Osteochondroma refers to non-cancerous tumors which develop during the childhood and adolescent phases of growth. They are abnormal growths in nature which usually form near the surface of a bone where growth plates are situated (American Academy of Orthopedic Surgeons, 2012). Growth plates are the areas in children where cartilaginous tissues are situated near the end of long bones. Osteochondroma develops in areas near these growth plates during the growth phase of children and when they attain maturity, the growth plates consolidate into concrete bones (American Academy of Orthopedic Surgeons, 2012). The commonest time when these growths occur is during the puberty stage of age 13 and 15 whereby there is the rapid growth of bones which cease during the end of puberty. The most commonly affected parts include long bones in the legs, scapula, or the pelvis (American Academy of Orthopedic Surgeons, 2012). The structural composition of osteochondroma comprises of bone and cartilage, and as such, when a child is growing, so do the benign bones. Since these growths are affected and respond to various growth factors and hormones just the same way as epiphyseal growth plates do, it means that the growth will cease when an individual achieves skeletal maturity (American Academy of Orthopedic Surgeons, 2012). The growth continues to the point where an individual has attained full maturity status when the growth ceases. Most osteochondroma incidences do not necessarily require treatments although there is the need to perform constant monitoring of the growth in order to identify any complications or changes that may present thereafter (American Academy of Orthopedic Surgeons, 2012).
This condition may develop either as a single benign tissue which is medically termed as osteocartilaginous exostosis or numerous tumors medically referred to as multiple osteochondromatosis.
a) Osteocartilaginous exostosis
These are the most common type of benign bone tumors which account for 35% to 40% of all osteochondroma cases (Dickey & Gellman, 2015). Since these tumors are non-cancerous, they do not spread to other body parts. These types of tumors are commonly found at the end of long bones that make up the structure of the body and in particular where these bones form joints particularly at the knee, shoulder and hip (Dickey & Gellman, 2015). They are likely to develop in situations where bones develop out of growth plates instead of the growth being in line with the growth plates. The bone outgrowths so formed may either have a stalk which is referred to as a pedunculated (Dickey & Gellman, 2015). In situations where the tumor outgrowth is attached to a broad-based bone, it becomes a sessile.
Cause
There is no classified known cause of this medical condition although it is associated with a particular gene referred to as EXT1 (Dickey & Gellman, 2015). The relationship between this gene and the cause of this condition is currently unknown although research into it is currently being conducted (Dickey & Gellman, 2015). As such, it has been a challenge for a physician to find a way of preventing it.
Symptoms
In most situations, these kinds of tumors do not show any kind of symptoms except when after the tumors arising from them fully develop. Therefore, this type of osteochondroma can only be diagnosed in individual of ages 10 to 30 years (Dickey & Gellman, 2015). The symptoms that are likely to present themselves in this situation include;
Bumps which are painless around joints on the knees and shoulder.
When an osteochondroma is located under a tendon, the tendon may snap over a bony tumor thereby leading to pain.
Cases of numbness may occur when the tumor is located near a nerve and pressure is applied to it.
In case the tumor is located on the way of a blood vessel, it may lead to periodic changes in the flow of blood, this will lead to changed limb color or pulse loss (Dickey & Gellman, 2015).
Diagnostic tests
An Osteochondroma can only be diagnosed only when imaging has been performed by a physician. As such, X-rays will be conducted to determine the extent of growth of the tumor (Dickey & Gellman, 2015). Magnetic Resonance Imaging (MRI) should also be conducted to provide detailed information about the growth in addition to their cross-sectional images (Dickey & Gellman, 2015). Such tumors even though rare to change into cancerous ones, it is vital that it be checked in elderly patients in case the tumors become painful (Dickey & Gellman, 2015). In such situations, therefore, a biopsy may be performed to determine whether there are any cancerous traces.
Treatment
The treatment regime for this condition may either be non-surgical or surgical. Non-surgical treatment involves regular X-ray sessions by a physician to keep track of the transformations in the growth (Dickey & Gellman, 2015). The surgical treatment involves the complete removal of the growth whereby a procedure referred to as an excision is performed (Dickey & Gellman, 2015). The removal is up to the level of the normal bone. Surgical treatment is performed when the growth causes pain, has a big cartilage cap and exerts pressure on a blood vessel or a nerve (Dickey & Gellman, 2015).
b) Multiple osteochondromatosis
This condition is also referred to as multiple osteocartilaginous exostosis or diaphyseal aclasia. In this condition, both sessile and pedunculated tumors may present themselves (Park, 2015). Severe conditions are likely to lead to bones growing abnormally which may be exhibited in the form of patients having short statures and deformities in the forearms (Park, 2015). Such signs make it easy to identify the condition in children. The condition is, however, more common in men than women
Cause
70% of this condition is inherited whereas the remaining 30% occur under random situations (Park, 2015). As is the case of Osteocartilaginous exostosis, gene EXT1 is the thought cause of the condition and is being researched on to actually determine if it is the cause of the situation (Park, 2015).
Symptoms
The symptoms of multiple osteochondromatosis are similar to those ones of Osteocartilaginous exostosis although in this state they are likely to lead to bumps which are painless at the sites of the tumor (Park, 2015). The pain manifests itself when pressure is applied on nerves, soft tissues or blood vessels.
Diagnostic tests
The diagnostic tests for this condition involve a taking a medical history of the patient coupled with physical examinations and imaging tests (Park, 2015). Physical examinations involve x-rays and in most cases, the findings are usually severe compared to Osteocartilaginous exostosis. In the case of any cancerous symptoms, an orthopedic oncology evaluation should be carried out (Park, 2015). Cancerous cells may be developing if a cartilage cap that is thicker than 2 cm and pain at the site of infection become evident (Park, 2015). Cancer fears can be confirmed by MRI and CT scans followed by a biopsy of the tumor tissue (Park, 2015).
Treatment
Keeping regular track of the growth through X-rays is vital to check on the development of the disease (Park, 2015). Surgical removal of the tumor is necessary to incase there is a pain on nerves and blood vessels or the development of a large cartilage cap (Park, 2015). Knock-knees or ankles are the ones that are removed through the surgical method. Radiotherapy combined with chemotherapy should be included in the treatment plan in case the tumors become cancerous (Park, 2015).
References
American Academy of Orthopedic Surgeons. (2012). Osteochondroma-OrthoInfo - AAOS. Retrieved from http://orthoinfo.aaos.org/topic.cfm?topic=A00079
Dickey, I. D., & Gellman, H. (2015). Solitary Osteochondroma: Background, History of the Procedure, Problem. Retrieved from http://emedicine.medscape.com/article/1256477-overview#a9
Park, Y. K. (2015). Multiple Osteochondromatosis. In Tumors and Tumor-Like Lesions of Bone (pp. 273-276). Springer London.
