|
|
(14 intermediate revisions by one other user not shown) |
Line 28: |
Line 28: |
|
| |
|
| ===Lamellar bone=== | | ===Lamellar bone=== |
| | [[File:Lamella bone H&E and under polarised light.gif|thumb|Animated GIF showing a photomicrograph of lamellar bone. The layers are accentuated under polarised light.]] |
| *Collagen organized in layers (lamellae). | | *Collagen organized in layers (lamellae). |
|
| |
|
Line 47: |
Line 48: |
| ==Bone marrow== | | ==Bone marrow== |
| {{Main|Haematopoiesis}} | | {{Main|Haematopoiesis}} |
| | ===General=== |
| *One of two ''[[primary lymphoid organs]]'' - the other one is the [[thymus]].<ref>URL: [http://www.life.umd.edu/classroom/bsci423/song/Lab1.html http://www.life.umd.edu/classroom/bsci423/song/Lab1.html]. Accessed on: 28 March 2012.</ref> | | *One of two ''[[primary lymphoid organs]]'' - the other one is the [[thymus]].<ref>URL: [http://www.life.umd.edu/classroom/bsci423/song/Lab1.html http://www.life.umd.edu/classroom/bsci423/song/Lab1.html]. Accessed on: 28 March 2012.</ref> |
| | |
| | Bone marrow biopsy adequacy:<ref name=pmid16477878>{{Cite journal | last1 = Rudzki | first1 = Z. | last2 = Partyła | first2 = T. | last3 = Okoń | first3 = K. | last4 = Stachura | first4 = J. | title = Adequacy of trephine bone marrow biopsies: the doctor and the patient make a difference. | journal = Pol J Pathol | volume = 56 | issue = 4 | pages = 187-95 | month = | year = 2005 | doi = | PMID = 16477878 }}</ref> |
| | *10 intertrabecular spaces or 10 mm. |
| | |
| | ===Microscopic=== |
| | One should see three cell lines:<ref>URL: [http://emedicine.medscape.com/article/199003-overview http://emedicine.medscape.com/article/199003-overview]. Accessed on: 28 March 2012.</ref> |
| | #Erythroid (red cells). |
| | #Myeloid (white blood cells). |
| | #Megakaryocytic (platelets). |
| | |
| | Adipose tissue: |
| *Fat content (%) ~= age in years.<ref>IAV. 26 Feb 2009.</ref> | | *Fat content (%) ~= age in years.<ref>IAV. 26 Feb 2009.</ref> |
| **e.g. 60 year old will have 60% fatty replacement. | | **e.g. 60 year old will have 60% fatty replacement. |
|
| |
|
| *One should see three cell lines:<ref>URL: [http://emedicine.medscape.com/article/199003-overview http://emedicine.medscape.com/article/199003-overview]. Accessed on: 28 March 2012.</ref>
| | Identifying the cell lines:<ref>[http://upload.wikimedia.org/wikipedia/commons/6/69/Hematopoiesis_%28human%29_diagram.png http://upload.wikimedia.org/wikipedia/commons/6/69/Hematopoiesis_%28human%29_diagram.png]</ref> |
| *#Erythroid (red cells).
| |
| *#Myeloid (white blood cells).
| |
| *#Megakaryocytic (platelets).
| |
| | |
| Note: Lymphocytes are considered separately and typically spared in bone marrow failure.<ref>[http://emedicine.medscape.com/article/199003-overview http://emedicine.medscape.com/article/199003-overview]</ref>
| |
| | |
| Identifying the lines:<ref>[http://upload.wikimedia.org/wikipedia/commons/6/69/Hematopoiesis_%28human%29_diagram.png http://upload.wikimedia.org/wikipedia/commons/6/69/Hematopoiesis_%28human%29_diagram.png]</ref> | |
| #Megakaryocytes: | | #Megakaryocytes: |
| #*Big cells ~ 3x the size of a [[RBC]]. | | #*Big cells ~ 3x the size of a [[RBC]]. |
Line 67: |
Line 73: |
| #*Reniform nucleus, i.e. kidney bean shaped nucleus. | | #*Reniform nucleus, i.e. kidney bean shaped nucleus. |
|
| |
|
| ===Images===
| | Note: |
| <gallery> | | *Lymphocytes are considered separately and typically spared in bone marrow failure.<ref>[http://emedicine.medscape.com/article/199003-overview http://emedicine.medscape.com/article/199003-overview]</ref> |
| Image:Bone_marrow_WBC.JPG| Myeloid line. (WC)
| |
| </gallery> | |
| ====Organization==== | | ====Organization==== |
| *Mature hematopoeitic cells at the centre (distant from bone). | | *Mature hematopoeitic cells at the centre (distant from bone). |
Line 78: |
Line 82: |
| *Immediately adjacent to the bone (paratrabecular)... is where [[follicular lymphoma]] is classically found.<ref name=pmid17284114>{{Cite journal | last1 = Iancu | first1 = D. | last2 = Hao | first2 = S. | last3 = Lin | first3 = P. | last4 = Anderson | first4 = SK. | last5 = Jorgensen | first5 = JL. | last6 = McLaughlin | first6 = P. | last7 = Medeiros | first7 = LJ. | title = Follicular lymphoma in staging bone marrow specimens: correlation of histologic findings with the results of flow cytometry immunophenotypic analysis. | journal = Arch Pathol Lab Med | volume = 131 | issue = 2 | pages = 282-7 | month = Feb | year = 2007 | doi = 10.1043/1543-2165(2007)131[282:FLISBM]2.0.CO;2 | PMID = 17284114 }}</ref> | | *Immediately adjacent to the bone (paratrabecular)... is where [[follicular lymphoma]] is classically found.<ref name=pmid17284114>{{Cite journal | last1 = Iancu | first1 = D. | last2 = Hao | first2 = S. | last3 = Lin | first3 = P. | last4 = Anderson | first4 = SK. | last5 = Jorgensen | first5 = JL. | last6 = McLaughlin | first6 = P. | last7 = Medeiros | first7 = LJ. | title = Follicular lymphoma in staging bone marrow specimens: correlation of histologic findings with the results of flow cytometry immunophenotypic analysis. | journal = Arch Pathol Lab Med | volume = 131 | issue = 2 | pages = 282-7 | month = Feb | year = 2007 | doi = 10.1043/1543-2165(2007)131[282:FLISBM]2.0.CO;2 | PMID = 17284114 }}</ref> |
| **Image: [http://www.flickr.com/photos/euthman/5691578596/in/set-72057594114099781 Paratrabecular follicular lymphoma (flickr.com)]. | | **Image: [http://www.flickr.com/photos/euthman/5691578596/in/set-72057594114099781 Paratrabecular follicular lymphoma (flickr.com)]. |
| | ===Images=== |
| | <gallery> |
| | Image:Bone_marrow_WBC.JPG| Myeloid line. (WC) |
| | </gallery> |
| | |
| | ===Sign out=== |
| | ====Essentially normal==== |
| | <pre> |
| | Bone Marrow, Posterior Superior Iliac Spine, Biopsy: |
| | - Bone marrow with trilineage hematopoiesis. |
| | - Cellularity within normal limits for age. |
| | - Case will be sent to hematology for consultation and correlation |
| | with other testing. |
| | </pre> |
| | |
| | ====Inadequate==== |
| | <pre> |
| | Right Posterior Superior Iliac Spine, Bone Marrow Biopsy: |
| | - Predominantly benign dense fibrous tissue with a small |
| | amount of laminar bone, and minute fragment of marrow (<2 mm). |
| | - Case will be sent to hematopathology for further assessment. |
| | </pre> |
|
| |
|
| =Benign variants= | | =Benign variants= |
Line 130: |
Line 156: |
| - SKIN ULCERATION. | | - SKIN ULCERATION. |
| - SOFT TISSUE SURGICAL MARGIN WITH FAT NECROSIS AND MUSCULAR ATROPHY. | | - SOFT TISSUE SURGICAL MARGIN WITH FAT NECROSIS AND MUSCULAR ATROPHY. |
| | - NEGATIVE FOR MALIGNANCY. |
| | </pre> |
| | |
| | <pre> |
| | TRAPEZIUM, RIGHT HAND, REMOVAL: |
| | - DEGENERATIVE JOINT DISEASE. |
| | - MARROW SPACE WITH FIBROSIS AND SCATTERED LYMPHOCYTES AND PLASMA CELLS, |
| | COMPATIBLE WITH MILD CHRONIC OSTEOMYELITIS. |
| | - NO MICROORGANISMS APPARENT WITH ROUTINE STAINS. |
| - NEGATIVE FOR MALIGNANCY. | | - NEGATIVE FOR MALIGNANCY. |
| </pre> | | </pre> |
Line 147: |
Line 182: |
|
| |
|
| A general DDx for cystic bone lesions is found on ''radipedia.com''.<ref>URL: [http://radipedia.com/WikiMedia/index.php?title=Benign_cystic_bone_lesions http://radipedia.com/WikiMedia/index.php?title=Benign_cystic_bone_lesions]. Accessed on: 15 March 2011.</ref> | | A general DDx for cystic bone lesions is found on ''radipedia.com''.<ref>URL: [http://radipedia.com/WikiMedia/index.php?title=Benign_cystic_bone_lesions http://radipedia.com/WikiMedia/index.php?title=Benign_cystic_bone_lesions]. Accessed on: 15 March 2011.</ref> |
| | |
| | ==Sequestrum== |
| | {{Main|Sequestrum}} |
|
| |
|
| ==Osteoarthritis== | | ==Osteoarthritis== |
Line 153: |
Line 191: |
|
| |
|
| ==Aneurysmal bone cyst== | | ==Aneurysmal bone cyst== |
| *Abbreviated ''ABC''.
| | {{Main|Aneurysmal bone cyst}} |
| :''Also see [[giant cell reparative granuloma]]'' ([[AKA]] ''solid aneurysmal bone cyst'').
| |
| | |
| ===General===
| |
| Features:<ref name=emed_abc>URL: [http://emedicine.medscape.com/article/1254784-overview http://emedicine.medscape.com/article/1254784-overview]. Accessed on: 4 February 2011.</ref>
| |
| *Benign.
| |
| **May grow rapidly.
| |
| *Osteolysis -> cystic space -> filled with blood.
| |
| *Relatively common; in children second only to [[osteosarcoma]].<ref name=pmid18157043>{{cite journal |author=van den Berg H, Kroon HM, Slaar A, Hogendoorn P |title=Incidence of biopsy-proven bone tumors in children: a report based on the Dutch pathology registration "PALGA" |journal=J Pediatr Orthop |volume=28 |issue=1 |pages=29–35 |year=2008 |pmid=18157043 |doi=10.1097/BPO.0b013e3181558cb5 |url=}}</ref>
| |
| | |
| ===Gross/radiologic===
| |
| Features:<ref name=pmid22531523>{{Cite journal | last1 = Parashari | first1 = UC. | last2 = Khanduri | first2 = S. | last3 = Upadhyay | first3 = D. | last4 = Bhadury | first4 = S. | last5 = Singhal | first5 = S. | title = Radiologic and pathologic correlation of aneurysmal bone cysts at unusual sites. | journal = J Cancer Res Ther | volume = 8 | issue = 1 | pages = 103-5 | month = | year = | doi = 10.4103/0973-1482.95183 | PMID = 22531523 }}</ref>
| |
| *Air-fluid levels (radiology).
| |
| *Usually metaphysis of long bones, but uncommonly the femur.
| |
| *May have an "aggressive" appearance, i.e. erode bone.
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=emed_abc/>
| |
| *Bony trabeculae ''or'' osteoid tissue.
| |
| *Osteoclast [[giant cell]]s.
| |
| **Multi-nucleated giant-cells with round randomly arranged nuclei.
| |
| *Benign spindle cells (fibroblasts) - surround bone/adjacent to the giant cells - '''important'''.
| |
| *Blood +/- surrounded by giant cells.
| |
| | |
| DDx:
| |
| *[[Giant cell tumour of bone]] - the nuclei of the cells surrounding the giant cells are similar to those in the giant cells (round nuclei).
| |
| *[[Telangiectatic osteosarcoma]].
| |
| *Other [[giant cell lesions]].
| |
| | |
| ====Images====
| |
| <gallery>
| |
| Image:Aneurysmal_bone_cyst_-_intermed_mag.jpg | ABC - intermed. mag. (WC/Nephron)
| |
| Image:Aneurysmal_bone_cyst_-_very_high_mag.jpg | ABC - very high mag. (WC/Nephron)
| |
| </gallery>
| |
| www:
| |
| *[http://www.webpathology.com/image.asp?n=4&Case=344 ABC - low mag. (webpathology.com)].
| |
| *[http://www.webpathology.com/image.asp?n=5&Case=344 ABC - intermed. mag. (webpathology.com)].
| |
| *[http://www.webpathology.com/image.asp?case=344&n=6 ABC - high mag. (webpathology.com)].
| |
|
| |
|
| ==Myositis ossificans== | | ==Myositis ossificans== |
Line 223: |
Line 224: |
|
| |
|
| ==Paget disease of the bone== | | ==Paget disease of the bone== |
| ===General===
| | {{Main|Paget's disease of the bone}} |
| *Benign - unlike [[Paget disease of the breast]].
| |
| *Afflicts ~ 3% of population > 55 years old.<ref name=pmid22396921/>
| |
| *Leading cause of ''secondary [[osteosarcoma]]''.
| |
| *Uncommonly associated with [[giant cell tumour of bone]].<ref name=pmid17437100>{{Cite journal | last1 = Hoch | first1 = B. | last2 = Hermann | first2 = G. | last3 = Klein | first3 = MJ. | last4 = Abdelwahab | first4 = IF. | last5 = Springfield | first5 = D. | title = Giant cell tumor complicating Paget disease of long bone. | journal = Skeletal Radiol | volume = 36 | issue = 10 | pages = 973-8 | month = Oct | year = 2007 | doi = 10.1007/s00256-007-0310-x | PMID = 17437100 }}</ref><ref name=pmid21319038>{{Cite journal | last1 = Karakida | first1 = K. | last2 = Ota | first2 = Y. | last3 = Aoki | first3 = T. | last4 = Akamatsu | first4 = T. | last5 = Kajiwara | first5 = H. | last6 = Hirabayashi | first6 = K. | title = Multiple giant cell tumors in maxilla and skull complicating Paget's disease of bone. | journal = Tokai J Exp Clin Med | volume = 35 | issue = 3 | pages = 112-7 | month = Sep | year = 2010 | doi = | PMID = 21319038 }}</ref>
| |
| *[[Diagnosis]] based on radiology.<ref name=pmid22396921/>
| |
| *Genetic component - several genes implicated<ref name=omim602080>{{OMIM|602080}}</ref> including ''TNFRSF11A'' ([[AKA]] PDB2)<ref name=omim603499>{{OMIM|603499}}</ref> and ''PDB4''.<ref name=omim606263>{{OMIM|606263}}</ref>
| |
|
| |
|
| ====Clinical====
| |
| Presentation:<ref name=pmid22396921>{{Cite journal | last1 = Britton | first1 = C. | last2 = Walsh | first2 = J. | title = Paget disease of bone - an update. | journal = Aust Fam Physician | volume = 41 | issue = 3 | pages = 100-3 | month = Mar | year = 2012 | doi = | PMID = 22396921 | URL = http://www.racgp.org.au/afp/201203/201203britton.pdf }}</ref>
| |
| *[[Fracture of bone|Fracture]].
| |
| *Bone pain.
| |
| *Bony deformity.
| |
| *Deafness.
| |
| *Incidental finding - radiologic or biochemical.
| |
|
| |
| Serology:
| |
| *Elevated ALP.
| |
|
| |
| Clinical features - mnemonic ''PANICS'':<ref>URL: [http://www.medicalgeek.com/orthopedics/2743-orthopedics-mnemonics.html http://www.medicalgeek.com/orthopedics/2743-orthopedics-mnemonics.html]. Accessed on: 30 April 2012.</ref>
| |
| *'''P'''ain (bone).
| |
| *'''A'''rthralgia and '''A'''LP elevated.
| |
| *'''N'''erve compression - deafness.
| |
| *'''I'''ncreased bone density.
| |
| *'''C'''ardiac failure (high output) - due to AVM formation in bone.
| |
| *'''S'''unburst skull on X-ray.
| |
|
| |
| ====Stage====
| |
| Classically divided into three phases:<ref name=emed_paget>URL: [http://emedicine.medscape.com/article/311688-overview http://emedicine.medscape.com/article/311688-overview]. Accessed on: 25 December 2010.</ref><ref>URL: [http://radiopaedia.org/articles/paget-disease-of-bone-1 http://radiopaedia.org/articles/paget-disease-of-bone-1]. Accessed on: 25 December 2010.</ref>
| |
| #Lytic (predominantly osteoclasts).
| |
| #Mixed lytic (osteoclastic) and blastic (osteoblastic).
| |
| #Sclerotic (burned-out).
| |
|
| |
| ===Microscopic===
| |
| Features:<ref name=emed_paget>URL: [http://emedicine.medscape.com/article/311688-overview http://emedicine.medscape.com/article/311688-overview]. Accessed on: 25 December 2010.</ref>
| |
| *Bone matrix has jigsaw-puzzle like pattern.
| |
| **Jigsaw-puzzle pieces each ~ 100-500 micrometres in size (largest dimension).
| |
| *Increased osteoclast activity.
| |
| **Osteoclast = macrophage that reabsorbs bone matrix.
| |
|
| |
| ====Images====
| |
| <gallery>
| |
| Image:Paget_disease_of_bone_-_high_mag.jpg | Paget disease - bone - high mag. (WC/Nephron)
| |
| Image:Paget_disease_of_bone_-_intermed_mag.jpg | Paget disease - bone - intermed. mag. (WC/Nephron)
| |
| </gallery>
| |
| ==Fibrous dysplasia== | | ==Fibrous dysplasia== |
| *[[AKA]] ''osteitis fibrosa''. | | *[[AKA]] ''osteitis fibrosa''. |
| ===General===
| | {{Main|Fibrous dysplasia}} |
| Classification:
| |
| *''Monostotic'' - one bone involved, ~80% of cases.
| |
| *''Polyostotic'' - several bones involved, ~20% of cases.
| |
| **May be associated with [[McCune-Albright syndrome]].
| |
| | |
| ===Microscopic===
| |
| Features:<ref>URL: [http://www.pathologypics.com/pictview.aspx?id=104 http://www.pathologypics.com/pictview.aspx?id=104]. Accessed on: 14 April 2011.</ref>
| |
| *Woven bone with odd irregular shapes - '''key feature'''.
| |
| **Described as "chinese characters".<ref>URL: [http://www.pathcases.com/bone_tumors_and_tumor.htm http://www.pathcases.com/bone_tumors_and_tumor.htm]. Accessed on: 31 May 2011.</ref>
| |
| *Fibrous tissue around bone.
| |
| | |
| Notes:
| |
| *No osteoblastic rimming.
| |
| | |
| DDx:
| |
| *[[Desmoplastic fibroma]] - has lamellar bone.
| |
| *Low grade [[fibrosarcoma]].
| |
| *[[Low-grade central osteosarcoma]].<ref name=inwards>{{cite journal |author=Inwards, CY |title=Low-grade central osteosarcoma versus fibrous dysplasia |journal=Pathology Case Reviews |volume=6 |issue=1 |pages=22-27 |year=2001 |pmid= |doi= |url= http://journals.lww.com/pathologycasereviews/Fulltext/2001/01000/Low_Grade_Central_Osteosarcoma_Versus_Fibrous.5.aspx }}</ref>
| |
| | |
| ====Images====
| |
| <gallery>
| |
| Image:Fibrous_dysplasia_-_low_mag.jpg | Fibrous dysplasia - low mag. (WC/Nephron)
| |
| Image:Fibrous_dysplasia_-_intermed_mag.jpg | Fibrous dysplasia - intermed. mag. (WC/Nephron)
| |
| Image:Fibrous_dysplasia_-_high_mag.jpg | Fibrous dysplasia - high mag. (WC/Nephron)
| |
| </gallery>
| |
| www:
| |
| *[http://www.pathologypics.com/pictview.aspx?id=104 Fibrous dysplasia of bone - high mag. (pathologypics.com)].
| |
| *[http://www.pathologypics.com/BigPicViewer.aspx?PictureID=103 Fibrous dysplasia of bone - low mag. (pathologypics.com)].
| |
|
| |
|
| ==Desmoplastic fibroma== | | ==Desmoplastic fibroma== |
Line 430: |
Line 360: |
| *[[Chondro-osseous tumours]]. | | *[[Chondro-osseous tumours]]. |
| *[[Femoral head]]. | | *[[Femoral head]]. |
| | *[[Spine]]. |
| *[[Hematopathology]]. | | *[[Hematopathology]]. |
| *[[Soft tissue lesions]]. | | *[[Soft tissue lesions]]. |
Line 437: |
Line 368: |
| {{reflist|2}} | | {{reflist|2}} |
|
| |
|
| [[Category:Weird stuff]] | | =External links= |
| | *[http://www.medicalhistology.us/twiki/bin/view/Main/CartilageAndBoneAtlas08 Bone and cartilage histology (medicalhistology.us)]. |
| | |
| | [[Category:Bone]] |