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Basic Human Pathology 2 > Bone, Joints, and Soft Tissue Tumors > Flashcards

Bone, Joints, and Soft Tissue Tumors Flashcards

1
Q

what are the two main components of bone

A

mineral (inorganic) component (65%)
osteoid (organic) component (35%)

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2
Q

what is osteopontin

A

extracellular structural protein that helps with bone formation

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3
Q

what role does the inorganic bone matrix play

A

gives rigidity and hardness to bone

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4
Q

what role does the organic bone matrix play

A

collagen fibers gives bone its tensile strength

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5
Q

what are the three main bone cells

A

osteoblasts
osteocytes
osteoclasts

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6
Q

what do osteoblasts do

A

build bone

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7
Q

what do osteocytes do

A

regulate calcium and phosphate levels

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8
Q

what do osteoclasts do

A

responsible for bone resorption

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9
Q

what is the difference between woven and lamellar bone

A

woven (left): cellular and disorganized (fetal)
lamellar (right): organized collagen (adult)

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10
Q

long bones develop through this process

A

endochondral ossification

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11
Q

how does endochondral ossification work

A

chondroclasts remove central portion of bone to make medullary cavity while osteoblasts deposit bone in the diaphysis and at growth plate
produces radial growth of bone

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12
Q

what are the five zones of a growth plate starting from the exterior

A

1.) reserve zone
2.) zone of proliferation
3.) zone of hypertrophy
4.) zone of mineralization
5.) primary spongiosa

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13
Q

flat bones develop through this process

A

intramembranous ossification

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14
Q

how does intramembranous ossification work

A

osteoblasts deposit new bone on the preexisting surface (appositional growth)

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15
Q

when is peak bone mass achieved

A

early adulthood after the cessation of skeletal growth

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16
Q

what is dyostosis

A

localized disruption of migration and condensation of mesenchyme

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17
Q

what are the three most common forms of dyostosis

A

1.) absence of bone or digit (aplasia)
2.) extra bones or digits (supernumerary digit)
3.) abnormal fusion of bones (syndactyly)

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18
Q

what is dysplasia

A

genetic systemic disorganization of bone and/or cartilage
ex. osteogenesis imperfecta

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19
Q

which gene mutation commonly causes developmental disorders of bone and cartilage

A

FGFR3

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20
Q

how do defects in nuclear proteins and transcription factors affect bone and cartilage

A

leads to abnormally developed bones

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21
Q

what is the most common skeletal dysplasia and a major cause of dwarfism

A

achondroplasia

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22
Q

what is achondroplasia

A

short stature, large head
does not usually cause life threatening side effects

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23
Q

what is the most common cause of achondroplasia

A

sporadic mutations in the paternal allele (90%)

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24
Q

which mutation is involved in achondroplasia

A

FGFR3

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25
Q

what is the most common form of dwarfism

A

thanatophoric dysplasia

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26
Q

what is thanatophoric dysplasia

A

underdeveloped thoracic cavity leads to respiratory issues and death

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27
Q

which mutation is involved in thanatophoric dysplasia

A

FGFR3

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28
Q

what is osteogenesis imperfecta (brittle bone disease)

A

a type 1 collagen deficiency disease
affects bone, joints, eyes, ears, skin, and teeth

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29
Q

what is a common sign of osteogenesis imperfecta (brittle bone disease)

A

blue sclera - thin scleral collagen allows choroid vasculature to be seen

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30
Q

what is osteopetrosis (marble bone disease)

A

reduced bone resorption due to issues with osteoclasts
leads to increased bone density as new, poor bone is being put down

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31
Q

what are the two other names for osteopetrosis

A

marble bone disease
albers-schonberg

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32
Q

what is a common sign of osteopetrosis

A

Erlenmeyer flask bone deformity

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33
Q

what is mucopolysaccharidoses

A

lysosomal storage disease
lack of certain enzymes leads to accumulation of mucopolysaccharides in chondrocytes
accumulation causes apoptosis and death of cells
leads to deformities of cartilage

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34
Q

what is osteopenia

A

decreased bone mass (-1 to -2.5 SD)

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35
Q

what is osteoporosis

A

severe osteopenia (-2.5 SD)
increases risk for fractures and compression

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36
Q

what are the five main causes of osteoporosis

A

1.) increasing age
2.) reduced physical activity
3.) genetic factors
4.) lack of calcium
5.) hormones

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37
Q

what is seen histologically in someone with osteoporosis

A

decreased amount of bony spicules

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38
Q

which class of drugs is used to treat osteoporosis

A

bisphosphonates - reduce osteoclast activity

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39
Q

what is the main cause of osteomalacia and rickets

A

deficiency in vitamin D

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40
Q

what is rickets

A

disorder in children due to lack of vitamin D
interferes with the deposition of bone in the growth plates

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41
Q

what is osteomalacia

A

disorder in adults due to lack of vitamin D
bone that is formed is unmineralized, making it soft and easy to fracture

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42
Q

which hormone is important for regulating calcium

A

parathyroid hormone (PTH) - causes increased osteoclast activity

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43
Q

what is the most common cause of hyperparathyroidism

A

parathyroid adenoma

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44
Q

osteoporosis mostly affects which three parts of the body

A

1.) phalanges
2.) vertebrae
3.) proximal femur

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45
Q

what is osteitis

A

inflammation of bone due to osteoclasts tunneling into spicules

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46
Q

what is a brown tumor

A

reactive bone lesion formed due to osteoclast activity heightened by hyperparathyroidism

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47
Q

what are the three main consequences of the bone due to hyperparathyroidism

A

1.) osteoporosis
2.) osteitis
3.) brown tumor

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48
Q

what is renal osteodystrophy

A

skeletal changes that occur in chronic renal disease and dialysis

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49
Q

what is Paget disease (osteitis deformans)

A

increased bone mass due to new bone that is abnormally shaped, weak, and brittle
leads to a thickened cortex

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50
Q

what are the three phases of Paget disease (osteitis deformans)

A

1.) initial - osteolytic phase (breakdown)

2.) mixed osteoclastic and osteoblastic stage (build up)

3.) final - osteosclerotic stage (bone doesn’t solidify)

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51
Q

what would you see histologically in someone with Paget disease (osteitis deformans)

A

mosaic pattern of lamellar bone

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52
Q

in which condition would you see a mosaic pattern of lamellar bone

A

Paget disease (osteitis deformans)

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53
Q

what is simple fracture

A

fracture where the overlying skin is intact

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54
Q

what is a compound fracture

A

fracture where the bone touches the skin surface

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55
Q

what is a comminuted fracture

A

bone is fragmented

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56
Q

what is a displaced fracture

A

the two ends of the bone are misaligned

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57
Q

what is a stress fracture

A

crack like fracture due to repetitive loads

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58
Q

what is a greenstick fracture

A

fracture extending only partially through the bone

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59
Q

which type of fracture is most common in children

A

greenstick - due to their soft bones

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60
Q

what is a pathologic fracture

A

bone is weakened by an underlying disease such as a tumor and then fractures

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61
Q

how long does it take a fracture to heal completely

A

3 weeks to months

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62
Q

what is a large component of impeded healing of fractures

A

smoking

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63
Q

what is avascular necrosis (AVN)

A

infarction of bone and marrow typically due to fractures or corticosteroids

cartilage begins to lift away from bone’s surface

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64
Q

what are the two things seen grossly in the case of avascular necrosis (AVN)

A

wedge-shaped subchondral infarct
separation of cartilage from bone

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65
Q

what is osteomyelitis

A

inflammation of bone and marrow

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66
Q

what is pyogenic osteomyelitis

A

inflammation of bone and marrow most commonly caused by hematogenous spread of staph. aureus

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67
Q

dead, necrotic bone in association with osteomyelitis is known as this

A

sequestrum

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68
Q

how does osteomyelitis spread in infants

A

spreads through cartilage or into a joint

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69
Q

what is tuberculous spondylitis (pott disease)

A

tuberculosis within the vertebral column

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70
Q

what is congenital syphilis

A

syphilis acquired from birth
spirochetes gather in areas of active ossification which leads to bowing of bone (saber shin)

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71
Q

saber shin is seen in which condition

A

congenital syphilis

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72
Q

what is the age range for developing most bone tumors

A

0-30 years of age

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73
Q

what is the most common primary bone tumor

A

osteosarcoma

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74
Q

which two conditions can increase your risk of a bone neoplasm

A

chronic osteomyelitis
Paget disease

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75
Q

what are the two main types of benign bone forming tumors

A

osteoid osteoma
osteoblastoma

76
Q

what is an osteoid osteoma

A

benign bone tumor
less than 2 cm
common in men
causes thickening of cortex
mostly affects femur or tibia

77
Q

what is an osteoblastoma

A

benign bone tumor
greater than 2 cm
mostly affects the spine
causes deformation

78
Q

what is an osteoid osteoma lesion called

A

nidus

79
Q

what is the most common primary malignant tumor of bone

A

osteosarcoma

80
Q

who, men or women, are more at risk for osteosarcoma

A

men

81
Q

where do osteosarcomas most commonly arise from

A

metaphysis region of long bones of the extremities - knee specifically

82
Q

what is a common feature of osteosarcomas

A

codman triangle

83
Q

which gene mutation is most responsible for osteosarcomas

A

TP53

84
Q

what are the three most common metastasis locations of osteosarcoma

A

1.) lungs
2.) bone
3.) brain

85
Q

what are the three main types of cartilage

A

hyaline (myxoid)
fibrocartailge
elastic

86
Q

what is the most common benign bone tumor

A

osteochondroma (exostosis)

87
Q

what is the most common form of osteochondroma (exostosis)

A

solitary

88
Q

what is an osteochondroma (exostosis)

A

benign cartilage capped tumor that is attached to underlying skeleton by bony stalk
develop in long bones

89
Q

who, males or females, are most affected by osteochondromas (exostosis)

A

males (x3)

90
Q

what is multiple hereditary exostosis syndrome

A

multiple osteochondromas that occur closer to the growth plate

91
Q

what is a chondroma

A

benign tumor of hyaline cartilage

92
Q

what is the most common type of intraosseous cartilage tumor

A

chondroma

93
Q

what are the two main types of chondromas

A

enchondroma and juxtacortical chondroma

94
Q

what is an enchondroma

A

benign tumor of hyaline cartilage that arises within the medullary cavity

95
Q

what is a juxtacortical chondroma

A

benign tumor of hyaline cartilage which arises on the surface (cortex) of the bone

96
Q

which two conditions are associated with enchondromas

A

Ollier disease and Maffucci syndrome

97
Q

those with Maffucci syndrome are at risk for developing which two types of malignancies

A

ovarian carcinomas and brain gliomas

98
Q

what is a chondrosarcoma

A

malignant tumor of cartilage that typically affects men over 40

99
Q

what are the four histologic classifications of chondrosarcomas

A

1.) hyaline cartilage producing (conventional tumor)
2.) clear cell
3.) differentiated
4.) mesenchymal variants

100
Q

what are the two main sites of chondrosarcomas and which is most common

A

central (intramedullary) and peripheral (juxtacortical)

101
Q

higher grade chondrosarcomas have which histologic feature

A

binucleation (dividing nuclei) of chondrocytes

102
Q

what is a Ewing sarcoma

A

malignant bone tumor that arises in the medullary cavity

103
Q

Ewing sarcoma is grouped with which other condition into a single category

A

primitive neuroectodermal tumor (PNET)

104
Q

where is the gene mutation for Ewing sarcoma located

A

translocation of the EWSR1 gene on chromosome 22

105
Q

what is the important histologic feature of a primitive neuroectodermal tumor

A

Homer-Wright rosettes

106
Q

Homer-Wright rosettes are commonly seen in which condition

A

primitive neuroectodermal tumors

107
Q

which is seen histologically in Ewing sarcoma

A

sheets of small round uniform cells

108
Q

what is important to note when grossing a Ewing sarcoma specimen

A

quantifying the amount of chemotherapy-induced necrosis

109
Q

what is a giant cell tumor of the bone

A

locally aggressive bone tumor
benign but can metastasize to the lungs

110
Q

what do you see histologically in a giant cell tumor of the bone

A

multinucleated osteoclast-type giant cells

111
Q

how is a giant cell tumor of the bone treated

A

with curettage

112
Q

what is an aneurysmal bone cyst (ABC)

A

benign tumor that develops in the metaphysis of long bones and in the vertebral bodies

113
Q

what is seen histologically in an aneurysmal bone cyst

A

multiple blood-filled cystic spaces with osteoclast-type giant cells

114
Q

how big is a typical non-ossifying fibroma

A

5-6 cm

115
Q

what is seen histologically in a non-ossifying fibroma

A

storiform pattern due to benign spindle cells

116
Q

what is seen histologically in fibrous dysplasia

A

lack of osteoblastic rimming

117
Q

what is the most common cause of a malignant bone tumor

A

metastasis - not a primary cancer

118
Q

what are the three metastatic ways of spread to the bone

A

1.) direct extension
2.) lymphatic/hematogenous
3.) intraspinal seeding (CSF)

119
Q

metastatic bone tumors in adults mostly come from which four location

A

1.) prostate
2.) breast
3.) kidney
4.) lung

120
Q

which five conditions are associated with metastatic bone tumors in children

A

1.) neuroblastoma
2.) Wilms tumor
3.) osteosarcoma
4.) Ewing sarcoma
5.) rhabdomyosarcoma

121
Q

what are the two main types of joints

A

solid (non-synovial)
cavitated (synovial)

122
Q

what is a solid (non-synovial joint)

A

provides structural integrity
ex. pubic symphysis

123
Q

what is a cavitated (synovial) joint

A

provides a wide range of motion
ex. fingers

124
Q

which type of joint is associated with rheumatoid arthritis

A

cavitated (synovial)

125
Q

what is hyaline cartilage

A

serves as an elastic shock absorber
made mostly of water but also of type 2 collagen

126
Q

what is osteoarthritis (degenerative joint disease)

A

degeneration of cartilage that causes failure of synovial joints

127
Q

what is the most common type of joint disease

A

osteoarthritis (degenerative joint disease)

128
Q

what are 4 things that pose a risk factor for osteoarthritis (degenerative joint disease)

A

1.) diabetes
2.) less physical activity
3.) infection
4.) obesity

129
Q

osteoarthritis most commonly affects what in women

A

hands and knees

130
Q

osteoarthritis most commonly affects what in men

A

hips

131
Q

what are Heberden nodes

A

prominent osteophytes at the distal interphalangeal joints that are common in women

132
Q

osteoarthritis (degenerative joint disease) mostly affects which age range of people

A

those over 70

133
Q

what are the 4 things seen grossly in osteoarthritis

A

1.) fibrillation
2.) bone eburnation
3.) subchondral cysts
4.) osteophytes

134
Q

what is fibrillation

A

characteristic of osteoarthritis

granular fissures and clefts in the cartilage

135
Q

what is a bone eburnation

A

characteristic of osteoarthritis

exposed subchondral bone that appears like polished ivory due to friction

136
Q

what are osteophytes

A

characteristics of osteoarthritis

mushroom-shaped bony outgrowths

137
Q

what is rheumatoid arthritis

A

autoimmune chronic inflammatory disorder

138
Q

who, women or men, are most at risk for rheumatoid arthritis

A

women (x3)

139
Q

rheumatoid arthritic lesions are most commonly found in which four locations

A

1.) skin
2.) heart
3.) blood vessels
4.) lungs

140
Q

what are the four main histologic features of rheumatoid arthritis

A

1.) synovial cell hyperplasia
2.) angiogenesis
3.) exudate
4.) osteoclastic activity

141
Q

what is an important feature of rheumatoid arthritis

A

production of a pannus (mass of synovium, inflammatory cells, granulation tissue, and fibroblasts)

142
Q

what are rheumatoid subcutaneous nodules

A

nodules that form in the case of RA in areas subjected to pressure

143
Q

what is juvenile idiopathic arthritis (JIA)

A

disorders that present with arthritis in those under 16 years of age
often systemic and affect the large joints

144
Q

what is ankylosing spondylitis

A

destruction of articular cartilage and bony fusion of the spine

145
Q

which two joints are most commonly affected by ankylosing spondylitis

A

sacroiliac and apophyseal joints

146
Q

reactive arthritis can be associated with which three conditions

A

1.) HIV
2.) chlamydia
3.) GI tract infections

147
Q

what is psoriatic arthritis

A

chronic inflammatory arthropathy associated with psoriasis

148
Q

psoriatic arthritis mostly affects which three things

A

sacroiliac joint, hands, and feet

149
Q

what is an important feature of psoriatic arthritis

A

pencil in cup deformity

150
Q

suppurative arthritis is often associated with which condition

A

osteomyelitis

151
Q

suppurative arthritis is seen often in which demographic of people

A

drug users

152
Q

viral arthritis is associated with which 4 conditions

A

1.) rubella
2.) EBV
3.) HCB and HCV
4.) HIV

153
Q

what is crystal induced arthritis

A

articular crystal deposits are associated with a variety of acute and chronic joint disorders

154
Q

what are the two types of crystals that cause crystal induced arthritis

A

endogenous and exogenous crystals

155
Q

what are two examples of endogenous crystals

A

monosodium urate (gout)
calcium pyrophosphate dehydrate (pseudogout)

156
Q

what are three examples of exogenous crystals

A

1.) corticosteroid ester crystals
2.) talcum
3.) silicone

157
Q

gout crystals are made of what

A

monosodium urate crystals (MSU)

158
Q

what is the pathognomonic feature of gout

A

tan-white chalky deposits

159
Q

what is important in processing gout specimens

A

do not place in formalin - only use alcohol

160
Q

what is seen under the polarizing light in a case of gout

A

needle-like crystals

161
Q

who, men or women, are more affected by gout

A

men over 30

162
Q

gout is associated with which four conditions

A

1.) alcohol
2.) obesity
3.) renal failure
4.) drugs

163
Q

pseudogout crystals are made of what

A

calcium pyrophosphate

164
Q

what is the histologic appearance of pseudogout

A

rhomboid crystals

165
Q

which, benign or malignant, soft tissue tumors are most common

A

benign

166
Q

which four conditions are associated with soft tissue tumors

A

1.) neurofibromatosis 1
2.) gardner syndrome
3.) Li-Fraumeni syndrome
4.) Olser-Weber Rendu syndrome

167
Q

what are the two types of soft tissue tumors and which is more common

A

simple
complex

168
Q

what are the two main types of simple soft tissue tumors

A

Ewing sarcoma
synovial sarcoma

169
Q

what are the two main types of complex soft tissue tumors

A

leiomyosarcomas
undifferentiated sarcomas

170
Q

what is the most common soft tissue tumor of adulthood

A

lipoma

171
Q

what are the 5 subclassifications of lipomas

A

1.) conventional
2.) fibrolipoma
3.) angiolipoma
4.) spindle cell
5.) myelolipoma

172
Q

liposarcomas mostly affect which age range

A

50 to 60 year olds

173
Q

what are the three histologic subtypes of liposarcomas

A

1.) well differentiated
2.) myxoid
3.) pleomorphic

174
Q

what is the histologic appearance of a well-differentiated liposarcoma

A

fat and spindle cells

175
Q

what is the histologic appearance of a myxoid liposarcoma

A

basophilic extracellular matrix and arborizing capillaries

176
Q

what is the histologic appearance of a pleomorphic liposarcoma

A

anaplastic cells and lipoblasts

177
Q

what is nodular fasciitis

A

proliferation of fibroblasts and myofibroblasts within the soft tissue, usually due to trauma

178
Q

nodular fasciitis mostly affects which area of the body

A

upper extremities

179
Q

superficial fibromatoses mostly affects men or women

A

men

180
Q

what are the three main types of superficial fibromatoses

A

1.) palmar (dupuytren contracture)
2.) plantar
3.) penile (peyronie disease)

181
Q

deep fibromatoses most commonly affects men or women

A

women

182
Q

what is the most common benign primary cardiac tumor in infants and children

A

rhabdomyoma

183
Q

what are the four subtypes of a rhabdomyosarcoma

A

1.) alveolar
2.) embryonal
3.) pleomorphic
4.) spindle cell/sclerosing

184
Q

which subtype of rhabdomyosarcoma is most common

A

embryonal

185
Q

what is seen histologically in an embryonal rhabdomyosarcoma

A

spindle cells and myxoid stroma

186
Q

what is seen histologically in an alveolar rhabdomyosarcoma

A

fibrous septae resembling those in pulmonary alveoli

187
Q

a leiomyosarcoma is most commonly found in which two areas

A

extremities and retroperitoneum

Basic Human Pathology 2 (14 decks)

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