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Module 7 > Cartilage Pathology > Flashcards

Cartilage Pathology Flashcards

1
Q

how does long bone growth occur

A
  1. endochondral ossification
  2. mesenchymal condensation
  3. differentation into hyaline cartilage
  4. calcification
  5. vascular invasion
  6. ossification centres
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2
Q

what are the structures shown

A
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3
Q

what are the zones shown of the metaphyseal growth plate cartilage

A

R = resting zone

P = proliferation zone

H = hypertrophic zone

C = front of cartilage calcification & ossification (primary spongiosa)

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4
Q

what is the blood supply to the physeal growth plate and why is it important

A

branches of the epiphyseal artery supply the resting zones of the growth plate

branches of the metaphyseal artery form capillary loops at the metaphyseal side where endochondrial ossification occurs

integrity of this vascular supply is critical to the process of endochondral ossification

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5
Q

what is the articular epiphyseal cartilage complex (AECC)

A

immature skeleton (young growing animal)

articular cartilage overlies the temporary growth cartilage of the epiphysis cartilage (EC)

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6
Q

what are the structures

A

articular cartilage (AC)

epiphyseal cartilage (EC)

the physeal growth plate EC undergoes endochondral ossification

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7
Q

where does articular cartilage lie

A

overlies the temporary growth cartilage of the epiphysis

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8
Q

what is epiphyseal cartilage

A

highly dependent on a network of blood vessels (running in the cartilage canals) from perichondrium & subchondral bone

contributes to growth/development of epiphysis

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9
Q

what is articular cartilage

A

smooth glistening and white to bluish grossly

thickest in young and at sites of maximal weight-bearing

in adult skeleton

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10
Q

how are nutrients obtained for articular cartilage

A

no blood vessels, lymphatics and nerves

nutrients obtained by diffusion from synovial fluid

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11
Q

what makes up articular cartilage

A

chondrocytes (5% of tissue)

95% matrix secreted by chondrocytes

proteoglycans (aggrecan –> chondroitin sulphate, keratin sulphate) bind to hyaluronic acid to form a large aggregate with negative charge –> water (70-80% of matrix)

collagen mainly type II and also type V, VI, IX, X and XI

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12
Q

what are the key components of synovial joints

A

SZ = superficial zone resists shearing forces

mid and deep zones (MZ and DZ) function in shock absorption

TM = tidemark –> boundary between uncalcified articular cartilage and calcified cartilage

CC = calcified cartilage attaches articular cartilage to bone by its irregular (interlocking) interfaces

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13
Q

what is synovial fossae

A

some joints of ruminants, horses, pigs

non-articulating depressions near midline of joints

aquired during joint modelling the first months of postnatal life

central depressions with distinct borders and a smooth, blue to pink surface, reflecting the proximity of the subchondral capillary bed

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14
Q

what is important to note about the synovial fossae

A

synovial fossae should not be mistaken for lesions in the articular cartilage or as indicators of collapsed subchondral bone

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15
Q

what structure is this

A

synovial fossae

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16
Q

what is articular cartilage response to a superficial injury

A

response varies with nature of the insult and depth of lesion

superficial lacerations not penetrating the tidemark (no hemorrhage/inflammation) –> chondrocytes adjacent to the lesion proliferate in small clusters (chondrones) –> may produce new matrix but do not migrate into lesion

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17
Q

what is a full thickness articular cartilage injury response

A

penetrating subchondral bone –> hemorrhage –> hematoma –> inflammation –> PDGF + TGFB from platelets –> inflammation + mesenchymal cell proliferation chondrocytes –> produce matrix rich in proteoglycans and collagen II

defect filled with fibrocartilage

attached to adjacent hyaline articular cartilage

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18
Q

what is fibrocartilage repair tissue

A

similar to fibrous scar in other organs

replacement of articular cartilage at sites of deep injury

but adequate performance when subjected to mechanical loading

–> new bone formation (at base of the lesion) –> restoring the subchondral bone plate

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19
Q

what are matrix metalloproteinases (MMPs)

A

enzymes capable of matrix digestion

normal constituents of the matrix, but present in an inactive form

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20
Q

what are the types of metalloproteinases (MMPs)

A

gelatinases –> degradation of type I & basement membrane collagen

collagenases –> degradation of various collagen types (including type II)

stromelysins –> degradation of non-collagenous proteins/aggrecan

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21
Q

how can MMPs be activated

A

degenerating/reactive chondrocytes

inflammatory cells –> MMPs also active in cartilage/bone remodelling in endochondral ossification

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22
Q

what are tissue inhibitors of metalloproteinases (TIMPs)

A

in the matrix

control mechanism counterbalancing the destructive effects of activated MMPs

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23
Q

what are aggrecanases

A

degredation of aggrecans

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24
Q

what occurs when proteoglycans are lost

A

altered hydraulic permeability of cartilage –> interfering with joint lubrication –> further mechanical injury –> disruption of collagen fibres on articular cartilage surface –> surfaces of affected cartilage yellow-brown with a dull roughened appearance

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25
what occurs with progressive proteoglycan loss
collagen fibres condensation and clefting/fissuring (fibrillation) --\> loss of surface cartilage (erosion/ulceration) --\> exposure of subchondral bone with thickening (eburnation) --\> polished appearance due to direct bone on bone contact
26
what is primary degenerative joint disease (DJD)
no apparent predisposing cause common in older animals
27
what is secondary degenerative joint disease (DJD) and common examples
associated with underlying abnormalities of the joint or supporting structures abnormal directional forces and/or joint instability hip dysplasia cruciate ligament rupture
28
what is occuring
loss of staining in the superficial articular cartilage stroma due to proteoglycan loss pink cartilage --\> indicating loss of proteoglycans goes to fibrilation stage next slide
29
what is occuring here
superficial cartilage is necrotic and ragged groups of chondrocytes (chondrones) within the remaining articular cartilage fibrilation stage
30
what is occuring here
osteophytes (bony projection)
31
what is occuring here
eburnation dense sclerotic subchondral bone
32
what is chondrodysplasias
hereditary development cartilage disorders --\> abnormalities of skeletal growth --\> disproportionate dwarfism
33
what is lethal bulldog type bovine chondrodysplasia
extremely short limbs usually rotated short domed head with protruding mandible short vertebral column cleft palate large ventral abdominal hernia
34
what is lethal bulldog type bovine chondrodysplasia caused bye
mutations in aggrecan (ACAN) gene
35
what is spider lamb syndrome and what causes it
autosomal recessive with incomplete penetrance long limbs and neck shallow body scoliosis and/or kyphosis of thoracic spine point mutation in FGFR3 gene disorganized ossification centers resulting in variably sized and abnormally shaped and orientated vertebrae
36
what is texel sheep chondrodysplasia
autosomal recessive trait reduced growth rate, short neck and legs both articular and physeal cartilage --\> disorganization of chondrocytes foci of chondrolysis (loss of chondrocytes & matrix) coalescing into clefts/cystic spaces
37
what is chondrodysplasia in the alaskan malamute
recessive disproportionate, short legged dwarfism hemolytic anemia
38
what is feline physeal dysplasia & slipped capital femoral epiphysis
most common in male & overweight cats affected females often have affected male littermates young cats (2-4) but older than the age of expected physeal closure
39
what is the pathology of feline physeal dysplasia & slipped capital femoral epiphysis
persistence of dysplastic growth plates --\> disorganized chondrocyte clusters surrounded by abundant matrix changes also present in other physeal growth plates --\> only the proximal femoral physis fractures --\> because of shear forces at that site
40
what is being shown here
unilateral slipped capital femoral epiphysis
41
what is shown here
fracture through the persistent dysplastic physis
42
what is shown here
persistent physis --\> abnormal hypertrophic chondrocytes arranged in clusters instead of well organized columns
43
what is osetochondrosis
failure of endochondral ossification affecting articular-epiphyseal cartilage (AEEC) & physeal growth plate --\> young growing animals
44
what are the 3 eitologies of osteochondrosis
1. genetics: influence on body conformation --\> contribution to lesion development 2. trauma: promotes progression of osteochondrosis latens to more advanced lesions(many young pigs have early lesions but most resolve in --\> pigs that get more exercise lesions are more likely to progress to advanced lesions) 3. vascular factors: focal failure of vascular supply to growing cartilage --\> localized ischemic necrosis --\> initiation of early subclinical lesions
45
what are 3 forms/stages of osteochondrosis
1. osteochondrosis latens 2. osteochondrosis manifesta 3. osteochondrosis dissecans (OCD)
46
what is osteochondrosis latens
focal ischemic necrosis of growth cartilage but not articular cartilage of the AECC (articular-epiphyseal cartilage) cannot see nuclei just pink amorphous substance damage to vessel canals --\> ischemic damage
47
what is osteochondrosis manifesta
retention of necrotic cartilage --\> failure of endochondral ossification grossly or radiographically visible focus of cartilage necrosis in subchondral bone (may or may not show c/s, can resolve by gradual removal of necrotic cartilage focus)
48
what is osteochondrosis dissecans (OCD)
necrosis dissecting through articular cartilage with cleft formation often resulting in flaps of articular cartilage --\> clinically relevant lesion, irreversible complete separation and necrosis of the growth cartilage --\> flaps of cartilage
49
what is shown here
ostechondrosis latens
50
what is shown here
osteochondrosis manifesta persistent focus of necrotic cartilage (with necrotic cartilage canals\*) incorporated into the epiphysis by the ossification front
51
what is shown here
medial and humeral condyle flaps of articular cartilage separated by fissures and clefts from the surrounding intact cartilage
52
what is shown here
dissecting band of necrosis and separation extending along the deep growth cartilage and communicating with the articular surface
53
what are the predilection sites of osteochondrosis in swine
distal femur (esp. medial femoral condyle) humerus (condyles and head)
54
where are the prediliction sites of osteochondrosis
distal femur (medial condyle and both trochlear ridges) distal tibia (cranial intermediate ridge and medial malleolus) talus (trochlear ridges) articular processes of the cervical vertebrae
55
what are the prediliction sites of osteochondrosis in dogs
humerus (head and medial condyle) distal femur (both condyles) talus (medial and lateral trochlear ridges)
56
what are the prediliction sites of osteochondrosis in cattle
talus (medial and lateral trochlear ridges) distal femur (both trochlear ridges)
57
what are the predilection sites of osteochondrosis in general
sites of high dynamic load during movement/exercise
58
what is shown here
dog humerus head OCD usually young males of large and giant breeds grossly similar lesion common in middle-aged and older dogs as a result of cartilage erosion without pre-exisiting osteochondrosis
59
what is shown here
horse cervicle vertebral malformation-malarticulation osteochondrosis of the articular facet joints can contribute to invertebral joint instability could affect joint stability --\> displacement and compression of spinal cord leading to cervical stenotic myelopathy (wobbler syndrome)
60
what is shown here
osteochondrosis dissecans severe cleft and collapse distal femur extensive clefting and loss of articular cartilage on the lateral trochlear ridge small cartilage nodules (attempts at local repair) --\> produce matrix to fill the defect (ineffective because surface is disrupted)
61
what occurs after early lesions of articular osteochondrosis
lesions with cartilage canal necrosis and **ischemic chondronecrosis** in regions where cartilage canal vessels traverse the chondro-osseuous junction subclinical ischemic chondronecrosis preceding and predisposing to OCD and subchondral bone cysts process of traversing tissue junctions renders the canal vessels vulnerable to failure in the distal femur
62
what is occuring here
cartilage canal necrosis & ischemic chondronecrosis at the junction between AEEC and subchondral bone
63
what is occuring here
osteochondrosis manifesta medial femoral condyle cystic lesions in subchondral bone --\> extensive errosion and cavities in the subchondral bone
64
what is the difference between these lesions
pseudocyst lesion --\> unifromly radiolucent defect within bone area of ischemic chondronecrosis surrounded by epiphyseal trabecular bone
65
what is a true cyst lesion
granulation tissue containing dilated blood vessel with a thin or thick wall
66
what occurs with osteochondrosis in physeal growth plate cartilage
lesions distinct from OC and AEEC early lesions --\> cone shaped foci of retained cartilage extending into the metaphysis no necrotic cartilage
67
what is the possible pathogenesis of osteochondrosis in physeal growth plate cartilage
**trabecular microfractures in primary spongiosa** --\> **interference with vascular invasion** of mineralized cartilage during endochondral ossification --\> **persistence of hypertrophic zone chondrocytes** (retained wedges of hypertrophic cartilage in metaphysis)
68
what are proliferative lesions of cartilage
1. tumours and tumour like lesions chondroma chondrosarcoma osteochondroma feline osteochondromatosis 2. other synovial chondromatosis
69
what is a chondroma
benign tumour of cartilage rare in all species, most commonly reported in aged dogs & sheep slow growth rate, with deformation of affected bones generally painless swelling phalanges, cervical spine, ribs
70
what is a chondrosarcoma
malignant tumour of cartilage
71
where is chondrosarcoma more frequently found
more in dogs mostly med/large breeds also in cats more common in flat bones, pelvis, ribs, nasal turbinates (long bones possible) slow growth but with local invasion, possible recurrence following surgery metastatic spread less frequent and with longer latency compared with OSA
72
what are the signs of nasal, pelvic, long bone chondrosarcoma
nasal --\> sneezing and epitaxis pelvic --\> masses possibly associated with constipation, tenesmus, hind limb lameness long bones --\> painful swelling, pathological fractures
73
what are extraskeletal chondrosarcomas
heart arteries retroperitoneum bladder omentum lung
74
what is osteochondroma
cartilage capped osseous outgrowth arising from surface of a bone formed by endochondral ossification
75
what is monostotic and polyostotic osteochondroma
monostotic single bone affected --\> solitary osteochondroma polyostotic multiple bones affected --\> osteochondromatosis
76
what are the clinical signs of osteochondromas
depend on size and location disfigurement, lameness, pain, paresis, paralysis --\> typically enlarge in synchrony with physeal growth --\> growth ceases once the skeleton reaches maturity --\> continued growth after skeletal maturity suggests malignant transformation
77
what is occuring here
1. tumour in spinal process of vertebrae --\> compression of spinal cord 2. lesion in lumen of trachea causing partial obstruction of airway histological appearance: superficial cartilage layer and the presence of the islands of cartilage with associated lamellae of new formed bone (endochondral ossification)
78
what is feline osteochondromatosis
unlike osteochondromas in dogs and horses which are developmental disturbances that cease growth at skeletal maturity **feline osteochondromatosis shows progressive growth**
79
what does feline osteochondromatosis affect
typically affecting multiple bones (skull, ribs, vertebrae)
80
what causes feline osteochondromatosis
oncogenic retroviruses (FeLV, FeSV) detected in cases of osteochondromatosis speculated viral-induced proliferation
81
what is primary synovial chondromatosis
idiopathic nodular cartilagineous metaplasia of the synovium mostly dogs (large and giant purebreds)
82
what is presentation of primary synovial chondromatosis and how is it diagnosed
lameness and painful swelling of single joint cartilage nodules NOT visible with x-rays --\> can be detected with echo, CT and contrast arthography
83
what is secondary synovial chondromatosis
**associated with chronic degenerative joint disease (DJD)** nodules less numerous (compared with primary SC) and often mixed with other forms of synovial proliferation and metaplasia erosive changes in the articular cartilage are more marked than the synovial proliferation
84
what is occuring here
primary synovial chondromatosis very prominant nodules arising from synovial membrane
85
what is occuring here
**secondary synovial chondromatosis** nodules and thickening of synovial membrane pieces of articular cartilage that break free metaplasia of the hyperplastic synovium into cartilage, which undergoes ossification to form bony nodules (osteophyte formation) these lesions can detach and become free floating within the synovial fluid (joint tropi)
86
what does chondrodysplasia in Alaskin Malamute cause
Rx changes apparent as early as 7-10 d and more pronounced after 3 weeks - bowing of radius and ulna - lateral deviation and enlargement of carpus - sclerotic and abnormally shaped metaphyses **--\> disruption of the metaphyseal blood supply --\> impaired vascular invasion of the developing growth plate** irregular thickening of growth plates in the limb bones islands of hypertrophic cartilage extend into metaphysis --\> close to healing trabecular microfractures **growth plate lesions similar to rickets**
87
what is the difference between pseudocysts and true cysts in the subchondral bone of horse due to osteochondrosis
pseudocysts: result of ischemic necrosis of cartilage being incorperated at level of endochondral ossification resulting in radiolucent lesion in the trabecular bone and maybe even the metaphyseal growth plate true cyst: focus of ischemic chondro-necrosis affecting blood vessels in the subchondral bone with dilation of the blood vessels, microfractures, formation of granulation tissue, and formation of cystic lesion --\> can progress with collapse of the superficial articular cartilage

Module 7 (50 decks)

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