Multisystem Flashcards by Taylor Flynn

Pathology?

Osteoporosis

increased resorption and decreased bone formation; overall organic to mineral matrix balance remains the same, but spicules are smaller, thinner, and more fragile

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Osteomalacia

overabundance of organic matrix that is not mineralized, due to a deficiency of vitamin D; see widening of osteoid seams

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Paget’s disease (osteitis deformans)

caused by infection of osteoclasts by Paramyxovirus; osteolytic stage (osteoclast stimulated by virus, resorbs bone) => osteolytic/osteoblastic stage (lysis of bone continues, but also osteoblastic activity laying down abnormal bone) => mosaic pattern

often incidental finding

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Osteomyelitis

infection of the bone (60% S. aureus; Beta hemolytic strep next most common)

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Radiographic finding?

Buttress

periosteal reaction caused by slow-growing tumors that provoke cortical thickening

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Codman’s triangle

elevation of periosteum to a significant degree, forming and acute angle

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Hair-on-end appearance

periosteal reaction due to new bone formation

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Osteoid

cloud-like or ill-defined amorphous densities with haphazard mineralization

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Chondroid

focal stippled or flocculent densities, or in lobulated areas, as rings or arcs of calcifications

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Osteoid osteoma

benign, bone-producing neoplasm; small size, limited growth potential, but causes extensive reactive changes in surrounding tissues

10-25 years; 50% in femur and tibia

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Osteoid osteoma

thin, often interconnected spicules of osteoid and woven bone rimmed by osteoblasts; osteoclast-like giant cells can be seen; intervening fibrous stroma shows prominent vascularity; without significant nuclear atypia

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Osteoblastoma

rare, bone-producing neoplasm

second and third decades; axial skeleton (spine and sacrum), mandible, and other craniofacial bones

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Osteoblastoma

resembles osteoid osteoma; osteoblasts and osteoclast-like giant cells rim interconnected spicules of osteoid and woven bone; intervening stroma shows prominent vascularity; no significant atypia

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Osteosarcoma

malignant tumor of neoplastic mesenchymal cells synthesizing osteoid or immature bone

second decade; distal femur and proximal tibia, proximal humerus

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Osteosarcoma

highly pleomorphic cells and haphazard deposits of osteoid; anaplastic features and mitotic activity; lace-like pattern

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Osteosarcoma

highly pleomorphic cells and haphazard deposits of osteoid; anaplastic features and mitotic activity; lace-like pattern

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Osteochondroma

cartilage-capped outgrowth attached to underlying bone by a bony stalk

M>F; usually stops growing when skeletal maturity reached

EXT1 and EXT2 gene deletions (q24 of chromosome 8, p11-12 of chromosome 11)

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Osteochondroma

uniform, cartilaginous cap with stippled calcifications; cortex and medulla are continuous with those of lesion

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Chondroma

common, benign, intramedullary bone tumor composed of mature hyaline cartilage

third and fourth decades; limited growth potential

vague lobularity (soap bubbles)

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Chondroma

abundant cartilaginous matrix, can be focally calcified; low cellularity; clustered and scattered chondrocytes with small, uniform, darkly staining nuclei; occasional binucleated chondrocytes

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Chondroblastoma

rare, benign neoplasm occurring second decade when growth plates are still open

70% in proximal humerus and knee, invariably at EPIPHYSIS

irregular but circumscribed, radiolucent epiphyseal lesion surrounded by reactive bone sclerosis

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Chondroblastoma

highly cellular, sheets of round to polygonal cells; multiple small foci of immature bluish-pink chondroid give a lobular appearance; multinucleated giant cells; chicken-wire (right photo) calcification

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Chondromyxoid fibroma

well-defined, expansile lytic lesion, centered at metaphysis and bordered by sclerotic rim

<40 years, peak incidence 10-20 years; 30% in knee area

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Chondromyxoid fibroma

moderately cellular chondromyxoid tissue with vague lobularity and mildly pleomorphic, angular and stellate cells set in bluish-pink chondromyxoid stroma

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Chondrosarcoma malignant, cartilage-producing tumor 30-50 years, extremely rare in children; bones of trunk (pelvis), femur, and humerus

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Chondrosarcoma large, lobulated, ill-defined lesion; moderately cellular, atypia

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Non-ossifying fibroma common, non-neoplastic, self-healing lesion occurring in skeletally immature individuals 5-20 years often incidental findings sharply demarcated, lucent, lobulated, meta-diaphyseal lesion surrounded by sclerotic rim

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Non-ossifying fibroma moderately cellular lesion composed of uniform spindle cells in a storiform pattern and scattered giant cells; mitotic figures easily found; foamy histiocytes (xanthoma cells) and hemosiderin-laden macrophages

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Fibrous dysplasia inability of tissue to produce mature lamellar bone; benign fibro-osseous lesion; 10-25 years; intramedullary location long bones (ribs, femur, tibia, jaw, humerus) in metaphysis or diaphysis

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Fibrous dysplasia thin wavy spicules of woven bone; lack of osteoblastic rimming or osteoclastic activity

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Giant cell tumor relatively uncommon, locally aggressive neoplasm that may produce bone destruction and soft tissue destruction 20-50 years 65% in distal femur, proximal tibia, and distal radius well-defined, lytic lesion eccentrically located in epiphysis with subchondral and metaphyseal extension

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Giant cell tumor multinucleated giant cells in a background of small, ovoid, mononuclear stromal cells with poorly defined cytoplasmic borders

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Ewing's sarcoma arises in medullar cavity, invades cortex and periosteum, and frequently produces soft tissue mass 80% occur between 5-20 years diaphysis of femur, tibia, humerus, pelvis, and ribs

Pathology?