deforming ostoz
Miksosarkoma
fibrosarcoma
Hemangiosarcoma
Hemangioendothelioma
Ewing's sarcoma
reticular sarcoma
Myeloma
Eosinophilic granuloma.
radicular cyst
follicular cyst
odontoma solid
Cementoma
FEATURES diagnosis of tumors
jawbone
The main difficulties in the diagnosis of bone tumors of the jaws due not only to a
variety of different kinds of diseases and malformations of the facial bones, but the
lack of specific initial symptoms. Sometimes feel that pain symptom, dominant at
some swelling caused by inflammatory diseases of the maxillofacial area and
prescribe treatment, leading to increased tumor growth (tooth extraction, antiinflammatory, restorative therapy and physiotherapy). Often the disease is detected
only in developing stage. The child, unlike the adult is not always able to assess
and build their complaints in the clinical diagnosis of tumors of the jaw bones play
a significant role first patient complaints, medical history, the duration of the
disease and its comparison with the size of the bone formation, visual inspection,
the overall condition of the patient, his age, localization of education.
Anamnesis.
At the beginning of the disease, children and their parents often pay attention to the
trauma, pain, swelling, tooth mobility, limited mobility of the lower jaw, which
occur in pathological processes of the maxillofacial region. The sequence of
occurrence of these symptoms can help in the differentiation of pathological
processes. When malignancy pain, swelling and dysfunction appear after some
time. A osteogenic tumor, unlike malignant tumors and indolent first attracted
attention deformation of the jaws.
Examination of the child.
When osteogenic tumors of the jaws general condition of the child is not getting
worse. Affected jaw bone tumors increased in volume. The tumor is detected early
by the child or parent in the case where the developing or periosteum located
directly underneath the coating layer of the bone. Later revealed swelling in the
localization of education in the thickness of the jaw bone, especially in the upper
jaw. Osteogenic tumors are characterized by a solid consistency, bumpy surface
and quite clear boundaries. In the bulging tumor should pay attention to the color
of the skin and mucous membranes of the mouth, the mobility of the soft tissue
over the tumor, expanding the network of veins, pulsing possible.
When osteogenic tumors, facial skin over the tumor moves freely. Malignant
tumors of the skin, first movable gradually becomes thinner, and in the future is
firmly soldered to the tumor. Subcutaneous veins usually dilate, the surrounding
soft tissues of the face swollen, sometimes becoming cyanotic color. In the
diagnosis of tumor disease duration is of particular importance. Malignant tumors
of the jaws for 1-2 months of the disease, with clinical and radiographic changes.
Some osteogenic tumors (myxoma, lytic giant cell tumor) in children are
developing very quickly, destroying the jaw sprout in the soft tissue, resembling a
picture of malignant growth.
X-ray examinations allow to specify the location of the tumor in the bones of the
face, its location, the direction of the growth of tumors, the boundaries with the
surrounding tissues. In a study of osteogenic tumors kompyutertomografiey have
the opportunity to assess the condition of the bone tissue in three-dimensional
spatial location of the tumor. A high-resolution level has a magnetic resonance
imaging. This research is important in the propagation of the tumor beyond the
jawbone. Both methods are very important in the study of tumor location in the
upper jaw, are important for the differential diagnosis with other tumors, tumorlike lesions of bone. These modern techniques allow for a clear plan for the amount
of surgical treatment. In some types of bone tumors highly informative method of
research is angiography, which allows us to determine vascular connection
tumor and treatment planning is used to perform pre-stage
rentgenangiooklyuzii to reduce blood loss during removal of such tumors.
Clinical and radiological findings must be confirmed by morphological study. The
final diagnosis is established after analyzing the results of the clinical, radiological,
morphological and other types of research.
Osteoma - benign tumor of bone. The tumor can be located centrally and
peripherally. They are spongy, compact and mixed. Clinical signs osteoma, the
following 1) extremely slow painless tumor growth. 2) Developing of the jaw
bone, causing thickening of the corresponding region. 3) This leads to a
deformation of the jaw, cosmetic and functional disorders.
The clinical course of the tumor depends on the location, size and direction of
growth. Squeezing the neurovascular bundle in the lower jaw, swelling can cause
neurological symptoms. Development of osteoma in the upper jaw leads to
exophthalmos, difficulty in nasal breathing (propagation on sinuses). With the
defeat of the TMJ marked limitation of lowering and increasing difficulties lateral
movements of the mandible.
Central osteoma radiographically detected in the form of intense focus seal of
round shape with smooth contours and peripheral osteoma is defined as a single
bone growth, a projection jutting out into the surrounding soft tissue.
Differential diagnosis of osteoma should be made with fibrous dysplasia, reactive
hyperostosis, myositis ossificans and ossified hematoma.
Treatment.
Removal of the tumor within the healthy bone. The indications for surgery are 1)
Pain 2) Large tumor size 3) Cosmetic and functional disorders.
Chondroma - a benign tumor made up of cartilage. Is a rare tumor of the jaw
bones. Distinguish chondroma, protruding beyond the normal limits of bone
growing ekzhofitno-ekhondromy (peripheral) and growing inside the bone enchondroma (central).
Ekhondromy - occur in the maxilla and nasal cavity. Clinical signs: 1) markedopen lips by raising the upper lip tissue growing tumor 2) tumor can displace teeth
and bite to break, but do not cause tooth mobility. 3) the mucous membrane
covering the tumor has not changed. 4) chondroma initially deforms the upper jaw
to the side of the hard palate 5) is determined by palpation dense painless nodular
fixed tumor. Upon germination ekhondromy into the nasal cavity is marked "snub"
of its front, which has a saddle shape. Nasal breathing is often difficult. The
mucous membrane covering the tumor more anemic. If the tumor extends to the
hard palate, nasal bone, the maxillary sinus, orbit, it may appear neurological
syndromes, functional and trophic disorders.
Enchondroma unlike ekhondromy localized in both the upper and the lower jaw.
Tumor growth occurs within the bone very slowly. Observed following clinical
signs.
), Tenderness, or mobility shift tooth located at the tumor site.
2) Appears swelling of the bone and tumor fixed, dense, often painful on palpation,
in which sometimes defined symptom parchment crunch.
3) Skin and mucous membrane swelling over unchanged.
When chondroma visible on the radiograph plotnovata shadow neoplasms, the
roots of the teeth not resorbed, the tumor has a structureless shadow uneven
density.
Differentiate chondroma accounts from fibrous dysplasia, chondrosarcoma, as well
as odontogenic cysts.
Chondroma surgical treatment. Surgery for ekhondromah enchondroma and can
only be reliable if completely remove neoplastic tissue.
Osteoblastoklastoma (giant cell tumor). On the basis of clinical and radiological
data should distinguish between two forms of osteoblastoklastomy: lytic and mesh.
Each of these different clinical features. Clinical signs of political forms
osteoblastoklastomy, which occurs in children 4-12 years: 1) grows quickly and
can be a pain, 2) in severe swelling of the tumor observed. Swelling and warming
the skin at the location of the tumor. 3) The venous network of vessels of the
mucous membrane covering the tumor extended. 4) Upon germination of the tumor
beyond the cortical bone oral mucosa becomes bluish-bagrovuyu color. Under her
palpable soft-woven education. 5) The teeth are sometimes shifted and become
mobile and in pathological lesions may be mandibular fractures. Lytic form
osteoblastoklastomy differentiated with osteosarcoma of the jaw. At the cellular
form of the tumor is more common in the age of 8-15 years and the beginning of
developing symptoms. Inherent to form cellular osteoblastoklastomy following: 1)
Swelling developed on one portion of the upper or lower jaw.
2) The tumor is painless, with a bumpy surface, diffusely thickened. 3) has a
spindle-shaped jaw. 4) The mucous membrane of the alveolar bone covering the
tumor, a few anemic and brilliant 5) palpation slightly painful and thus can be
detected symptom parchment hrusta.6) Teeth that are in the area of the tumor,
rarely change their position and are movable.
Cellular form osteoblastoklastomy differentiated with fibrous dysplasia,
odontogenic cysts.
Radiograph.
During lytic form osteoblastoklastomy hearth destruction structureless. If the
process is limited to a part of the jaw bone, this defect is marginal. If the bone is
destroyed around the diameter, on the background of the tumor determined by the
free ends of the jaw fragments with jagged edges blurred. Cortex drastically
thinned or not detected.
When the honeycomb form in the lesion reveals numerous small cavities or larger
honeycomb formations which are separated from each other by partitions with
different bone thicknesses.
Treatment of children with osteoblastoklastomoy surgery. Given that it is prone to
relapse, and shows the radical surgery.
Hemangioma.
Bone hemangioma with the localization of the field with the upper or lower jaw - a
vascular malformations, occur infrequently and is very difficult to diagnose and
treat. They are observed in patients from the moment of birth, but their clinical
manifestations are more likely to occur after 7-11 years on the background of
hormonal changes. The reason progression is vice hemodynamic alteration, often
associated with regional hypertension affecting the surrounding tissues, including
bone structures, with the formation of intraosseous cavities.
The most characteristic features of hemangiomas of bone in the jaw are in the early
stages of the emergence of mild soft tissue swelling cheeks, teleangiektatsii on the
skin, eventually increasing the mobility of the teeth and gingival margin hyperemia
of these teeth, bleeding. Bleeding occurs either by removing the abnormal mobility
of teeth, either spontaneously from the subgingival region, as well as during the
eruption of permanent teeth. With the defeat of the upper jaw are often marked
nosebleeds.
Determined by clinical examination of the jaw body increase, due to the
asymmetry of facial swelling and presence of arteriovenous fistulas in the soft
tissues, vascular pattern of varying intensity on the skin or oral mucosa, and skin
temperature rise above the mucosal lesion. Auscultation auscultated
diastolosistolichesky rough noise in the carotid artery on the affected side and
pulsation in the soft tissues of the affected person.
Radiologically marked areas pulping bone petlistogo large structure, combined
with areas of cellular degradation of character. Defined pathological roots
resorption milk teeth, which leads to their pronounced mobility. Rudiments of
permanent teeth are displaced, there is a delay of their formation.
Treatment: hemangioma before a radical surgery. But lately, the most effective
treatment is a combination of endovascular embolization with intraosseous
administration of a liquid biopolymer glue. This method is based on the restriction
of blood flow and hemodynamics restructuring in conjunction with the closing of
bone cavities and subsequent repair, which makes it resistant therapeutic effect