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Organ Pathology Exam 1 > Skeletal system--bone and joints > Flashcards

Skeletal system--bone and joints Flashcards

1
Q

What are osteoblasts?

A

Bone forming cells that produce collagenous matrix scaffold

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2
Q

What are osteoclasts?

A

Bone resorption

• Large, multinucleated cells of monocyte-macrophage origin

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3
Q

What are osteocytes?

A

Osteoblasts incorporated into lacunae of mature bone

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4
Q

What are chondrocytes?

A

Cartilage forming cells found in lacunae of cartilage

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5
Q

What does PTH do?

A

Produced in the parathyroid gland in response to decreased blood calcium
• Induces osteoclast activity and renal resorption of calcium

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6
Q

What does vitamin D do?

A

Stimulates GI absorption of calcium and mineralization of bone

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7
Q

What does calcitonin do?

A

Produced by C-cells of thyroid gland in response to increased blood calcium
• Inhibits osteoclast activity with subsequent overall increase of bone formation

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8
Q

What is cortical bone?

A

Outer shell of bone

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9
Q

What is cancellous bone?

A

Bony trabeculae within cortical bone covering
• Intertrabecular space contains vascular structures, adipose tissue and blood element forming bone marrow (axial >appendicular)

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10
Q

What is lamellar bone?

A

Normal bone formed by concentric depostion of bone in parallel sheets

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11
Q

What is woven bone?

A

Disorganized new bone without concentric architecture

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12
Q

What are the flat bones?

A

skull, sternum, pelvis

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13
Q

Describe long bones

A

Growth plate: Occupies area between the epiphysis and the metaphysis and closes with full maturity
• Epiphysis: Region between growth plate and joint end of bone
• Metaphysis: Region on central shaft (diaphyseal) side of growth plate
• Diaphysis Central shaft of bone

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14
Q

How do we determine types of fractures?

A

Clinical classifications indicate underlying cause and severity of fracture

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15
Q

Describe the stages of healing

A

1) Organization of hematoma with influx of fibroblasts
2) Callus formation
• Deposition of bone & cartilage matrix within hematoma
• Begins by end of first week and usually completed by three weeks
3) Callus remodeling: Osteoblasts and osteoclasts work together to form strong bone architecture

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16
Q

What is the mechanism of infection for osteomyelitis?

A

Hematogenous: Most common source via spread through bloodstream
• Spread from adjacent soft tissue infection
• Trauma

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17
Q

organisms of osteomyelitis

A

Staphylococcus aureus: 80-90% of infections
Other pyogenic bacteria: Salmonella (esp. in sickle cell anemia), E. coli, etc.
-Tuberculosis and syphilis are rare causes

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18
Q

Complications of osteomyelitis

A

-Chronic osteomyelitis: Delayed diagnosis or inadequate antibiotic treatment
• Pathologic fractures
• Bacteremia/endocarditis

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19
Q

What is the pathogenesis of osteoporosis?

A

• Metabolic imbalance: Bone resorption > bone deposition
Determinants:
• Total bone mass
• Accumulation up to 20-30; then downhill
• African > caucasian; Male > female
• Aging related changes: Normal variable degree of bone loss
• Estrogen deficiency: Increased osteoclastic activity secondary to cytokines
• Genetic predisposition: Genetic variants of vitamin D receptor
• Physical activity: Immobilization (paralysis; may be localized); Inactivity
• Other hormonal influences: PTH (hyperparathyroidism); Excess steroid (Cushing?s, exogenous)

20
Q

What are histological characterizations of osteoporosis?

A

Less bone with thin cortical bone and bony trabeculae

• Normal mineralization and architecture of cortical and trabecular bone

21
Q

Complications of osteoporosis

A

Fractures – Weight bearing bones (i.e.spinal vertebrae) most prone to fracture

22
Q

Dental disease in osteoporosis/menopause

A

-Oral X-rays show significant jaw bone loss
• Possible association with increased tooth loss and attachment loss
• Dental implants – May be contraindicated; Long-term follow up
• Renal osteodystrophy, osteomalacia & Paget?s dis. also may cause complications
• Menopause also assoc. with gingivitis/periodontitis, caries, taste/saliva alts.

23
Q

Vit. D deficiency names for children vs. adults

A

Rickets (children) or Osteomalacia (adults)

24
Q

Causes of Vit. D deficiency

A

-Inadequate sunlight: Required for synthesis of vitamin D precursors
• Malabsorption: Fat soluble vitamins such as vitamin D
• Inadequate dietary intake of vitamin D
• Abnormal vitamin D activity: Loss due to chronic renal failure; End-organ resistance to vitamin D

25
Q

What is the pathology of vit. D deficiencies?

A
  • Decreased bone causes deformities and/or fractures

• Decreased mineralization

26
Q

What is the cause (pathogenesis) of Osteitis Fibrosa Cystica?

A

Hyperparathyroidism
• Parathyroid adenomas most common cause; Parathyroid hyperplasia
• Induction of osteoclastic and fibroblastic activity leads to increased resorption of mineral from bone

27
Q

What is the pathology of Osteitis Fibrosa Cystica?

A

Irregular, moth-eaten trabecular bone

• ?Brown tumor? – Repeated hemorrhage due to micro-fracture with subsequent fibrosis and macrophage infiltration

28
Q

What is the epidemiology of Paget’s disease?

A

Older age: Approximately 3% of population over 50 y.o. affected in U.S.
• Cause unknown: Potential viral etiology
• Monostotic (localized) form is less common; Polyostotic form approx. 90%

29
Q

What are the three stages of Paget’s disease?

A

1) Irregular osteoclastic resorption
2) Osteoblastic reformation
3) Osteosclerosis: Late thickening of bone due to net osteoblastic activity

30
Q

What is the Pathology of Paget’s disease?

A
  • Haphazard bone architecture: Normal concentric lamellar pattern absent
  • Highly vascularized bone
31
Q

What are the unique characteristics of neoplastic bone disease?

A

Type of neoplasm often affect specific bones or age groups:
Differential diagnostic considerations greatly affected by these parameters
• Characteristic radiologic features: May be more informative than histology

32
Q

What are two types of non-neoplastic mass forming diseases?

A

1) Fibrous dysplasia
• Slow replacement of bone by fibroblasts, collagen and irregular bony trabeculae
• Monostotic form more common than polyostotic form
2) Aneurysmal bone cyst: Characteristic radiographic appearance; Histology concerning for malignancy

33
Q

What type of benign bone tumor is an osteoma (benign bone tumor)?

A
  • Exophytic lesions that usually affect skull and facial bones
  • Usually don?t need treatment
  • Gardner?s syndrome: Osteomas, GI polyps and soft tissue tumors
34
Q

What are endochondromas (benign bone tumor)?

A

Exophytic lesions with prominent cartilaginous caps
• Occur on metaphyseal portions of long bones with predilection for bones of hand
• Rarely may progress to malignancy

35
Q

What type of malignant potential do Giant Cell Tumors of the bone have?

A

unknown

36
Q

What is giant cell tumor of the bone? Who does it affect?

A

Middle aged patients (20 - 40 y.o.)
• Occur in epiphyses of long bones of legs and arms
•

37
Q

What is the histology of giant cell tumor of the bone?

A
  • Numerous multinucleated giant cells mixed with small uninucleate cells
  • Small cells thought to be neoplastic cells
  • 90% benign/10% malignant
  • No histologic or other features that allow differentiation of benign from malignant tumors
  • Development of metastases only sure indicator of malignancy
38
Q

What type of cancer is osteosarcoma?

A

Affects adolescents and young adults, 10-25 y.o. mostly with involvement of metaphyses of appendiceal bones (femur, humerus, etc.)
• Histology characterized presence of osteoid and malignant, anaplastic osteoblasts
• Treat with surgery, chemo- and radio-therapy; 60% 5 year survival

39
Q

What is chondrosarcoma?

A 
Older patients (>35 y.o.) with predilection for involvement of central skeleton
•  Histology characterized by presence of multiple chondrocytes in lacunae with variable degree of atypia
•  Survival dependent on degree of differentiation
40
Q

What is Ewing’s Sarcoma and whom does it affect?

A

Younger age group: Rare after 30 and peak incidence in second decade
• Male > female (2:1)
• Histology: sheets of uniform small blue cells with syncytial appearance and separated by fibrous septae
Cytogenetics:
• Translocation 11;22 present in nearly 100% of tumors
• PCR assay can be used to establish diagnosis or screen for residual disease
Treatment via surgery, chemo- and radio-therapy
Prognosis ranges from 45–70% 5 year survival

41
Q

What is the pathology of osteoarthritis?

A

Pathogenesis
• Trauma (wear and tear) and congenital abnormalities are primary influences
• Other factors may contribute to small degree – Genetics, osteoporosis
Clinical Features
• Pauci- or oligo-articular
• Large joints (hip, knee) and back are primarily affected
• Worse after use (i.e. late in the day)
Pathologic features
• Cartilage degeneration (loss, fibrillation) with little inflammation
• Bone spurs and osteophytes without ankylosis and subchondral cyst formation

42
Q

Discuss Rh. Arthritis

A

Pathogenesis
• Autoimmune – Complex lymphocyte and immune complex mediated
• Extra-articular disease including rheumatoid nodules, lung disease, etc.
• Rheumatoid factor – Serum marker of disease
Clinical Features
• Multi-articular and usually bilateral/symmetric
• Small joints initially (i.e. hand) but may progress to large joints
• Worse after inactivity (i.e. in the morning)
Pathologic Features
• Cartilage destruction with inflammation and pannus form./granulation tissue
• Bony and fibrous ankylosis (unlike osteoarthritis)

43
Q

Discuss infectious arthritis–an inflammatory arthropathy

A

Clinical/Pathogenesis
• Hematogenous (sepsis) or traumatic/direct spread from soft tissue
• Pyogenic bacteria (Staph., Strep., Hemophilus, GNRs) or TB
• Pathology – Large numbers of neutrophils in the synovial fluid

44
Q

Discuss gout/crystal arthropathies (inflammatory arthropathies)

A

Clinical/Pathogenesis
• Hyperuricemia (renal dis., overproduction) leads to deposits in joints
• Big toe (classic site) and others (knee, etc) can be involved
• Other crystal arthropathies also occur (pseudogout – Ca pyrophosphate)
• Pathology – Crystals (& neutrophils) with specific polarization characteristics in synovial fluid and gouty tophi (deposits in soft tissues)

45
Q

What is an osteochondroma?

A

Exophytic lesions with prominent cartilaginous caps
Occur on metaphyseal portions of long bones with predilection for AROUND THE KNEWW
Rarely may progress to malignancy

46
Q

What is enchondroma?

A

Benign cartilage tumor arising in medullary cavity of bone

Metaphyseal lesion of tubular bones, especially of hands and feet

Organ Pathology Exam 1 (4 decks)

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