Path Pics Flashcards
Name the cell at each arrow.
top: osteoblasts
middle: osteocytes
bottom: osteoclasts
Name cells at arrow.
osteoblast
Name the structures at the arrows.
left black: osteoclast
right black: osteocyte
green: Howship lacunae (pits created by osteoclasts)
Name the structures at each arrow.
black: periosteum
blue: bone marrow
green: residual cartilage
Name the stages of bone formation at the epiphyseal plate.
green: proliferation
black: maturation
blue: mineralization
What type of bone is in each picture?
left: lamellar bone
right: woven bone (weaker, coarse random orientation): normally remodeled to lamellar
blue sclerae
osteogenesis imperfecta type I
small misshapen teeth due to dentin deficiency
osteogenesis imperfecta type I
lots of fractures in utero
osteogenesis imperfecta type II
top: marked reduction in both the marrow space and haversion system
bottom: abscence of osteoclasts and cortical-appearing bone
Osteopetrosis
top arrow: osteosclerosis
bottom arrows: Erlenmeyer flask shaped deformity
osteopetrosis
irregular bony trabeculae, increased number and containing residual strips of unremodeled cartilage (blue-gray within the pink)
osteoclasts are not increased
marrow cavity shows hematopoiesis (dark cells) but the size of the marrow cavity is markedly reduced by the excess, only partially ossified trabeculae
Osteopetrosis
distal ends of long bones are flared, frayed and cupped
distance between the distal end of the radius and metacarpal bones wider than normal (filled with osteoid)
Rickets
pigeon chest
Rickets
frontal bossing
Rickets
rachitic rosary
Rickets
bowing of the legs
Rickets
Normal costochondral junction of child on left. Describe Right.
Rachitic costochondral junction: palisades of cartilage is lost.
darker trabeculae are well formed bone. Paler trabeculae: uncalcified osteoid.
Rickets
normal bone
osteoporotic bone
Normal on left.
osteoporosis
Hip fracture
osteoporosis
acute osteomyelitis
osteomyelitis
Arrows? Disease?
gray: involcrum (subperiosteal shell of reactive viable new bone)
yellow: sequestrum (inner necrotic cortex)
Osteomyelitis
left: dark necrosis
middle: red hemorrhage
right: purulence
top and middle arrow: necrotic bone (EMPTY LACUNAE)
bottom arrow: neutrophils
osteomyelitis
osteomyelitis in diabetes
large area of necrosis and ulceration casued by small vessel atherosclerotic disease, peripheral neuropathy, impaired neutropinl function of diabetes
right: straight arrow: draining sinus; curved arrow: squamous carcinoma (white tissue)
wedge shaped pale infarct
osteonecrosis/ avascular necrosis
diffusely congested and hemorrhagic marrow
sickle cell crisis
normal bone marrow
What are the three phases numbered?
What is this?
- lytic
- mixed
- sclerotic
Paget’s
cotton wool appearance of skull
Paget’s disease
irregular thick, coarse cortex and replacement of normal cancellous bone with coarse, thick bundles of trabecular bone
Paget Disease of bone
mosiac or cement line pattern of lamellar bone
Paget disease of bone
von Kossa stain: calcified tissue is black
surfaces of bony trabeculae are covered with layer of unmineralized osteoid: persistant osteoid
osteomalacia/ Rickets
brown tumor: cystic and hemorrhagic, fibrous tissue and woven bone without matrix
hyperparathyroidism or osteitis fibrosa cystica
brown tumor: fibroblasts (left) mixed with osteoclasts (right) at edge of trabecula
hyperparathyroidism
top left: hemotympanum
top right: mastoid ecchymoses (Battle sign)
bottom: periorbital ecchymoses (raccoon eyes)
Basilar skull fracture
Location of all bone tumors for those less than 30.
Location of all bone tumors for those older than 30.
Common locations of blood lesions.
osteoma
on face
osteoma
sessile with polypoid shape around 3 cm
osteoma
dense compact bone within a paucicellular stroma
osteoma
colon polyps: gardner Syndrome
osteoma
epidermoid cyst: Gardner syndrome
osteoma
desmoid tumor: Gardner syndrome
osteoma associated
osteoid surrounded by a rim of reactive bone
osteoid osteoma
cortex of long bone
bony mass <2cm with radiolucent core (osteoid)
black arrow: nidus usually <1 cm
white arrow: surrounding bony sclerosis and cortical thickening
left arrow: randomly interconnected trabeculae of woven bone, prominently rimmed by a single layer of osteoblasts
right arrow: stroma surrounding the neoplastic bone consists of loose connective tissue containing dilated and congested capillaries
vertebrae: radiolucent lesion
osteoblastoma
anastomosing trabeculae of osteoid and woven bone rimmed by osteoblasts
osteoblastoma
codman trinagle: tumor margin destroys periosteal new bone before it ossifies (periosteom lifts)
osteosarcoma
top arrow: normal bone
orange arrow: osteosarcoma invading normal bone: poorly formed bone spicules in a hypercellular matrix of osteoid and numerous pleomorphic malignant cells (bottom arrow)
LACE LIKE
formation of MALIGNANT OSTEOID by tumor cells is diagnostic
tumor cells vary in size and shape and have hyperchromatic nuclei
bizarre tumor giant cells are common
mitoses (some abnormal: tripolar)
osteosarcoma
osteosarcoma making malignant cartilage
chondroblastic osteosarcoma
gray-white mass similar to normal cartilage (this one less well circumscribed than usual)
chondroma
numerous chondrocytes closely packed near the periphery in a pink ground substance that vaguely resembles normal cartilage
(normal in left corner)
chondroma
mushroom out of femur: starts as small outpouching of cartilage that grows proximally to the epiphyseal plate
osteochondroma
prominent cartilage cap over mature bone
osteochondroma
osteochondroma
radiolucent nodule of hyaline cartilage with scalloped endosteal surface (this one has an associated pathologic fracture)
enchondroma
cartilgae tumor (NO osteoid)
chondrosarcoma
knee joint: highly destructive; bulk of tumor is distal, invading tibia but crosses joint space (malignant)
chondrosarcoma
cells mimic normal chondrocytes: float in a chondroid-like matrix
chondrosarcoma
high power: large nuclei, high nuclear/cytoplasmic ratio, abundant mitotic figures
chondrosarcoma
> 5 cm and intramedullary
fibrous cortical defect (non-ossifying fibroma)
spindle cells in storiform pattern with scattered giant cells, histiocytes, cholesterol clefts, and hemosiderin
pinwheel
fibrous cortical defect (non-ossifying fibroma)
fibrous cortical defect (non-ossifying fibroma)
fibrous dysplasia
variably sized circumscribed, medullary, tan-white, gritty mass lesions
big ones like this one: distort and expand bone
fibrous dysplasia
poorly formed islets and trabeculae of woven bone, often with curvilinear shapes resembling Chinese characters, WITHOUT rim of osteoblasts
fibrous dysplasia
moderately cellular fibroblastic proliferation with lots of collagen surrounding poorly formed islets and trabeculae of woven bone (like Chinese character)
fibrous dysplasia
What are these?
What syndrome are they associated with?
What else is involved in this syndrome?
Cafe-au-lait skin
McCune-Albright syndrome
fibrous dysplasia, endocrine abnormalities (precocious puberty)
soap bubble on epiphysis
giant cell tumor of bone
regular and uniform distribution of stromal cells and giant cells
Giant Cell Tumor of Bone
fibroblastic activity and formation of reactive bone and osteoid
Giant Cell Tumor of Bone
white, fleshy, ill-defined tumor with extensive involvement of medulla and cortex with periosteal elevation
may be necrotic or resemble pus
Ewing sarcoma
small round uniform cells, indistinct cell membranes, glycogen rich cytoplasm may appear clear
little stroma, no spindling
Ewing sarcoma
post treatment: marked pleomorphism, tumor giant cells
periosteal reaction produces layers of reactive bone
ONION SKIN or SUNBURST
Ewing sarcoma
Homer Wright rosettes: dark blue tumor cells surrounding pink fibrillar material resembling neuropil suggestive of neural differentiation
Ewing sarcoma
Ewing Sarcoma
femur: lytic lesion, fluid filled cyst with a thin wall
solitary bone cyst
sponge filled with blood
aneurysmal bone cysts
Low power: clotted lood in upper right and richly vascularized tissue in lower left
high power: sometimes there are giant cells (misdiagnosis of giant cell tumor)
differentiate by: RICH CAPILLARY BED
aneurysmal bone cyst
metastatic bone tumor (from lung)
lytic lesion: metastaic bone tumor (from breast)
What type of cancer and what is it’s origin?
How do you know?
metastatic bone tumor from prostate cancer
multiple osteoblastic (white) bone lesions
ganglion cyst
cyst space, no epithelial lining, contains myxoid material
giant cell tumor of tendon sheath
well circumscribed tumor: yellow due to lipid laden macrophages
giant cell tumor of tendon sheath
multinucleated giant cells in background of histiocytes
diffuse type tenosynovial giant cell tumor (pigmented vilonodular synovitis)
localized destructive lesion in single joint (knee usually): HEMOSIDERIN deposition and joint destruction
mobile, slow growing, painless
lipoma
lipoma
gross: well circumscribed YELLOW lobulated mass
micro: mature adipose
arrow: lipoblast
liposarcoma
left: well differentiated liposarcoma: adipocytes and scattered spindle cells
middle: myxoid liposarcoma: abundant basophilic matrix, CHICKENWIRE vessels, various stages of adipocyte differentiation (like fetal fat)
right: pleomorphic liposarcoma: anaplastic cells, bizarre nuclei, LIPOBLAST (immature adipocytes)
deltoid
rapidly growing
nodular fasciitis
location in the subdermal fat
nodular fasciitis
lots of cells
top arrow: plump immature fibroblasts in short fascicles
bottom arrow: abundant mitotic figures
young athlete after trauma in proximal extremities
myositis ossificans
xray: periosteal reaction with EGGSHELL calcifiation
mature bone at periphery, fibrous materal at center with osteoid in between
fibromatosis: superficial
nodular or poorly defined broad fascicles of fibroblasts in dense collagen
superficial fibromatosis
left: palmar (Dupuytren contracture): irregular nodular thickening of palmar fascia; half are bilateral with progressive contracture of 4th and 5th fingers
middle: plantar; young patients, unilateral without contractures
right: penile (Peyronie) disease: palpable mass on dorsal penis with eventual curvature of shaft and/or constriction of urethra
immunostain for beta-catenin
deep fibromatosis
gross: large, firm, white cut surface, infiltrative borders
micr: broad fascicles in dense collagen
deep fibromatosis
encapsulated mass in mesentary of sigmoid colon draped on it
micro: bland, spindle cell proliferation with no mitoses or necrosis
fibrosarcoma
HERRINGBONE PATTERN (chevrons repeated)
rhabdomyoma
SPIDER CELL
eosinophilic inclusions: RHABDOMYOBLASTS
Rhabdomyosarcoma
rhabdomyosarcoma
bizarre cells with abundant cytoplasm (right), elongated strap cells recapitulate skeletal muscle cells (left arrow)
middle: t(2:13) or t(1: 3)
right: myogenin (IHC stain)
rhabdomyosarcoma
left: embryonal: soft grey infiltrative mass composed of spindled and round cells in myxoid stroma
middle: alveolar: fibrous septae that divide cells into clusters or aggregate to resemble pulmonary alveoli, round cells with little cytoplasm
right: pleomorphic: large, sometimes multinucleated, bizarre eosinophilic tumor cells
sarcoma botyoides: embryonic rhabdomyosarcoma
micro: lobulated masses of cells, covered by mucosa with underlying hypercellular zone of poorly differentiated cells (cambium layer)
leiomyoma
densely eosinophilic spindle cells that often intersect at right angles
leiomyoma of uterus
leiomyosarcoma
eosinophilic spindle cells with blunt ended, hyperchromatic nuclei in interweaving fasicles
synovial sarcoma
left: monophasic: uniform spindle cells with scant cytoplasm
right: biphasic: spindle cells but also gland like structures
undifferntiated pleomorphic sarcoma
high grade waste basket
can’t use histo to identify
sheet of anaplastic spindled to polygonal cells, atypical mitotic figures, bizzare nuclei
