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bone pathology
n/a
57
Health Care
Graduate
10/25/2009

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Term
pain usually indicates what kind of pathology?
Definition
fracture or osteonecrosis
Term
systemic sx usually indicates what kind of path?
Definition
metastatic cancer or metabolic bone disease
Term
localized sx usually indicates what kind of path?
Definition
tumors
Term
elevated alkaline phosphatase activity (increased osteoblast activity) indicates what disease?
Definition
paget's
Term
define compound fracture, comminuted fracture, displaced fracture, pathologic fracture, stress fracture
Definition
compound (site communicates with skin), comminuted (splintered, multiple pieces), displaced (ends of bone not aligned), pathologic (occurs in a bone already altered by a disease process), stress (develops slowly in a bone subjected to repetitive loads as in sports training)
Term
how is achondroplasia acquired?
Definition
hereditary, autosomal dominant.80% due to mutations
Term
what are the pathology and clinical features of achondroplasia?
Definition
premature obliteration of growth plates --> shortened proximal extremities (with normal trunk, enlarged head, bulging forehead) --> dwarfism. (homozygous achondroplasia leads to death at or son after birth d/t respiratory insufficiency secondary to small thorax)
Term
what is the pathogenesis of osteogenesis imperfecta?
Definition
type I collagen abnormaltiy --> increased bone fragility (brittle bone disease) --> skeletal fragility, mult frac & joint laxity, blue sclera, hearing impairment, teeth and skin changes
Term
what is the pathogenesis behind osteomalacia/ricketts?
Definition
defect in hydroxyapatite formation of bone (either lack of Ca or lack of phosphate. low vit D? renal disease? (peeing out phosphate))
Term
what is a long-term effect of osteogenesis imperfecta?
Definition
multiple microfractures over a prolonged period of time --> bent bones --> dwarfism
Term
whats the pathogenesis behind osteopetrosis?
Definition
abnormal osteoclast activity (d/t carbonic anhydrase type II deficiency) --> increased bone radiodensity, lack of medullary canal (bones get stuck in calcified cartilage bc not capable of absorbing the calcified cart of the growth plate) --> stone-like bone quality, abnormally weak, fractures easily, bulbous ends of long bones, neural foramina narrow and compress exiting nerves (blindness, deafness, paresis)
Term
what are the 3 types of osteopetrosis?
Definition
infantile-malignant (autosomal recessive), intermediate (autosomal recessive), autosomal dominant (bone marrow transplant necessary)
Term
what are the most common organisms causing osteomyelitis?
Definition
staph and strep cause pyogenic osteomyelitis, and TB causes granulomatous inflammation
Term
describe the pathogenesis of osteomyelitis
Definition
infective organisms gain access to bone marrow (via bacteremia, direct expansion from adjacent focus of inf, or compound fracture) -->inflammation spreads within shaft of the bone through haversian system --> reaches periosteum --> subperiosteal abscesses --> segmental bone necrosis --> rupture of periosteum --> new periosteal bone formation
Term
what are the joints most likely to be affected by osteomyelitis?
Definition
big bones - femur, humerus
Term
what part of the bone would we see osteonecrosis in adults? childreN?
Definition
in adults, metaphysis, diaphysis, or subchondral region of epiphysis. in children (idiopathic) epiphysis of growing children
Term
what would we observe in the bone with osteonecrosis?
Definition
cloudy marrow, dont see discrete adipose cells, bone has pallor, devoid of osteocyte nuclei, lots of lacunar space with no osteocyte
Term
whats the peak age and location for osteochondroma?
Definition
2nd decade, distal femur - metaphyseal location
Term
what is the pathophysiology of osteochondroma?
Definition
perichondrial proliferation of cartilage with transformation into bone (cartilage pushes out and forms its own center of ossification) looks like mature bone with cartilaginous cap. grows in direction of muscle pull, away from the joint. rarely can have malignant transformation into chondrosarcoma.
Term
enchondroma peak age and common site of occurance.
Definition
2nd decade, small bones of hands/feet, femur, humerus (in medullary cavity, i.e. inside bone)
Term
chondroblastoma (aka giant cell tumor) peak age and common location
Definition
2nd decade, proximal humerus, distal femur, proximal tibia (in epiphysis or on apophysis)
Term
what is the most common presenting feature of giant cell tumor (chondroblastoma)?
Definition
pain predating the dx by mos or yrs
Term
chondromyxoid fibroma peak age and common location
Definition
2nd and 3rd decade, around knee in eccentric metaphyseal location w/sharp sclerotic and scalloped margins
Term
histology of osteochondroma
Definition
mimicks normal growth plate
Term
histology of enchondroma
Definition
hypocellular tumor, blue-gray cartilagenous matrix, small nuclei, rare binucleation
Term
chondroblastoma histology
Definition
pink-blue fibrochondroid islands and multinucleated giant cells scattered randomly in a sea of mononuclear cells
Term
histology of chondromyxoid fibroma
Definition
distinct lobular growth pattern with peripheral hypercellularity and hypocellular spindled and stellate cells in the chondromyxoid central portion of the lesion
Term
chondrosarcoma peak age and common locations
Definition
adulthood (3-6 decade), acetabular region, central skeleton, vertebrae, proximal femur, proximal humerus, intermedullary in metaphysis or diaphysis
Term
histology of chondrosarcoma
Definition
homogenous blue-gray tumor with lobules of myxoid and hyaline cartilage, hypercellular with pleomorphism, hyperchromatism and frequent binucleation of cells (mitotic, bizarre cells, disorganization)
Term
describe where you'd normally find an osteoma and what it'd look like on an xray
Definition
radiodense mass projecting from subperiosteal or endosteal surfaces of cortex. nearly always in skull or nasal sinuses --> impinge on brain or eye
Term
osteoid osteoma peak age and common location
Definition
2nd decade, proximal femur and femoral neck in cortex of diaphysis
Term
clinical presentation of osteoid osteoma
Definition
pain of increasing severity, worse at night and relieved with aspirin
Term
osteoblastoma peak age and common location
Definition
2nd decade, vertebrae (central lesion vs. appendicular skeleton involvement in osteoid osteoma)
Term
clinical presentation of osteoblastoma
Definition
pain of long duration, not relieved with aspirin; possible neurological defecit d/t vertebral tumor compressing the cord or nerve roots.
Term
histology of osteoid osteoma vs osteoblastoma
Definition
common features: interlacing network of thin osteoid trabeculae, haphazardly arranged, interspersed loose fibrovascular CT rimmed by oblasts. difference: osteoid osteoma <2cm; osteoblastoma >2cm
Term
how does an osteoid osteoma look on xray
Definition
small round lucency with surrounding sclerosis
Term
tx of osteoblastoma
Definition
local excision
Term
osteosarcoma peak age and common location
Definition
bimodal distribution (2nd decade - 75%; in elderly secondary to paget's, bone infarcts or radiation); distal femur, proximal tibia, metaphysis of long bones
Term
radiographic hallmark of osteosarcoma
Definition
tumors frequently break through cortex and lift the periosteum (codman's triangle"
Term
tx for osteosarcoma
Definition
surgical resection and chemotherapy
Term
describe simple bone cysts, where they occur and how they resolve
Definition
first 2 decades of life, common dev abn, occur at end of long bones (diaphysis of prox humerus, prox femur and prox tibia), can be left alone bc theyre small and go away on their own, can tx with curettage and bone grafting
Term
describe aneurysmal bone cysts, where they occur and how they resolve
Definition
2nd decade, vertebrae femur tibia (any bone though), rapidly growing blood-filled cystic mass in metaphysis of long bones, tx is surgical removal
Term
what is thought to cause non-ossifying fibromas and where are they located
Definition
related to insertion of a tendon/lig into the perichondrium of the epiphyseal growth plate. located on circumference of metaphysis of long tubular bones (distal femur, prox tibia)
Term
what is the etiology of fibrous dysplasia?
Definition
developmental disorder causing delayed development of normal bone. can be monostotic or polyostotic, when its polyostotic it may be assoc with endocrine dysfunction (sexual precocity, hyperthyroidism, pituitary adenomas, primary adrenal hyperplasia), also possibly d/t abnormalities in the G protein pathway that stimulates cyclic AMP
Term
polyostotic fibrous dysplasia is typically associated with?
Definition
endocrinopathy and cafe-au-lait skin pigmentation, involves shoulder and pelvic girdles and can result in crippling deformities (shepherd's crook deformity aka angular defect in proximal femur d/t femur sustaining mult fractures). mccune-albright syndrome if assoc with cafe-au-lait
Term
what are 2 common clinical problems with fibrous dysplasia?
Definition
bulging (d/t bone expansion) and resulting pathologic fracture
Term
fibrosarcoma peak age and common location
Definition
broad range 2-8 decade, metaphyseal or diaphyseal distal femur and proximal tibia. cortical destruction with extension in to adjacent soft tissue
Term
histology of fibrosarcoma
Definition
malignant fibroblasts arranged in herringbone pattern
Term
ewings sarcoma peak age and location
Definition
2nd decade, medullary cavity of pelvic girdle and diaphysis of long tubular bones of lower extremities
Term
classic presentation of ewings sarcoma on xray
Definition
onion skinning
Term
etiology of ewings sarcoma
Definition
chromosomal translocation t(11:22)
Term
tx of ewings sarcoma
Definition
chemo, surgery
Term
giant cell tumor peak age and common location
Definition
3rd decade, distal femur prox tibia dist radius and sacrum
Term
pigmented villonodular synovitis peak age/sex/location
Definition
3-4 decade, women, knee (80%) hip (15%)
Term
describe the pathophysiology and sx of pigmented villonodular synovitis
Definition
locally destructive fibrohistiocytic proliferation --> innumerable villous and nodular synovial protrusions (may have hemosiderin which gives it a pigment) --> pain, progressive swelling, bloody effusions worsening further the increasing limitation of range of motion
Term
tx for pigmented villonodular synovitis
Definition
surgical excision, but high recurrence rate
Term
common locations for synovial sarcoma
Definition
extremities (knee most common) arising in vicinity of joints, bursae, and tendon sheaths, metastasizes to lungs, lymph nodes, skin, abdomen, bone, brain
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