Bone pathology Flashcards
Composition of bone
65% inorganic (calcium hydroxyapatite)
35% organic (protein matrix, bone cells)
3 types of bone cell + functions
Osteoblasts - build bone + stimulate osteoclast dev by RANKL
Osteoclasts - chew bone
Osteocytes - osteoblast-like
2 types of mature bone
- Cortical (highly calcified, densely packed osteons, outer bone)
- Cancellous ‘trabecular’ (less calcified metabolic large SA, gaps filled with BM, inner bone + epiphyses)
Stages of bone development
Woven bone (collagen fibres in irregular directions) Lamellar bone (collagen fibres in parallel)
Bone anatomy
Diaphysis = shaft, epiphysis = head, metaphysis = boundary
Diaphysis = inner cancellous, outer cortical
Largest bone cells
Differentiation regulated by RANK-L
Osteoclasts
First presentation NOF # (vertebrae, Colles, NOF) Elderly woman falls over Thin bone + enlarged Haversian canals No demineralisation of bone Bone density DEXA >2.5SD below normal
Osteoporosis
Bone demineralisation
Pseudofractures, bone deformity + widened epiphyses
Proximal muscle weakness
Low calcium + phosphate
Osteomalacia (Rickets in children)
Chaotic bone turnover Raised ALP Bony pain and deformity Deafness due to CNVII compression Mosaic lamellar bone + huge osteoclasts Lytic + sclerotic lesions
Paget’s disease
Osteitis fibrosis cystica
High calcium
Brown cell tumour
Hyperparathyroidism
No periosteal reaction
Well developed bone
Intraosseous, even calcification
Benign neoplastic bone disease (osteoid osteoma, osteoma, enchondroma, osteochondroma, fibrous dysplasia, simple bone cyst, osteoblastoma)
Acute periosteal reaction (e.g. Codman’s triangle, onion skin, sunburst)
Irregular bone formation
Extraosseous, irregular calcification
Malignant neoplastic bone disease
Osteosarcoma, chondrosarcoma, Ewing’s, giant cell
Children + adolescents
Histology: Sheets of small round cells, scanty cytoplasm, droplets of glycogen
CD99+, T11;22 translocation
X-ray: ‘Onion skin reaction’ of perisoteum
Ewing’s sarcoma
X-ray + organisms osteomyelitis
X-ray - lytic lesions 10d post onset
Organisms - S aureus adults, Hib / GBS children
Histology: Malignant chondrocytes
X-ray: Fluffy calcification, axial skeleton
Chondrosarcoma
“Cloud like fluffy calcification”
Codman’s triangle, sunburst appearance
Osteosarcoma
Multinucleated giant osteoblasts with surrounding spindle cells
Soap bubble appearance (lytic lesions in epiphysis)
Giant cell tumour
Renal osteodystrophy
Secondary hyperparathyroidism
GI polyps + multiple osteomas + epidermoid cysts
Gardner’s syndrome
Hands
Cotton wool calcification
Enchondroma (‘Ends in hands’)
Bulls eye appearance
Osteoid osteoma
Cartilage capped bony spurs (‘mushrooms’) on surface of bone
Teenage boys
Osteochondroma
Soap bubble osteolysis
Shepherd’s croook deformity
Chinese letters
McCune Albright (precocious puberty, cafe au lait spots)
FIbrous dysplasia
Lytic well defined lesion
Simple bone cyst
Speckled mineralisation
Osteoblastoma
Associated with Gardner’s syndrome (GI involvement)
Osteoma
Bowed legs
Renal failure
Raised PTH, low calcium + low vitamin D
Secondary hyperparathyroidism with chronic renal osteodystrophy (renal failure prevents vitamin D activation)