You may have noticed small lumps on your little one's body, especially on their limbs. Sometimes these can be painful or painless. Don't worry , not all lumps are dangerous. However, today we are going to talk about a condition that shows these symptoms, which is not very common but is very important for us all to be aware of. This condition is called HMO, which stands for `Hereditary Multiple Osteochondromas`.
What exactly is HMO (Hereditary Multiple Osteochondromas)?
Simply put, HMO is a genetic condition . It is caused by a small change, or mutation, in our genes, or the basic blueprint that determines how our bodies grow. This change causes some of our bones to develop benign, or harmless, tumors , which we medically call osteochondroma , and they start to grow in large numbers. These are not actually cancer, so there is nothing to worry about.
Are there other names for this HMO?
Yes, you may come across several other names when you search for this condition. Doctors sometimes use these names:
- `Hereditary Multiple Osteochondromas (HMO)` (this is the most commonly used now)
- `Multiple Hereditary Exostoses` (previously this was the most common name)
- `Diaphyseal aclasis`
No matter which name you use, it's the same medical condition. So if you see one of these names, don't get confused, okay?
So what is this osteochondroma?
Osteochondroma, as I mentioned earlier, is a non-cancerous, in other words, benign, bone tumor . Imagine, these tumors form when the cells in our bones, instead of growing normally, start growing in a slightly different, abnormal way.
These tumors usually develop on the flat surface of a bone or in the flexible tissue called cartilage at the ends of bones, called growth plates, which help children grow and their bones grow. These tumors are also covered by a cartilage cap. The important thing is that they are not cancerous , so they do not spread throughout the body. Isn't that a great relief?
Who can develop this condition? How common is it?
Doctors usually diagnose HMO in early childhood or adolescence . It can affect both boys and girls equally.
However, HMO is not a very common condition . Roughly speaking, it affects about one in 50,000 people. So it's not surprising if you haven't heard of it.
What causes HMO? Is there a genetic link?
Yes, HMO is primarily a genetic disease . That means it has to do with our genes.
Ninety percent (90%) of people with HMO develop it if there is a change, or mutation , in the genes called `EXT1` or `EXT2` (these genes are the instructions in our `DNA` that tell our body how to make some important proteins). Unfortunately, the exact genetic cause that affects the other 10 percent (10%) has not yet been found.
Most often , these genetic mutations are passed down from parents to children . This means that if either the mother or father has the mutation, the child can also get it. However, some people with HMO do not have any of their parents who have the mutation. This means that even if no one in the family has HMO, sometimes someone can develop the condition for the first time. This is called a new mutation.
What are the symptoms of HMO? What kinds of things do you see?
HMO can cause painful lumps to form on one or more bones. These lumps are called osteochondroma. In addition, you may experience symptoms such as:
- Abnormal growth of bones , including changes in the bones of the forearm. Sometimes the arm may appear slightly elongated.
- Frequent bone fractures and growth plate ruptures.
- Limb length discrepancy . Think of one leg being slightly shorter than the other, or one arm being shorter than the other.
- Inability to move joints properly, feeling of stiffness in the joints.
- Pinched nerves can be caused by bone spurs, which can cause numbness and pain.
- Premature osteoarthritis , which means premature wear of joints at a young age.
- Ankle or knee problems, pain when walking.
- Short-term and long-term pain . This pain can sometimes be difficult to bear.
- Short stature .
Some children experience more pain when these tumors develop near blood vessels or nerves. However, sometimes these tumors can be painless and just appear as a lump.
Important: If you see any lumps like this on your child's body, or if your child frequently complains of bone pain, please see a doctor.
Is this HMO condition contagious from one person to another?
No, HMO is not a contagious disease . That means it is not spread from one person to another by touching or being in close proximity, like a cold. It is a completely genetic condition.
However, if you have HMO, there is about a 50% chance that you will pass on the gene mutation that causes this disease to your child. That means there is a 50% chance with each pregnancy.
How do doctors identify HMO status?
You or your child's doctor may notice a lump on or near a bone, or other symptoms of HMO (e.g., slight swelling, pain). Doctors will first:
1. Asking carefully about the family's medical history . Checking to see if anyone in the family has had this condition.
2. A complete physical examination . Checking for lumps, their size, and joint movement.
What kind of medical tests are performed?
After a physical examination, doctors usually recommend imaging tests to confirm the condition of HMO.
- The first step is often an X-ray . An X-ray can clearly show these osteochondroma tumors.
- Sometimes, to learn more about the tumor, or to see if it is affecting things like nerves, you may also need to do these tests:
- `CT scan`
- `MRI` (M.R.I.)
It is based on the information obtained from these tests that doctors determine whether or not to have an HMO.
How is HMO treated? What are the options?
Treatment for HMOs is not the same for everyone. It depends on your symptoms, the number of tumors, their location, and the effects they have . Doctors may recommend treatments such as:
- Observation of the tumor / watchful waiting: Sometimes, if the tumor is not causing any major problems or pain, doctors may recommend waiting a while to see if the tumor grows or causes problems. This is called "watchful waiting."
- Pain management: If there is pain, medications (such as paracetamol or ibuprofen) can be given to control it. Sometimes stronger painkillers may be needed.
- Physical therapy: A physical therapist teaches exercises to help maintain joint mobility and strengthen muscles. This can also help reduce pain.
- Surgery:
- Surgery to remove one or more tumors: If a tumor is causing unbearable pain, pressing on a nerve, interfering with the movement of a joint, or if there is a suspicion that the tumor may be cancerous, the tumor may be removed surgically.
- Surgery to lengthen or straighten limbs that are not growing properly: If an arm or leg is shortened or stretched due to HMO, there are special surgeries to correct it.
Can complications arise from treatment?
Some people who have surgery to remove an osteochondroma may develop scars . As with any surgery, there is a small risk of infection or nerve damage. However, doctors do their best to minimize these risks.
Is there a way to avoid the HMO situation?
Actually, there is nothing you can do to prevent HMO because it is a genetic condition.
However, if you know that someone in your family has HMO, and you are expecting a child, you may want to consider prenatal genetic testing during pregnancy to find out if your baby has inherited the condition. For example:
- ``Chorionic Villus Sampling (CVS)''
- `Genetic amniocentesis`
These tests can help determine if the embryo has HMO in advance. In some cases, if you are using artificial insemination methods (such as IVF), preimplantation genetic testing may also be an option. Talk to your doctor about this to learn more.
How do I know if my child is at risk of developing HMO?
If you, your husband/wife, or a close family member has HMO, it is very important to inform your doctor about it, as the baby may also be at risk.
If there is no family history, the risk of a child developing HMO is very low. However, as I said earlier, it can also be caused by a new mutation, so it is not completely impossible.
What can I expect if my child has an HMO?
If your child has HMO, the condition can vary from child to child. Some children may develop just a few osteochondroma tumors, or they may develop many tumors.
The good news is that , in most cases, after a child's growth plates close, meaning that the child's height and bone length stop increasing, these tumors will no longer grow.
But for some people, even after the growth plates have closed, they can recur. It's a bit rare.
HMO can also cause other symptoms. Some children and adults may experience fatigue , pain, and difficulty moving their body or doing tasks.
Not everyone with HMO will need treatment. But some may need surgery or physical therapy. Doctors may also recommend medication or other treatments to help control pain.
How long will this situation last?
HMO is a lifelong condition . This means that it cannot be completely cured. However, many people with these benign osteochondromas can live a normal life . The most important thing is to control your symptoms, get the necessary treatment, and maintain a good quality of life. Always talk to your doctor about treatment options that will help your child stay healthy and happy.
Can osteochondroma tumors become cancerous? This is what many people fear.
This is a really important question. Yes, very rarely , that is, very rarely , osteochondroma tumors in people with HMO can become malignant. Between 2% and 5% of people with HMO (that is, between 2 and 5 out of 100) develop this type of cancer. When that happens, these benign tumors turn into bone cancers called `chondrosarcoma` or `osteosarcoma`.
Your doctor may suspect that an osteochondroma may be cancerous if:
- If your child develops new moles after puberty , or if an existing mole suddenly starts to grow rapidly.
- If a previously painless osteochondroma suddenly becomes painful , or if the existing pain becomes very severe.
- If the cartilage cap on top of a tumor is more than 2 centimeters thick (this is seen with an MRI scan).
Many cancerous tumors can be removed surgically. Depending on the stage of the cancer, whether it has spread (metastasized), your child may not need additional treatment (such as chemotherapy or radiotherapy). That's why it's important to have regular checkups.
How to care for a child with HMO? What can we do as parents?
If your child has HMO, it is very important to pay attention to your child's symptoms .
- If your child develops any new symptoms , especially a sudden change in the size of the lump, increased pain, or numbness, notify your doctor immediately.
- Follow the doctor's instructions exactly (how to take your medication, how to exercise, and when to come for tests).
- If your child is in pain, don't let them endure it. Talk to your doctor and find ways to manage the pain.
- Think about your child's mental health as well. Living with a situation like this can sometimes be a challenge for a child. Talk to your child, support your child.
When should I seek medical advice if my child has HMO? What are the emergencies?
If your child has been diagnosed with HMO, seek medical advice immediately in the following cases:
- If the child develops new tumors .
- If you feel like a lump is suddenly getting bigger .
- If the pain suddenly increases or if a new, severe pain occurs (especially after puberty).
- If the skin where the lump is is red, swollen, and feels warm (this could be a sign of infection).
- If you experience numbness or weakness in an arm or leg.
Don't ignore these symptoms. Seeing a doctor early can prevent major problems from developing.
Can children with HMO develop autism?
Some parents ask about this too. Medical experts have reported several cases of children with HMO and a condition called `autism spectrum disorder`. However, they still do not know for sure whether there is a definite, direct link between the two conditions. Researchers are still studying whether the genetic mutations (`EXT1`, `EXT2` genes) that cause HMO also contribute to the development of autism. At present, no firm conclusion has been reached on this.
Finally, the most important things you need to remember
HMO, which stands for `Hereditary Multiple Osteochondromas` (sometimes called `Multiple Hereditary Exostoses`), is a genetic condition in which benign tumors (osteochondromas) form along the bones and in the growth plates of children and young adults.
Although HMO is a lifelong condition, it can cause pain and skeletal changes. However, treatments such as surgery, physical therapy, and pain management can greatly relieve symptoms, correct bone deformities, and help you live a good life.
The most important thing is not to panic or panic if your child has these symptoms, but to see a qualified doctor as soon as possible. Talk openly with the doctor and decide what tests your child needs and what the best treatment is. Your support and understanding will be a great strength for your child to live successfully with this condition.
` Hereditary Multiple Osteochondromas, Multiple Hereditary Exostoses, Osteochondromas, Bone Tumors, Genetic Diseases, Children's Diseases, Bone Pain
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