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SYSTEMIC PATHOLOGY > bones and joints > Flashcards

bones and joints Flashcards

1
Q

inflammatory diseases

A

CAID

  • crystals formation (gout, pseudogout)
  • autoimmune (RA)
  • infection (septic arthritis/ osteomyelitis)
  • degenerative (OA)
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2
Q

OA presentation (3) + pathology

A

presentation:

  • generalised OA - post-menopausal
  • erosive inflammatory OA - destructive, quick progression
  • hypertrophic OA - ostophyte (bone spurs)

pathology

  • eburnation** (bone rub bone)
  • subchondral bone cyst
  • thickened joint
  • inflammation of synovium - synovitis
  • degeneration of articular cartilage
  • bone spurs
  • sclerosis
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3
Q

what is RA+ who is more susceptible

A

chronic inflammatory autoimmune disease: CD4+ T cells.
RF and ACPA antibodies produced
-> destructive granulation tissue (pannus) formed + synovial inflammation
bone erosion**
affecting joints - esp proximal (UL)
more common in women

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4
Q

RA histology

A 
rheumatoid nodules
fibrinoid necrosis (granuloma) in the centre
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5
Q

crystals formation and deposition

  • analysis
  • location
  • 2 types
A

deposited in joints and soft tissue
gram stain, culture, crystal analysis
- gout + pseudogout

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6
Q

gout pathogenesis + risk factors

A

caused by increased serum uric acid
-> form urate crystals that deposit in the bone

primary: obesity, alcohol, HTN, fatty diet
secondary: anything that causes hyperuricemia

pathogenesis:

  • over-production of purines
  • catabolism
  • kidney failure: uric acid cannot get eliminated
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7
Q

gout complications

A
  • deformities, erosion of joints
  • gouty tophi
  • renal stones/ renal failure
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8
Q

gout crystals examintaion

A

polarised light to examine synovial fluid

birefringent (refractive) needle shaped crystals

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9
Q

pseudogout crystals made of what + shape

A
  • calcium pyrophosphate (chondrocalcinosis)

- rhomboid shaped, weakly birefringent

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10
Q

inflammation caused by infection - osteomyelitis

  • common cause of infection
  • way of entering the bone
A
  • staph aureus** (most common)
  • E.coli, Group B strep, anaerobes
  • direct implantation - trauma
  • blood (lung TB)*
  • contiguous spread (share a border) - middle ear infection
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11
Q

osteomyelitis clinical presentations + where does it happen

A

tuberculosis
pain, swelling, fever

children: UL/LL
adults: LL, spine

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12
Q

osteomyelitis pathogenesis

A

bacteria and inflammation spread within shaft of the bone, harversian system and periosteum* (similar to osteosarcoma
(periosteum: impair blood supply -> bone necrosis -> sequestrum (bone within bone)
may also spread to synovium -> septic arthritis

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13
Q

osteomyelitis complications

A
  • fracture and deformity
  • amyloidosis
  • distal infection
  • malignant transformation
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14
Q

TB osteomyelitis

A

highly destructive - extensive necrosis
chronic inflammation - epithelioid granulomas + caseating necrosis
usually affects the spine

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15
Q

TB osteomyelitis complications

A
  • compression fractures
  • severe deformities - kyphosis (hunchback)
  • compress spinal cord and nerves -> neurological deficits
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16
Q

metabolic bone diseases (4)

A

(POOO)

  • osteoporosis (reduced bone mass)
  • osteomalacia and rickets (mineralisation defects)
  • osteitis fibrosa cystica (excessive bone resorption)
  • paget’s disease (uncontrolled resorption + uncoordinated osteoblastic effects - formation of new bone)
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17
Q

osteoporosis

  • how to measure
  • characteristics (serum ca/hormones, mineralisation)
A

reduced bone mass - BMD <2.5
BMD measurement = X ray absorptiometry at hip/lumbar spine
thinned and reduced trabeculae -> increase risk of fracture
- but normally mineralised!! (osteomalcia has decreased mineralisation)
- normal serum ca/phosphate
- normal ALP (alkaline phosphatase protein: tests liver/bone fn)
- normal PTH hormone

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18
Q

causes of osteoporosis (primary + secondary)

+ site

A

primary: post-menopause cause of estrogen def
estrogen def
-> increase inflammatory cytokines
-> osteoclast recruitment = bone resorption
increase both bone resorption and formation (but resorption more) = overall bone resorption

secondary: decrease in calcium intake/absorption
- GIT/endocrine, drugs

affects spine, fracture of femur/wrist

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19
Q

osteomalacia cause

A

defect in mineralisation (calcification) cause of vit D def

- > weak bone: microfactures/softening of bone
children: bowing of legs, may even distort skull

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20
Q

rickets pathogenesis

A

disturbances of endochondral ossification
-> overgrowth of epiphyseal cartilage - cartilage cells cannot mature

non-calcified, hypertrophied growth plate

21
Q

vit D def causes

A
  • inadequate dietary intake
  • lack of sun exposure
  • GI problems -> malabsorption (IBD, bowel resection, celiac disease)
  • renal disease: vit D cannot be converted to active form
22
Q

osteitis fibrosa cystica pathogenesis

- serum calcium/phosphate levels

A

excessive bone resorption by osteoclasts - because of increased PTH hormones

  • high serum calcium (cause of the bone resorption), low serum phosphate
  • loss of bone mass
  • the bone loss replaced by fibrous tissue
23
Q

osteitis fibrosa cystica complications

A
  • formation of brown tumour: cystic solid lesion

developed cause of the osteoclasts

24
Q

Paget’s disease

A

disorderly bone formation cause of excessive/disorganised bone resorption + formation
-> distorted bone architecture
mosaic pattern of lamellar bone, irregular w/ collagen fibres

25
Q

Paget’s disease affects who + sites

A
  • elderly and caucasian

- mainly polyostic - pelvis, spine, skull

26
Q

complication of Paget’s disease

A
  • bone overgrowth -> OA
  • chalkstick fractures (affect long bones that become brittle)
  • nerve compression
  • CVS issues cause of hypervascularity of bone
  • osteosarcoma
27
Q

types of bone tumours

A
  • osteosarcoma - children/young adults** most common
    malignant
  • Ewing sarcoma (EWS)/ PNET** - children/ young
    ^ respond to chemotherapy
  • chondrosarcoma** - older pts (malignant)
  • chondroma, osteochondroma (benign)
  • giant cell tumours
  • fibrous/ fibro-osseous tumours
28
Q

primary malignant bone tumour presentation

A

pain, swelling
possibly fracture, loss of fn
fever, anemia, weight loss, elevated WBC & ESR (cause of inflammation)

may metastasise: lungs, bone, bone marrow

29
Q

investigation of bone tumours

A
  • X-ray** first line!!
  • MRI - relations: nerves/vessels
  • radionuclide scan: detect metastasis
  • PET scan: detects spread to see if tumour is malignant
  • biopsy
30
Q

osteosarcoma

- who it affects more

A

malignant, high grade
produces osteoid from tumour cells

  • males high proportion
  • 10-25 yrs
31
Q

osteosarcoma on x-ray

A

destructive
lytic masses
permeative margins - arises within medullary cortex -> breaks through cortex & periosteum (like septic arthritis)
- tumour: bone formation in soft tissue -> SUNBURST pattern
- affects long bones of LL (femur, tibia, humerus)
- lots of necrosis & hemorrhage -> fleshy appearance

32
Q

osteosarcoma histology

A

osteoid** produced by eosinophilic matrix (diagnosis)

33
Q

EWS

- who it affects more

A

2nd most common malignant bone tumour in children, esp <10yrs
affects 5-25yrs, more common in males

34
Q

EWS on x-ray

A

destructive
poorly marginated + permeative
layered periosteum -> “onion skinning’

35
Q

EWS on histology

A

small, round, uniform blue cells
arranged around vessels
+ve w. CD99 stain**

  • differentials:
    lymphomas, rhabdomyosarcoma, metastatic carcinoma, neuroblastoma, small cell osteosarcoma
36
Q

chondrosarcoma

A
  • malignant
  • produces cartilage
  • DOES NOT produce osteoid
  • painful, large
37
Q

chondrosarcoma

  • who it affects more
  • sites
  • reacts to chemo?
A

males, 30-60yrs (older pts)
sites: long bones/ ribs (>8cm) that grow rapidly during adolescence
does not respond to chemo

38
Q

macroscopic chondrosarcoma

A

large lobulated tumour w/ focal calcification

hemorrhagic necrosis present

39
Q

microscopic chondrosarcoma

A

cartilaginous matrix
permeation of bone trabeculae
soft tissue and marrow invasion

40
Q

osteochondroma

A

benign* - most common benign tumour
arises from long bones

  • overgrowth of bone - bone extension containing cortex and periosteum covered by a thin cartilaginous cap
41
Q

types of chondroma

A
  • enchondroma: medullary cavity
    Ollier’s disease; Maffucci syndrome
    solitary enchondromas: caused by heterozygous mutations of IDH genes
  • subperiosteal chondroma: surface of bone
  • soft tissue chondroma: inside soft tissue
42
Q

differences in benign and malignant bone tumour

A
  • permeation of bone trabeculae and marrow

- soft tissue & organ invasion

43
Q

giant cell bone tumour

A

benign, but locally aggressive (does not metastasise distally)
most common skeletal neoplasm

44
Q

giant cell bone tumour

  • who it affects more
  • site
A 
oriental countries (SEA)
affects females more
  • affects long tubular bones (knee)
  • epiphyseal-metaphyseal region (growth plate)
45
Q

giant cell tumour characteristics

A
  • NO osteoid formation
  • NO malignant transformation
  • abundant giant cell w/ numerous nuclei
46
Q

non-ossifying fibroma

  • who it affects
  • site
A

benign
affects children
metaphysis of long bones (esp femur)
micro: cellular lesions, fibroblasts, activated macrophages, giant cells

47
Q 
fibrous dysplasia (FD)
\+ 2 polyostotic examples
A 
benign
developmental arrest: does not develop into mature bone structure 
mutation in GNAS1 gene**
- Mazabraud syndrome
- McCune-Albright
48
Q

FD microscopy

A

tan-white and gritty (sandy)

histo:
trabeculae surrounded by fibroblastic proliferation
trabeculae is curvilinear

SYSTEMIC PATHOLOGY (27 decks)

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