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Pathology eLearning - Y5 > Bone Tumours > Flashcards

Bone Tumours Flashcards

1
Q

What are different classifications of fractures?

A

Complete or Incomplete

Closed (Simple): Clean break with intact soft tissue

Comminuted: Splintered bone with intact soft tissue

Compound: Fracture site communicates with skin surface

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2
Q

What are the stages of fracture repair?

A

Organisation of haematoma at fracture site (pro-callus)

Formation of fibrocartilaginous callus

Mineralisation of fibrocartilaginous callus

Remodelling of bone along weightbearing lines

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3
Q

What is this?

A

Fractured bone

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4
Q

What is this?

A

Repaired fracture

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5
Q

What is this?

A

Fracture callous - can be mistaken for osteosarcoma

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6
Q

What are factors influencing fracture healing?

A

Type of fracture

Presence of infection

Pre-existing systemic condition:

  • Neoplasm
  • Metabolic disorder
  • Drugs
  • Vitamin deficiency

Pseudoarthrosis may result

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7
Q

What are common sites of osteomyelitis?

A

Adults:

  • Vertebrae
  • Jaw (2º to dental abscess)
  • Toe (2º to diabetic skin ulcer) (>3mm)

Children:

  • Long bones (usually metaphysis)
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8
Q

What are clinical features of osteomyelitis?

A

General: Malaise, fever, chills, leucocytosis

Local: Pain, swelling and redness

60% positive blood cultures

X-ray: Mixed picture eventually lytic

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9
Q

What are common causative organisms of osteomyelitis?

A

Almost always bacterial

Rarely fungal

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10
Q

What are routes of infection for osteomyelitis?

A

Haematogenous (blood borne)

Direct extension

Traumatic (inc surgery)

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11
Q

What are the causative bacterial species in adults with osteomyelitis?

A

Staph Aureus(90%)

E. Coli

Klebsiella

Salmonella (associated with sickle cell disease)

Psuedomonas (IVDA)

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12
Q

What are the causative bacterial species in neonates with osteomyelitis?

A

Haemophilus influenzae

Group B Streptococcus

Occasionally enterobacter

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13
Q

What is this?

A

Core biopsy - Osteomyelitis

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14
Q

What are common X-Ray changes of osteomyelitis?

A

Usually appear 10 days or so post onset

Mottled rarefaction and lifting of periosteum

>1week: Irregular sub-periosteal new bone formation called involucrum

Later: Irregular lytic destruction (takes 10-14 days)

Some areas of necrotic cortex may become detached called sequestra (takes 3-6 weeks).

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15
Q

What is the Cierny-Mader staging system for osteomyelitis?

A

Anatomic type:

  • Stage 1: Medullary OM
  • Stage 2: Superficial OM
  • Stage 3: Localised OM
  • Stage 4: Diffuse

Physiologic class:

  • Host A: Normal
  • Host B: Local or systemic compromise
  • Host C: Treatment worse than disease
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16
Q

What is the association between TB and osteomyelitis?

A

Rare cause of OM (3-5% cases of extra-pulmonary TB). Affects immunocompromised patients. More destructive and resistant to control.

Spinal disease (50% cases) may result in psoas abscess and severe skeletal deformity (Pott’s disease).

Systemic amyloidosis may result in protracted cases.

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17
Q

What is the association between of syphillis and osteomyelitis?

A

Another rare cause of OM (Treponema pallidum)

May be congenital or acquired

Congenital skeletal lesions:

  • Osteochondritis
  • Osteoperiostitis
  • Diaphyseal osteomyelitis
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18
Q

What are late skeletal lesions associated with syphillis?

A

Non-gummatous periostitis

Gummatous inflammation of bone and joints

Neuropathic joints (Tabes Dorsalis)

Neuropathic shaft fractures

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19
Q

What is Lyme Disease?

A

Inflammatory arthropathy as part of a complex multisystem illness resulting from tick bite. It is the most prevalent vector bone disease in temperate Northern hemisphere.

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20
Q

What is the organism and tick species causing Lyme Disease?

A

Organism: Borrelia burgdorferi

Tick Species: Ixodes dammini

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21
Q

What is the epidemiology of Lyme Disease?

A

Affects both sexes equally.

Onset between May and November

22
Q

What are the three clinical stages of Lyme Disease?

A

Stage 1: Early localised

Characterised by rash (90%) usually within 7-10 days and between 1 & 50cm diameter. Often thigh, groin, axilla (earlobe in children).

Stage 2: Early Disseminated

Effects many organs, musculoskeletal, heart, nervous system.

Stage 3: Late, persistent

Dominated by arthritis.

23
Q

What is the management of Lyme Disease?

A

Treatment is based on prevention.

Vaccines are available.

Antibiotics for proven disease.

No effective prophylaxis.

Diagnosis is clinical. No specific histological features.

24
Q

What is osteoarthritis?

A

Degenerative joint disease

25
What is primary and secondary osteoarthritis?
**Primary:** Age related **Secondary:** Any age, previously damaged or congenitally abnormal joint.
26
What is this?
Osteoarthritis - femoral head
27
What is this?
Femoral head avascular necrosis
28
What is the aetiology of osteoarthritis?
Biomechanical factors Biochemical factors Ageing Genetic
29
What is the result of osteoarthritis?
Cartilage degeneration Fissuring Abnormal matrix calcification Osteophytes
30
Where are common sites for osteoarthritis?
Main sites vertebrae hips and knees DIPJ/PIPJ of the hand Carpometacarpal and metatarsophalangeal joints
31
What is this?
Synovium in OA
32
What is rheumatoid arthritis?
Severe chronic relapsing synovitis Unpredictable course
33
What is the epidemiology of rheumatoid arthritis?
Incidence 1% world population (Europeans 0.3-1%; Asians 0.1-1.5%; Native Americans 5-7%) 3F:1M Age 30-40y
34
What is the aetiology of rheumatoid arthritis?
Aetiology: Most likely autoimmune 80% patients RF +ve RF mostly IgM RF forms immunocomplexes with IgG These circulating immune complexes may underlie associated extra-articular disease.
35
What are risk factors for rheumatoid arthritis?
Genetic predisposition (risk alleles TNFA1P3, STAT4) Increased incidence amongst first degree relatives Associated with HLA DR4 & DR1 (Chr 6p21)
36
What are clinical features of rheumatoid arthritis?
Mild anaemia Raised ESR RF+ve(80%) +/- Rheumatoid nodules (25%) Can be multisystem disease
37
What are characteristic sites for rheumatoid arthritis?
Radial deviation of wrist Ulnar deviation of fingers ‘Swan neck’ & ‘Boutonniere’ deformity of fingers ‘Z’ shaped thumb
38
What are differentiating features between RhA and OA?
RhA: * Symmetrical * Small joints, hands and feet, sparing DIPJ * Wrists elbows ankles and knees
39
What is the histology of RhA?
Proliferative synovitis with: * Thickening of synovial membranes (villous) * Hyperplasia of surface synoviocytes * Intense inflammatory cell infiltrate * Fibrin deposition and necrosis Pannus is the exuberant inflamed synovium the articular surface
40
What is this?
Rheumatoid Arthritis
41
What is the inflammatory features of RhA?
Proliferative synovitis Associated upregulation of CFos /AP1 and osteoporosis, IL1β and TNFα Intense inflammatory cell infiltrate Production of IL6, TNFα and CRP by liver IL1 & IL6 induce MMPs – joint destruction Circadian rhythm of host disturbed
42
What are these?
Grimley-Sokoloff cells
43
What are the 5 stages of RhA?
* Unknown antigen reaches synovial membrane * T–cell proliferation associated with increased; B-cells and angiogenesis * Chronic inflammation with inflammatory cytokines * Pannus formation * Cartilage and bone destruction
44
What is this?
Gout
45
What is gout?
Affects any joint but great toe in 90% Usually limited to lower extremities Precipitate of needle shaped crystals into joint Tophus is the pathognomic lesion
46
What is this?
Gouty tophus
47
What is this?
Urate crystals
48
What are features of pseudogout?
**Calcium pyrophosphate:** Mainly knees **Calcium phosphates (hydroxyapatite):** Knees and shoulders Usual age \> 50y
49
What is this?
Ca pyrophosphate crystals
50
What is this?
Calcium pyrophosphate crystals
51
What is this?
Calcium pyrophosphate crystals
52
What are subsets of pseudogout?
**Sporadic:** 8% pts \<75; 22%\>85 ?F\>M **Metabolic:** Haemochromatosis, primary HPT, hypoMg; low PO4 **Hereditary (autosomal dominant) ANKH mutn:** Transmembrane glygoprotein. Chr 8q, 5p, younger age 18% OA knee; 10% hip) **Traumatic**

Pathology eLearning - Y5 (17 decks)

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