What Is Osteoblastoma?
Osteoblastoma is a special type of tumor, which has no malignant manifestations in histology, but is invasive, and even has lung metastases or malignant changes, so it is classified as a primary malignant tumor. Used to be known as benign osteoblastoma, giant osteoid osteoma and so on. The clinical manifestations are local pain, radical radiation pain, nocturnal pain, and varying degrees of neurological symptoms. The main surgical methods are local curettage and bone grafting to fill the cavity. The postoperative recurrence rate does not exceed 10%.
Basic Information
- nickname
- Benign osteoblastoma, giant osteoid osteoma
- English name
- osteoblastoma
- Visiting department
- orthopedics
- Multiple groups
- Before the age of 30
- Common locations
- Lumbar, thoracic, cervical and sacral vertebrae
- Common symptoms
- Local pain, radical radiation pain, nocturnal pain, and varying degrees of neurological symptoms.
Causes of osteoblastoma
- The etiology of osteoblastoma is unknown. It may be related to factors such as viral infection, non-purulent infection, and vascular abnormalities.
Clinical manifestations of osteoblastoma
- Osteoblastoma is clinically uncommon, accounting for about 1% of bone tumors, 80% of patients develop disease before the age of 30, peak incidence at the age of 25, and the ratio of male to female is 2: 1. 41% to 50% of the disease occurs in the spine, mostly in the lumbar, thoracic, cervical, and sacral vertebrae. The lesions are mostly behind the spine, especially the pedicle. The early manifestations of the lesions were local pain, radical radiation pain, and nocturnal pain, but it did not worsen and was not sensitive to aspirin. In the nervous system, different neurological symptoms occur depending on the affected spinal plane. Tumors in the lumbar spine can appear with calf radiation pain and lumbar muscle spasms; tumors in the cervical or thoracic spine can develop weakness in the upper and / or lower limbs, numbness, or even complete motor dysfunction; tumors in the sacrum can cause nerve root compression symptoms.
Osteoblastoma examination
- Laboratory inspection
- In individual cases of osteoblastoma, the erythrocyte sedimentation rate increases, and if the tumor becomes malignant, serum alkaline phosphatase (AKP) may increase.
- 2. X-ray performance
- The X-ray of osteoblastoma showed osteolytic swelling changes, clear boundaries, and thinning of the cortex outside the lesion. Depending on the degree of calcification and vascular abundance, it may appear as plaque-like calcification or as a large translucent area. If the lesion spreads to one side of the bone cortex, it can be ruptured, and the tumor can invade the spinal canal or surrounding soft tissue.
- 3.CT inspection
- The CT examination of osteoblastoma is characterized by swollen bone destruction, high-density sclerosis margins and calcification points. Can be divided into central type, cortical type, subperiosteal type and cancellous type.
- 4.MRI examination
- The MRI of osteoblastoma showed no calcified ossifying lesions. T 1 WI was moderate signal and T 2 WI was high signal. After calcification of the lesions, both T 1 WI and T 2 WI showed speckled, cable-like, lumpy or irregular low-signal areas. As calcification progresses, the low-signal area can gradually increase. The T 1 WI and T 2 WI around the sclerotic margin of the lesion were both low signal loops. Congestion and edema appeared in the medullary cavity and soft tissue adjacent to the lesion. The periosteal response is not obvious, and the surrounding soft tissue may be slightly swollen, but the soft tissue mass is not obvious. The enhanced scan showed that the blood-supply-rich bone-like tissue was enhanced, the adjacent medullary cavity and soft tissue of the lesion were slightly enhanced, but the calcification, cystic changes and bleeding areas within the lesion were not enhanced.
Osteoblastoma diagnosis
- The main points of diagnosis of osteoblastoma are:
- 1. More common in young people, 40% to 50% are located in the spine, and the pedicle is damaged first.
- 2. Radical symptoms appear earlier, and neurological symptoms vary depending on the level of involvement.
- 3.X-rays show that the bones with clear boundaries and different sizes are damaged, with varying degrees of ossification, and the marginal bones become thinner.
- 4. Pathological examination showed a large amount of osteoblasts, bone-like tissues and vascular fibrous tissues in the tumor tissue.
Osteoblastoma treatment
- According to the special anatomical structure of the spine and the histological characteristics of osteoblastoma, local curettage and bone grafting can be used to fill the cavity. The current treatments are:
- Local scraping
- Osteoblastoma on the spine can be cured after local scraping, and the recurrence rate is low. If the range is large and the local resection is difficult, only scraping and scraping will be performed, combined with radiotherapy after surgery.
- Spinal decompression
- If osteoblastoma has symptoms of nerve root or spinal cord compression, surgical treatment is intended to decompress. The decompression effect depends on the degree and time of compression, and whether the decompression surgery is complete or not.
- 3. Radiation therapy
- Radiotherapy for osteoblastoma is suitable for those who cannot be operated on, who have recurrence after surgery, or who need adjuvant therapy. The radiation dose is usually 20-50Gy.
Prognosis of osteoblastoma
- Osteoblastoma should be followed up after surgery and closely observed to prevent malignant transformation. For irradiation cases, it should be observed whether it is transformed into fibrosarcoma or osteosarcoma. The postoperative recurrence rate does not exceed 10%.