MY OBSESSION WITH A TUMOR THE SIZE OF A PEPPERCORN
Hey everyone! For this week's blog, I'm filling in with an article on a rather fascinating topic-a 'peppercorn'-sized tumor that was found to be an osteoid osteoma. Ever since I got to know about this tumor that barely even qualifies to be called one, it has been looming at the back of my head and through this short tale, I'll tell you how I came to find out about it and where it led me.
It all started when I was in the tenth grade and my cousin complained about pain in his leg. Of course, we thought it would be like any normal leg pain, like the air conditioning directly hitting his leg or he had hit his leg somewhere. A week later the pain persisted, and we decided to get it checked.
And there it was, the start of my obsession with this small-sized tumor, an osteoid osteoma.
Now, this tumor is a benign (noncancerous) growth on the bone and has no potential to become malignant. The average tumor is less than an inch in diameter. osteoid osteomas typically manifest in the long bones in of the body. The tibia (shin bone) and femur (thigh bone) are two examples of these long bones. It is usually radio-lucent and is visible on CT or MRI modalities.
Histologically, it is made up of a central nidus that houses immature woven bone sheets that occasionally have osteoblastic rimming, scattered osteoclasts in the fibrous connective tissue that divides the osteoid trabeculae, and small- to medium-sized vascular spaces. A zone of mature, solid bone surrounds the nidus in the lesion's periphery.
How is it found out?
The typical age range for the development of osteoid osteoma is 5 to 25. Men are three times more likely than women to have this condition. Most males would have had this tumor but were unaware of it because it doesn't require treatment until the person feels the pain. It classically causes severe pain at night.
As with any other bone tumor, plain radiography is the initial exam of choice.
The appearance of an osteoid osteoma on plain film is classically a small, round, radiolucent nidus with surrounding sclerosis. If conventional radiographs are inconclusive, Three-phase skeletal scintigraphy is an option. The "double density sign" is characteristic of an osteoid osteoma in a three-phase skeletal scintigraphy.
This is what got my attention—why does it happen to men more often? How does it occur?
The pathogenesis of osteoid osteoma has remained controversial. Some authors believe that the formation of the lesion is an attempt at repair but there has been no evidence of fracture or injury.
One of the reasons for the occurrence of osteoid osteoma might be the role of Prostaglandins (more research has to be conducted on this). Bone metabolism is multi-functionally regulated by prostaglandins (PGs), which promote both bone growth and resorption. PGs have been associated with both bone production linked to fracture repair and heterotopic ossification, as well as bone resorption linked to inflammation and metastatic bone disease. In these mechanisms, inducible cyclooxygenase-2 (COX-2) and PGE2 receptors have been implicated in studies recently. Although cAMP generation and PKA activation have been most frequently linked to the effects of PGs, they can also activate a vast G-protein signaling network. Additional research on COX-2 and PG receptors and their downstream G-protein signaling in bone may offer crucial hints about how skeletal cell proliferation is regulated in both healthy and diseased bone.
Prostaglandins, thus, increase the vessels’ diameter and permeability, raising the vessels’ size and flow in the bony lesion, and finally increasing pressure and pain. Alternatively, prostaglandins affect the bradykinin system, amplifying pain, just like injured soft tissues.
How to treat it?
CT-guided radiofrequency ablation: In this minimally invasive procedure, the tumor is heated out by your surgeon.
NSAIDs can be used to treat osteoid osteomas. Aspirin, ibuprofen, and naproxen are examples of NSAIDs that are available without a prescription. NSAIDs aid in pain relief and could promote osteoid osteoma shrinking.
Since the beginning of medical school, I have devoted most of my days to researching this peppercorn tumor by reading publications and carrying out additional research, but nobody appears to have a clear understanding of the reason.
Is trauma to be blamed? Is the increased level of PG (prostaglandin) contained in them a reason? Could it play a role? Or what if, in the opinion of some authors, the healing process is unusual? Sometimes when I come to a dead end, I tell myself, "Maybe it's simply a glitch in the body."
I'm in my second year and I'm still trying to figure this out.
I have written this post in the hopes that anybody who reads it may learn something new about our bodies. And yes, I’m aware that it might just be a benign tumor that appeared out of nowhere, but until we keep looking, we will never know.
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We'll be back with another post next week!
Happy New Year,