Bone Pathology snaps

OSTEOGENESIS IMPERFECTA

Type 1 collagen Blue sclera Hearing loss: ossicles Dentin

OSTEOPETROSISMarble bone diseaseAlbers – Schonberg

Skeletal sclerosis Impaired osteoclast

function

Tx: BMT

Deficient osteoclast activityAbsence of medullary cavity

Erlenmeyer flask deformityBulbous ends of long bones

OSTEOPOROSIS

Porous bonesReduced bone mass

Fracture

PostmenopausalThin perforated trabecular plates

with loss of interconnections

SenileThinned cortex

Subperiosteal endosteal resorptionWidened Haversian systems

PAGET DISEASE

Osteolytic phase

mixed osteoclastic – osteoblastic stage

quiescent osteosclerotic stage

Osteitis deformans

Leontiasis ossea platybasia Chalkstick – type fracturesOsteosarcoma high – output CHF

PAGET DISEASE Osteitis deformans

MosaicJigsaw puzzle

irregular lamellae and cement lines Prominent osteoclast

Osteoblast

thicker weaker Irregular cement lines

PTH detected by osteoblasts osteoclastic activity

Osteitis fibrosa cysticVon Recklinghausen disease of bone area of reactive fbrous

tissue proliferation w admixed multinucleated giant cells

Brown tumor

HYPERPARATHYROIDISM

Dissecting osteitisRailroad track appearance of cancellous bone

Thinned cortices Subperiosteal periosteum

OSTEONECROSIS

Disruption of microcirculationInfarct

Avascular necrosis

Femur scaphoid digits

Legg – Calve – Perthes disease

Empty lacunar surr by necrotic adipocytesCreeping substitution: necrotic trabeculae as scaffolding for deposition of new bone

Absent osteocyte nuclei

PYOGENIC OSTEOMYELITIS

Bacteria hematogenous spreadS. Aureus

Salmonella sickle cellH. influenza, GB S neonates

E. coli, Pseudomonas, Klebsiella UTI, drug users

Subperiosteal abscess w draining sinusSequestrum: deadInvolucrum: newBrodie abscess: small intraosseous abscess

Inflammatory cells

fibrosis

Osteoblastoma > 2 cm

Metaphysis long bonescortex

10 – 30 y.o.

<2 cm

Oval masses of hemorrhagic gritty tan tissueHaphazardly interconnecting woven boneNidus formation: irreg reactive new woven bone formation

OSTEOID OSTEOMA

OSTEOSARCOMA

Metaphysis long bonescortex

10 – 25 y.o.

MC primary malignant bone tumor

50% knee, distal femur, prox tibia

Cystic degenerationLace – like patternSunburst pattern

Codman triangle: periosteum liftedCodman triangle

OSTEOSARCOMA

Metaphysis long bonescortex

10 – 25 y.o.

MC primary malignant bone tumor

50% knee, distal femur, prox tibia

Cystic degenerationLace – like patternSunburst pattern

Neoplastic pleomorphic cells makes pink osteoid

Osteoid production by a sarcoma is diagnostic of osteosarcomaOsteoid matrix vaguely resembles primitive woven bone

Metaphysis long bonescortex

10 – 30 y.o.

Benign bluish-white cartilaginous cap

overlying a bony cortex

Benign hyaline cartilage cap covered peripherally by perichondrium

OSTEOCHONDROMA

Exostosis: bony stalk

well-circumscribed nodules of hyaline cartilage containing cytomorphologically benign chondrocytes

Small bones of hand and feet30 – 50 y.o.

enchondroma chondrosarcoma

ENCHONDROMATOSIS, OLLIER DISEASE, MAFUCCI DISEASE: multiple endochondroma

CHONDROMA / ENCHONDROMA

Epiphysis of long bone10 – 20 y.o.

Chicken wire mineralization: dystrophic calcification of the cell membrane

Sheets of compact polyhedral chondrocytes

CHONDROBLASTOMA

2nd mc malignant bone tumor

CHONDROSARCOMA

salt and pepper popcorn

white to bluish-white cartilaginous tumor tissue eroding bone and extending outward from the residual bone

Extends from medulla through cortex into soft tissuesChondrocytes with increased cellularity and atypiaAnaplastic chondrocytesMalignant hyaline & myxoid cartilage

Pelvis, shoulder, axial, ribs40 – 50 y.o.

EWS gene chr 22

Diaphysis of long bone10 – 20 y.o.

Sheets of uniform small round cells

Onion skin appearance

EWING SARCOMA

Homer – Wright rosettes:Tumor cells arranged around a central fibrillary space

Can also be found in neuroblastoma

Localized developmental arrest of bone components

Shepperd’s crook

Chinese – character lookingCurvilinear trabeculae

FIBROUS DYSPLASIAMcCune – Albright

syndrome

Polyostotic fibrous dysplasia

Café – au – lait spots

Endocrinopathies (e.g. Cushing, precocious puberty)

Fibroblast between trabeculaeNo osteoblastic trimming

Expansile, lytic

Epiphysis of long bone20 – 40 y.o.

RANK/RANKL signaling pathway

GIANT – CELL TUMOROSTEOCLASTOMA

Multinucleated osteoclast type – giant cells with background of mononuclear stromal cells

done

….Created by Bryan Atas MD (WVSU 2015)Using texts and pictures from Robbins, Rubins, Netter, Topnotch materials

…

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