Term
| what are the 6 cells/components of bone turn over |
|
Definition
matrix: type 1 collagen
cytokiines and GF deposited at some point and are liberated when needed vi osteoclast
resistant acid phosphatases
osteoblasts and osteoclasts |
|
|
Term
| osteoblast: function, origin |
|
Definition
build bone
come from mesenchymal cells |
|
|
Term
| osteoclast: function, origin |
|
Definition
reabsorb bone
monocyte cell line in marrow |
|
|
Term
|
Definition
| ruffled border to cause acidic area where they make contact and resorb bone |
|
|
Term
| what are the 10 signalers in bone turn over |
|
Definition
IL1
IL6
TNF
RANK Ligand
M CSF
estrogen
PTH
osteoprotagerin
calcitonin
bisphosphates |
|
|
Term
| what is the function of IL1 IL6 TNF in bone turn over |
|
Definition
| stimulate reabsorption by stimulating osteoblasts which turn on osteoclast |
|
|
Term
| what is the function of RANK L and M CSF in bone turn over |
|
Definition
| made on osteoblast and presented to osteoclast to tall them to resorb bone |
|
|
Term
| what is the function of estrogen in bone turn over |
|
Definition
|
|
Term
| what is the function of PTH in bone turn over |
|
Definition
|
|
Term
| what is the function in calcitonin in bone turn over |
|
Definition
not much unless it is from another species
inhibits osteoclast |
|
|
Term
| what is the function of bisphosphates in bone turn over |
|
Definition
|
|
Term
| 5 bone congenital diseases |
|
Definition
bone dystrophies
bone dysplasia
acondroplasia
osteogenesis imperfecta
osteopetrsis / marble bone disease / albers-schonberg disease |
|
|
Term
|
Definition
| congenital malformations: defect in nuclear proteans and transcription factors (usually homeobox genes and some cytokines) |
|
|
Term
| 4 examples of bone dysostoses |
|
Definition
failure of development: rib, phalanx, clavicle
supernumerary bones: extra ribs and digits
syndactyly: fusion of digits
craniorachischisis: failure of skull / spinal column to close |
|
|
Term
| what is a complication of craniorachischisis |
|
Definition
| CNS and meningies herniate through opening causing meningomyelocele or meningoencephalocele |
|
|
Term
|
Definition
| mutation in matrix or cell signaling affects all cartiladge and bone |
|
|
Term
| 4 examples of bone dysplasias |
|
Definition
achhondroplasia
thanatrophic dwarfism
osteogensis inperfect
osteopetrosis |
|
|
Term
| in genera, what is achondroplasia |
|
Definition
| disorder of structure of growth of cartilage causing chondrodysplasia |
|
|
Term
| what is the most common disease of the growth plate |
|
Definition
|
|
Term
| what is the inheritence of achondroplasia |
|
Definition
|
|
Term
| what causes achondroplasia |
|
Definition
inherited fibroblast GF receptor 3 mutation
receptor has influence on matrix, inhibits cartilage proliferation to keep growth in check
point mutation causes activation that supresses growth in bones formed by endochondral ossification (esp long bones) |
|
|
Term
| 13 signs of achondroplasia |
|
Definition
large head
frontal bossing
hypoplastic nose bridge
base of skull underdeveloped
posterior elements of spine underdeveloped
narrow spinal canal
narrow neural foramina
short tubular bones
bowing tibia, femur, humerus
premature deposition of bone seals growth plate
zone of proliferation and hypertrophy in growth plates narrowed and disorganized
clusters of chondrocytes instead of growth plate columns |
|
|
Term
| what are the two types of achondroplasia |
|
Definition
homozogyous achondroplasia
thanatrophic dwarfism |
|
|
Term
| cause of homozygous achondroplasia and inheritence |
|
Definition
two abnormal FGFR3 genes
autosomal domonant |
|
|
Term
| thanatophoric dwarfism: cause, clinical signs |
|
Definition
frameshift or point mutation in FGFR3 that is more severe, often due to offspring of two dwarves
most common form of lethal dwarfism, respiratory insufficiency due to underdeveloped thoracic cavity |
|
|
Term
| in general, what is osteogenesis imperfecta |
|
Definition
| disorder of type I collagen synthesis causing too little bone resulting in skeletal fragility |
|
|
Term
| what is the most common genetic disease of the skeleton |
|
Definition
|
|
Term
| what are the main areas of the body affected in osteogenesis imperfecta |
|
Definition
90% in osteoid protein in bone
joints, EYES, ears, skin, TEETH |
|
|
Term
| cause of osteogenesis imperfecta |
|
Definition
| mutation in type I collagen synthesis a1 (COL1A1 CH17) or a2 (COL1A1 CH7) chain triple helix mutation or both |
|
|
Term
| what are the two types of mutation s in osteogenesis imperfecta |
|
Definition
null allele effect (1/2 normal collagen): mutant gene not transcribed or mutant chain degraded
dominant negative: more severe chain abnormalities compormise function usually due to glycine substitution. most severe in C terminus, less severe in smaller AA still allowing helix |
|
|
Term
| what is the most common cause of osteogenesis imperfecta and its inheritence |
|
Definition
type I
autosomal dominant |
|
|
Term
| what is the most severe form of osteogenesis imperfecta and its inheritence |
|
Definition
type II
autosomal recessive |
|
|
Term
| what is the intermediate and least common form of osteogenesis imperfecta and its inheritence |
|
Definition
type IV
autosomal dominant |
|
|
Term
| signs of osteogenesis imperfecta type I |
|
Definition
diagnosed middle age due to osteopenia and fracture history
normal stature in 50%
hearing impairment in 25%
skeletal fragility
blue sclerae |
|
|
Term
| why is sclerae blue in osteogenesis imperfecta |
|
Definition
| translucent sclera so can see choroid |
|
|
Term
| signs of osteogenesis imperfecta type II |
|
Definition
excessive fragility especially during birthing, often die in utero or within days of birth
blue sclerae |
|
|
Term
| signs of osteogenesis imperfecta type III |
|
Definition
growth retardation (<4ft)
multiple fractures (~200 as adult)
limb bowing
blue sclera
hearing impairment |
|
|
Term
| signs of osteogenesis imperfecta type IV |
|
Definition
moderate skeletal fragility
short stature
intermediate symptoms |
|
|
Term
| signs of osteogenesis imperfecta upon birth |
|
Definition
big forehead
deafness
white of eye blye
poor teeth
barrel chest
round back |
|
|
Term
| in general, what is osteopetrosis |
|
Definition
| decreased bone reabsorption causes radiodense bones (bone keeps getting built) |
|
|
Term
|
Definition
carbonic anhydrase II deficiency osteoclasts
mutation in CIC-7 osteoclasts
macrophage colony stimulating factor (M-CSF) deficiency |
|
|
Term
| explain how carbonic anhydrase deficiency causes osteopetrosis |
|
Definition
needed by osteoclast for renal tubular cells to excrete H+ and acidify area
mutation prevents acidification of resorption put and solubulization of hydroxtapatite favoring bone building |
|
|
Term
| explain how mutation in CIC-7 osteoclasts cause osteopetrosis |
|
Definition
Cl- channel gene helps proton pumo of ATPase on osteoclast ruffled border
osteoclasts cannot acidify resbsorption pit favoring bone building |
|
|
Term
| how does M-CSF mutation cause osteopetrosis |
|
Definition
osteoblasts cannt make M-CSF for osteoclast differentiation
osteoclasts are reduced |
|
|
Term
|
Definition
high bone densiry
fragile bones
erlenmeyer fkast long bones
rugger hersey vertebraw (also hyperparathyroidism)
bones of skull thick and sclerotic
CN compression, blindness, deafness
hair on calvarium (skull hematopoesis)
primary spongiosa persists and fills medullary cavity leaving no room for hematopoietic marrow leading to anemia |
|
|
Term
| treatment of osteopertrosis |
|
Definition
marrow transplant - not effective in dosorders where osteoclasts are dysfunctional
high dose vitamin D
INFy stimulates osteoclast superoxide |
|
|
Term
|
Definition
| increased porosity of skeleton that esults from decreased bone mass causes predisposition to fracture |
|
|
Term
| what are the risk factors for osteoperosis |
|
Definition
post menopausal
white
female
(men and african americans start out with higher level of bone density to begin with) |
|
|
Term
| what are 6 causes of osteoperosis |
|
Definition
receptor mutation
decreased physical activity
post-menopause
vitamin D deficiency
aging
prolonged glucocorticoids |
|
|
Term
| what receptor mutations lead to osteoperosis |
|
Definition
| vit D, estrogen, IGF-a, COL1A1 |
|
|
Term
| why does osteoperosis happen post menopause |
|
Definition
| decreased estrogen decreases IL1, 6, TNF which increases RANK and RANKL which increases bone reabsorption, osteoblast activity goes down and osteoclast up |
|
|
Term
| how does age cause osteoperosis |
|
Definition
decreased replication of osteoprogenitor cells
decreased osteoblast activity
reduced physical activity |
|
|
Term
| how do glucocorticoids cause osteoperosis |
|
Definition
stimulate bone reabsorption
reduce bone formation on cortical and trabecular surfaces |
|
|
Term
| how can glucocorticoid osteoperosis be avoided |
|
Definition
keep therapy short term
bisphosphate administration minimizes bone loss |
|
|
Term
| clinically, how can glucocorticoid therapy be distinguished |
|
Definition
| osteoperosis develops rapidly |
|
|
Term
| what are the osteoperosis tests, which is better, why |
|
Definition
bone density testing - better, more acurate
heel ultrasound - fast, cheap, not acurate |
|
|
Term
| what is the WHO recomendation on osteoperosis testing |
|
Definition
| recommends density test in all women >65 and younger women with risk factors |
|
|
Term
| what does bone density testing measure, why |
|
Definition
| hip, vertebrae, and wrist because they are most prone to fracture |
|
|
Term
| what are the components of a bone density testing reading |
|
Definition
T score: compares to young adult mean, more usefuk
Z score: compares to others in same age group |
|
|
Term
| what is a normal bone density test |
|
Definition
| T > -1 within one standard deviation of young adult mean |
|
|
Term
| what is a low / osteopenic bone density test |
|
Definition
T = -1 to -2.5 with no predisposition to fracture
>2.5 standard deviations below mean |
|
|
Term
| what is a severe / osteoperosis bone density test |
|
Definition
| >2.5 standard deviation below young adult mean and one or more osteoporotoc fractures |
|
|
Term
|
Definition
vertebral compression fracture leading to lumbar lordosis/kyphoscoliosis
wrist, femur neck, head of vertebrae are most common fractures due to aging
complications of pulmonary embolism and pneumonia
Ca P, and alkaline phosphatase levels (not diagnostic) |
|
|
Term
| how is osteoperosis prevented |
|
Definition
exercise
Ca
vit D
bisphosphonates
estrogen replacing agents |
|
|
Term
|
Definition
| multisystemic disease unknown cause likley autoimmune |
|
|
Term
| who is most at risk for sarcoidosis |
|
Definition
| adults <40, danish, swedish and US blacks 10x>US whites |
|
|
Term
|
Definition
| noncaseating granuloma in many organs and tissues |
|
|
Term
| regions of involvement in sarcoidosis and the frequency |
|
Definition
noncaseating epitheloid granulomas
hilar lymphadenopathy 75-90%
lung involvement 90%
spleen involvement 75%
bone involvement 20%
skin lesions 33-50%
eye, eye gland, salivary glands 20-50%
muscle |
|
|
Term
| what are the components of a noncaseating granuloma |
|
Definition
multinucleated giant cells
schaumann bodies: laminated concentration of Ca and protein
asteroid bodies: stellate inclusions inside giant cells |
|
|
Term
| what is the major presenting manifestation in most sarcoidosis cases |
|
Definition
|
|
Term
| what occurs in spleen in sarcoidosis |
|
Definition
| small granulomas coalesce to form small nodules |
|
|
Term
| what occurs in bone in sarcoidosis |
|
Definition
granulomas produce PTH like hormone, TNF, IL6 enhancing vitamin D activation increasing osteoclast activity
enhances bone rabsorption that is most detectable in hands in eet
high Ca levels in serum |
|
|
Term
| what are signs of sarcoidosis in xray |
|
Definition
fine reticular patterns
total destruction of phalanges seen in advanced stages |
|
|
Term
| what occurs in skin in sarcoidosis |
|
Definition
| erythematous plaques, scaling, lesions of mucous membrane |
|
|
Term
| what occurs in eye in sarcoidosis |
|
Definition
| corneal opacities, glaucoma, total vision loss |
|
|
Term
| what occurs in muscle in sarcoidosis |
|
Definition
| weakness, ache, tenderness, fatigue |
|
|
Term
| causes of vitamin d deficiency |
|
Definition
inadequate sun exopsure
decreased intake, absorption, metabolism
poor Ca or P homeostasis
rare in developing countries, elderly most susceptible |
|
|
Term
| what occurs as a result of a vitamin d deficiency |
|
Definition
decrease in Ca and P absorption in gut
hypocalcemia increases PTH activating renal a-hydroxylase which causes Ca absorption in gut, Ca reabsorption in kidney, and P excretion in kidney
Ca serum levels are near normal, hypophosphatemia causes impaired bone mineralization |
|
|
Term
| what are the two types of vitamin d deficiency, what is the difference |
|
Definition
osteomalacia: growth plates closed so bone isnt deranged but osteoid matrix is inadequatly ineralized and susceptible to fracture
ricketts: deficiency before plates close so epiphyseal cartiladge is inadequatly calcified causing dernaged bone growth |
|
|
Term
| what are the areas most susceptible to fracture in osteomalacia |
|
Definition
| vertebral bodies, femoral neck |
|
|
Term
| histology signs of osteomalacia, distinguish from osteoperosis and osteopenia |
|
Definition
| unmineralized osteoid visible on H&E aranged around mineralized trabeculae (rather than loss of skeletal mass like in osteoperosis and osteopenia) |
|
|
Term
| what would the Ca and P levels be like in osteomalacia |
|
Definition
low vitamin D, low ionized Ca by 40%, low P
later: elevated PTH and normal Ca
increased alkaline phosphatase in 94% due to upregulation from Ca and P levels |
|
|
Term
| what test can be done to confirm osteomalacia |
|
Definition
| decalcified bone biopsy: give tetracycline and if there is no space between the two doses you get no gap and they have osteomalacia |
|
|
Term
| what are the histological signs of rickets |
|
Definition
overgrowth of epiphyseal cartiladge cells with projection of irregular cartilage masses into marrow
deposition of osteoid matrix into cartilage remnants
enlargment and expansion of osteochondral junction
overgrowth of capillaries and fibroblasts due to microfractures
inadequate calcification of epiphyseal cartilage causing deranged bone growth |
|
|
Term
|
Definition
occipital flat
parietal buckle inward
frontal bossing: excess osteoid/square head
soft spot slow to close
bony necklace |
|
|
Term
| signs of rickets in chest |
|
Definition
rachitic rosary: overgrowth of cartilage or osteoid at costochondral junction
pigeon brest deformity due to pull of respiratory muscles
harrisons groove; from inward pull od diaphragm |
|
|
Term
| what are ambulatory signs of rickets |
|
Definition
mottledn enamel due to dentin effects
deformities mostly in spine, pelvis, long bone
bowing of legs, bulging of wrists, big lumpy joints |
|
|
Term
| what is the cause of hyperparathyroidism |
|
Definition
| uncontrolled PTH (maybe parathyroid tumor) |
|
|
Term
| how is hyperparathyroidism diagnosed |
|
Definition
| x-ray pattern virtually diagnostic: thinned cortices in radial middle phalangies of the index and middle finger |
|
|
Term
| 4 signs of hyperparathyroidism |
|
Definition
generalized osteotis fibrosa cystica
dissecting osteitis
peritrabecular fibrosis
cystic brown tumor |
|
|
Term
| what is dissecting osteitis |
|
Definition
| osteoclasts tunnel through trabecular |
|
|
Term
| what is peritrabecular fibrosis |
|
Definition
| marrow replaced by fibrovascular tissue |
|
|
Term
| what causes cystic brown tumor, what are the concerns with this |
|
Definition
brown due to hemosiderin deposition
bone loss perdisposes to microfracture and secondary hemorrhage so macrophages come and make mass of reactive tissue |
|
|
Term
| what is the cause of renal osteodystrophy |
|
Definition
chronic renal failure is ALWAYS complicated by wide spread bone disease
kidney can no longer regulate Ca and P metabolism causes hyperphosphatemia and secondary hyperparathyroidism that increases osteoclast activity |
|
|
Term
| explain the pathology of renal osteodystrophy |
|
Definition
kidney cannot get rid of P causing secondary hyperparathyroidism and increasing osteoclast activity
hypocalcemia causes kidney damage and stops vitamin D activation so Ca cannot be absorbed
metabolic acidosis: stimulates Ca hydroxyapetite release from matrix and bone reabsorption |
|
|
Term
| what is aluminum bone disease, and the cause |
|
Definition
may come from dialysis
Al interferes with deposition of Ca hydroxyapatite causing deposition of amyloid in bone (long term hemodialysis leads to B2-microglobulin) |
|
|
Term
| in general, what is paget's disease |
|
Definition
| collage of matrix maddness: gain in bone mass but new bone is highly disorganized |
|
|
Term
| risk factors of paget's disease |
|
Definition
mid adult and likleyhood increasing with age
white female
england, france, austria, germany, australia, new zeland, US
rare in japan, china, africa, scandinavia |
|
|
Term
| what are the stages of pagets and the activities in each |
|
Definition
osteolytic: increased osteoclast activity,lytic lesions
mixed osteoclastic-osteoblastic: ends facoring bone formation
osteosclerotic: quiescent, lack of remodeling causes deformity |
|
|
Term
|
Definition
paramyxovirus infection
osteoclasts hyperresponsive to vit D and RANKL
antigens found to measles, RSV
particles like necleocapsids in cytoplasms and nuclei of paget osteoclasts |
|
|
Term
| how does paramyxovirus cause pagets |
|
Definition
| induces secretion of IL6 which happens in pagets disease |
|
|
Term
| how does measles cause pagets |
|
Definition
| virus transcripts in affected osteoclasts |
|
|
Term
| most common affected bone in pagets |
|
Definition
| vertebrae, humerus, femur head, femur, tibia |
|
|
Term
| what are the signs in bone in pagets |
|
Definition
pain, deformity, chalk stick, compression fracture, neoplasm
platybasia: compression of posterior fossa sutures
teeth problems
lentiasi ossea: lion shaped head, large head difficult to hold up
secondary osteoarthritis |
|
|
Term
| what are the non bone signs of pagets |
|
Definition
CN compression
deafness
blindness
hypertrophic heart with high output failure
hypervascularity causes shunt leading to heart failure |
|
|
Term
| pagets increases tumor probability, what are the two types of tumors and their defining characteristics |
|
Definition
benign: giant cell reparative granuloma, extraosseous hematopoietic masses
malignant: OSTEOSARCOMA, malignant fibrous histocytoma, chondrosarcoma |
|
|
Term
| what are some radiologic signs of pagets |
|
Definition
mosaic lamellar bone: haphazard cement lines
lytic lesions: nelarged misshapen bone
large, numerous osteoclast nuclei
marrow replaced by loose CT and reformed in osteosclerotic stage
large bones with thick trabecular |
|
|
Term
| what will the blood levels of Ca and P look like in pagets |
|
Definition
| increased alkaline phosphate |
|
|
Term
| what does the bone scane look like in pagets |
|
Definition
| hydrpxyproline: areas of bone remodeling |
|
|
Term
|
Definition
|
|
Term
|
Definition
fracture
corticosteroids
thrombosis and embolism
vessel injury
vascular compression
venous HTN |
|
|
Term
| associated conditions with osteonecrosis |
|
Definition
pregnancy, trauma, corticosteroids, infection, dysbarism, radiation therapy, CT disorders, gauchers disease
sickle cell, anemia, alcohol abuse, chronic pancreatitis, tumors, epiphyseal disorders |
|
|
Term
|
Definition
cancellous bone and marrow involvement
chest pain
predisposition to osteoarthritis |
|
|
Term
| what is the cause of 10% of all joint replacements |
|
Definition
| osteonecrosis via osteoarthritis |
|
|
Term
|
Definition
medullary infarction: most stable
subchondral infarction |
|
|
Term
| subchondral infarction: shape, location, composition |
|
Definition
wedge: due to vessel pattern
over articular cartilage getting nutrients from synovial fluid
dead bone with necrotic adipocytes around it |
|
|
Term
| pathogenesis of subchondrial infarction |
|
Definition
frequently reuptues releasing FA and binding Ca causing Ca soaps
creeping substitution: osteoclasts reabsorb dead bone, osteoblasts cannot keep up replacement so articular cartilage collapses and soloughs off |
|
|
Term
|
Definition
| inflammation of bone and marrow ususlly due to infection (or secondary infection like TB, but usually primary infection) |
|
|
Term
| causes of osteomyelitis and where they get picked up |
|
Definition
staph aureus: most common, injury
E. coli, pseudomonas: GU tract
H. influenza, GBS: neoates infector
salmonella: sickle cell pt |
|
|
Term
| routes of infection for osteomyelitis |
|
Definition
hematogenous spread- most common
extension from contigous site
direct implantantion (prostetic) |
|
|
Term
| what is the pathology of osteomyelitis in kids |
|
Definition
spreads to subperiosteum causing it to lift
interrupting blood supply causing necrosis and sequestration
rupturing periosteum causing abscess in soft tissue |
|
|
Term
| what is the pathology of osteomyelitis in infants |
|
Definition
epiphyseal infection usually
spreads to joints causing septic/suppurative arthritis |
|
|
Term
| what is the pathology of oseeomyelitis in adults |
|
Definition
necrosis due to inflammatory reaction within 48h
inflammatory cells attract cytokines stimulating osteoclasts to resorb bone increasing fibrous tissue causing sclerotic rim around lesion on x-ray
involucrum: reacrive bone in a sleeve of dead bone |
|
|
Term
| what are clinical and x-ray signs of osteomyelitis |
|
Definition
sclerotic rim around lesion: fibrous tissue
involucrum: reactive bone in sleeve of dead bone
malaise, fever, chills, leukocytosis
infants: just fever |
|
|
Term
| what are the diagnostic tests for osteomyelitis |
|
Definition
blooc culture: only finds 50% of microbes
biopsy: do whtn culture is negative or antibiotics are not working |
|
|
Term
| what is the prognosis of osteomyelitis |
|
Definition
5-25% persist and cause chronic infection: falure ups, pathologic fracture, secondary amyliodisis, endocarditis, sepsis, squamous cell carcinoma in sinus, sarcoma (rare)
CAUSES CANCER! |
|
|
Term
| TB sometimes spreads to bone, where does it go, why is it a big concern |
|
Definition
very destructive
usually in spine (pott disease), knee, hip |
|
|
Term
|
Definition
|
|
Term
|
Definition
| malignant tumor from mesenchymal tissue |
|
|
Term
|
Definition
| benign tumor of osteoblasts |
|
|
Term
|
Definition
| cartiladgenous malignant tumor |
|
|
Term
| what type of bone tumors cause pain |
|
Definition
benign pressing on something - uncommon
growing lesions
agresive osteoblastoma
giant cell tumor
malignant tumor: fast growht, destruction
pathologic fracture complication - benign or malignant
signigicant loss of tissue due to tumor |
|
|
Term
| who is at risk for metastasis to bone |
|
Definition
|
|
Term
| what is the most common location and presentation of metastasis to bone |
|
Definition
multi focal lesions in ribs, vertebrae, pelvis, cranium, proximal long bones
AXIAL |
|
|
Term
| what is the uncommon location and presentation of metastasis to bone |
|
Definition
solitary lesions
thyroid, lung, kidney |
|
|
Term
| what are the cancers that usually metastasize to bone |
|
Definition
prostate
thyroid
lung
kidney
breast |
|
|
Term
| where does cancer from bone metastasize to |
|
Definition
|
|
Term
| who usually gets bone tumors |
|
Definition
| teens and twenties (first 3 decades) |
|
|
Term
| are bone tumors usually benign or malignant |
|
Definition
|
|
Term
| where do most primary bone tumors originate (benign or malignant) |
|
Definition
| distal femur, proximal tibia |
|
|
Term
| what are two characteristics of bone cancer that are unique and important |
|
Definition
de-differentiation to more anaplastic (agressive) type
high grade sarcome comes from damaged bone |
|
|
Term
| what are two examples of tumor de-differentiation |
|
Definition
enchondroma
low grade chondrosarcoma transforming into high grade |
|
|
Term
| what are 3 examples of high grade sarcome coming from damaged bone |
|
Definition
bone infarct site
radiation osteitis
paget's disease |
|
|
Term
| what are the characteristics of a non-growing lesion |
|
Definition
|
|
Term
| what are the characteristics of a slow growing lesion |
|
Definition
well demarcated zone of bone destruction without sclerotic rim
provoke focal cortical thinking (solid periosteal reaction)
with continued growth such lesions may show cortical expansion |
|
|
Term
| what are the characteristics of a rapidly growing lesion |
|
Definition
penetrate through cortex causing seperation of periosteum (codman's triangle)
hair on end or sunburst pattern
moth eaten appearance |
|
|
Term
| osteoma: locations, associated conditions, malignant or benign |
|
Definition
mandible usually, skull, long bone
often seen with clonic polyposis (familial adenomatous polyposis) which is cardner syndrome
osteome usually comes before radiological signs of clonic polyposis
benign |
|
|
Term
| osteoid osteoma: malignant or benign, clinical signs, epidemology |
|
Definition
benign
painful, worse at night
males > females (2:1) |
|
|
Term
| osteoid osteoma: pathology |
|
Definition
releases COX causing pain (relieved by aspirin)
growth in diaphysis of long bone (<2cm lesion of cortex)
Xray shows central radionuclency surrounded by sclerotic rim |
|
|
Term
| lesions in intramedullary diaphysis |
|
Definition
eqings sarcoma
enchondroma |
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Term
| lesions in cortex diaphysis |
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Definition
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|
Term
| lesions in metaphysis cortex |
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Definition
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Term
| lesions in metaphysis intramedulary |
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Definition
osteosarcoma
chondrosarcoma
osteoblastoma |
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Term
| lesions in metaphyseal exostosis |
|
Definition
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Term
|
Definition
chondroblastoma in open growth plate
giant cell tumor: often crosses into metaphysis, only in closed growth plate |
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Term
| what condition is similar to osteoid osteoma |
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Definition
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|
Term
| where does osteoblastoma occur |
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Definition
| vertebrae or metaphysis of long bone |
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Term
|
Definition
dull pain, not relieved by aspirin
no sclerotic rum (growing too fast) |
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Term
| who gets osteochondroma(exostosis), what bones |
|
Definition
adolescents
long bones esp at knee |
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|
Term
| physiology of osteochondroma |
|
Definition
come from metaphysis near growth plate of tubular bones of endochondral origin
made of BONE and CARTILAGE
usually solitary lesion |
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|
Term
| clinical signs of osteochondroma |
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Definition
asymptomatic or painful
produce deformity |
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|
Term
| is osteochondroma malignant or benign |
|
Definition
benign
but it can undergo malignant transformation |
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|
Term
|
Definition
| easy to excise because it is solitary and on top of bone but dont unless painful |
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Term
| what os osteocondromatosis |
|
Definition
multiple hereditary exostosis
osteochondroma with multiple often symmetric lesions
more likey to transform and be malignant |
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|
Term
| chondroma malignant or benign, location |
|
Definition
benign
hayline cartilage
endochondrial origin bones (hands, feet) |
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|
Term
| endochondroma: define, location, age range |
|
Definition
condroma of the medullary cavity
20-50yo
most common intraosseous tumor |
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|
Term
| what is the most common intraosseous tumor |
|
Definition
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|
Term
| define endochondromatosis, associated conditions |
|
Definition
multiple endochondroma
soft tissue hemangioma of endothelial cell orogin |
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|
Term
|
Definition
epiphysis
epiphyses: iliac crest |
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|
Term
| pathology chondroblastoma |
|
Definition
disorder apparent in chondroblasts
cellular tomor with little hayline matrix
when calcifies looks like chicken wire |
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|
Term
|
Definition
painful due to joint effusions causing limited mobility
x-ray: spotty calcifications in apiphysis |
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|
Term
| who gets giant cell tumor |
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Definition
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|
Term
| giant cell tumor: location, malignant or benign |
|
Definition
epiphysis but can spread to metaphysis
usually around knee
benign but can metastazise |
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|
Term
| composition of giant cell tumor |
|
Definition
| osteoclast like giant cells and stroma |
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|
Term
| signs of giant cell tumor |
|
Definition
x-ray: expanding lytic lesions, demacrated, not sclerotic (cell in bone)
red brown mass with cystic degeneration |
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Term
| what is giant cell tumor often confused with, why |
|
Definition
| red brown mass with cystic degeneration looks like brown tumor of hyperparathyroidism. here its due to high vascularization |
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|
Term
| prognosis of giant cell tumor |
|
Definition
surgical removal leaves with 40-60% reoccurance
4% spread to lungs |
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|
Term
| what is a fibrous cortical defect |
|
Definition
| not neoplasm! developmental defect in 30-50% of kids >2yo |
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|
Term
| signs of small fibrous cortical defect |
|
Definition
<0.5cm
bilateral
maybe multiple
usually asymptomatic
spontaneously resolve in a few years replaced by normal bone |
|
|
Term
| signs of large fibrous cortical defect |
|
Definition
5-6cm
aka non-ossifying fibroma
metaphyseal lesion with rim of sclerotic bone
usually involves cortex |
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|
Term
| what is the most common primary malignant tumor of bone |
|
Definition
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|
Term
| who gets osteosarcoma, where |
|
Definition
teenagers
usually around knee (sometime hip) |
|
|
Term
| where does osteosarcoma come from |
|
Definition
| malignant mesenchymal tumor that makes bone matrix |
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|
Term
|
Definition
agressive
can become very large |
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|
Term
| radiograph signs of osteosarcoma |
|
Definition
codmans triangle: as tumor penetrates it seperates periosteum
sunburst pattern
bone destruction |
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|
Term
|
Definition
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|
Term
| location of chondrosarcoma |
|
Definition
AXIAL
pelvic bones, spine, shoulder, ribs, long bones |
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|
Term
|
Definition
atypical chondrocytes and chondroblasts with multiple nuclei in lacuna
produce neoplastic cartilage |
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|
Term
| what are the grades of chondrosarcoma, how are they identified |
|
Definition
more radiolucent higher grade
slow growing: reactive thickening of cortex
fast growing: no time for reaction, cortex destoried |
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|
Term
|
Definition
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|
Term
| signs of ewing sarcoma on xray |
|
Definition
| concentric onion skin layering of periosteum |
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|
Term
| clinical signs of ewing sarcoma |
|
Definition
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|
Term
| location of ewing sarcoma |
|
Definition
| DIAPHYSIS of femur, pelvis, tibia |
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|
Term
| histological signs ewing sarcoma |
|
Definition
homer wright rosettes: tumors cells in circle around fibrillary space due to neural differention
sheets of undifferentiated blue cells resembling lymphocytes |
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|
Term
|
Definition
translocation of EWS gene to a member ot ETS family transcription factors and EWS acts as an oncogene activating chimeric protein stimulating cell proliferation
t(11;22) |
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|
Term
| what condition is ewing sarcoma similar to, what is the difference |
|
Definition
primitive neuroectodermal tumor (PNET)
ewing is less differetiated, everything else is the same |
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|
Term
| prognosis of ewing sarcome |
|
Definition
used to be poor
now 75% 5 year survival with chemo
50% long term cure |
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