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(→Osteoporosis: expand, +images) |
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=Normal bone= | =Normal bone= | ||
==Bone | ==Bone anatomy== | ||
*Epiphysis = rounded end of the bone. | *Epiphysis = rounded end of the bone. | ||
*Metaphysis = between epiphysis and diaphysis; contains ''epiphyseal plate'' - site of growth in childhood. | *Metaphysis = between epiphysis and diaphysis; contains ''epiphyseal plate'' - site of growth in childhood. | ||
*Diaphysis = shaft, mid-portion, contains [[bone marrow]]. | *Diaphysis = shaft, mid-portion, contains [[bone marrow]]. | ||
Image | ===Image=== | ||
<gallery> | |||
Image:EpiMetaDiaphyse.jpg | Bone. (WC) | |||
</gallery> | |||
== | ==Bone histology== | ||
Two types (based on arrangement of collagen): | Two types (based on arrangement of collagen): | ||
#Woven | # Woven bone. | ||
# Lamellar bone. | |||
#Lamellar | |||
Woven | ===Woven bone=== | ||
* | *Always abnormal in adults. | ||
*Collagen arranged haphazardly - mechanically weak. | |||
Images: | Images: | ||
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*[http://www.brown.edu/Courses/Digital_Path/systemic_path/bone/paget.html Woven bone (brown.edu)]. | *[http://www.brown.edu/Courses/Digital_Path/systemic_path/bone/paget.html Woven bone (brown.edu)]. | ||
=== | ===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). | |||
===Woven versus lamellar=== | |||
*Easiest way to differentiate: polarize; lamellar bone has well-defined layers. | |||
==Bone cells== | |||
*Osteocytes. | *Osteocytes. | ||
**Sit in lacunae. | **Sit in lacunae. | ||
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==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. | ||
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> | |||
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]]. | ||
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#*Reniform nucleus, i.e. kidney bean shaped nucleus. | #*Reniform nucleus, i.e. kidney bean shaped nucleus. | ||
Note: | |||
*[http:// | *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> | ||
====Organization==== | ====Organization==== | ||
*Mature hematopoeitic cells at the centre (distant from bone). | *Mature hematopoeitic cells at the centre (distant from bone). | ||
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*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= | ||
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=Infections= | =Infections= | ||
== | ==Acute osteomyelitis== | ||
General | ===General=== | ||
Pathophysiology/entry: | |||
*Hematogenous - often in children. | *Hematogenous - often in children. | ||
*Direct entry (skin defect) - adults with diabetes. | *Direct entry (skin defect) - adults with diabetes. | ||
===Microscopic=== | ===Microscopic=== | ||
Features: | |||
*[[PMN]]s. | *[[PMN]]s. | ||
*Micro-organisms - esp. cocci. | |||
Image: | |||
*[http://osteomyelitis.stanford.edu/pages/histo_002.html Acute osteomyeelitis (stanford.edu)]. | |||
===Stains=== | |||
*[[Gram stain]]. | |||
==Chronic osteomyelitis== | ==Chronic osteomyelitis== | ||
===General=== | |||
Most common organism: | |||
*''Staphylococcus aureus''.<ref name=pmid22046943>{{Cite journal | last1 = Hatzenbuehler | first1 = J. | last2 = Pulling | first2 = TJ. | title = Diagnosis and management of osteomyelitis. | journal = Am Fam Physician | volume = 84 | issue = 9 | pages = 1027-33 | month = Nov | year = 2011 | doi = | PMID = 22046943 | URL = http://www.aafp.org/link_out?pmid=22046943 }}</ref> | |||
Risk factors:<ref name=pmid22046943/> | |||
*[[Diabetes mellitus]]. | |||
*Peripheral vascular disease. | |||
===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
*Plasma cells. | *Plasma cells - '''key feature'''. | ||
**May be sterile, i.e. no organisms. | **May be sterile, i.e. no organisms. | ||
*+/-Fibrosis. | |||
*+/-Necrotic bone - bone with empty lacunae. | |||
*+/-[[Amyloid]]. | *+/-[[Amyloid]]. | ||
**~10% of patients in one series.<ref name=pmid2071276>{{Cite journal | last1 = Alabi | first1 = ZO. | last2 = Ojo | first2 = OS. | last3 = Odesanmi | first3 = WO. | title = Secondary amyloidosis in chronic osteomyelitis. | journal = Int Orthop | volume = 15 | issue = 1 | pages = 21-2 | month = | year = 1991 | doi = | PMID = 2071276 }}</ref> | **~10% of patients in one series.<ref name=pmid2071276>{{Cite journal | last1 = Alabi | first1 = ZO. | last2 = Ojo | first2 = OS. | last3 = Odesanmi | first3 = WO. | title = Secondary amyloidosis in chronic osteomyelitis. | journal = Int Orthop | volume = 15 | issue = 1 | pages = 21-2 | month = | year = 1991 | doi = | PMID = 2071276 }}</ref> | ||
Image: | |||
*[http://osteomyelitis.stanford.edu/pages/histo_001.html Chronic osteomyelitis (stanford.edu)]. | |||
===Sign out=== | |||
<pre> | |||
LOWER LEG, RIGHT, BELOW KNEE AMPUTATION: | |||
- ACUTE AND CHRONIC OSTEOMYELITIS. | |||
- MODERATE ATHEROSCLEROSIS. | |||
- SKIN ULCERATION. | |||
- 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. | |||
</pre> | |||
=Bone tumours= | =Bone tumours= | ||
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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== | ||
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==Aneurysmal bone cyst== | ==Aneurysmal bone cyst== | ||
{{Main|Aneurysmal bone cyst}} | |||
==Myositis ossificans== | ==Myositis ossificans== | ||
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**Lesion is well-circumscribed. | **Lesion is well-circumscribed. | ||
**Normal muscle is adjacent to the lesion - '''key feature'''. | **Normal muscle is adjacent to the lesion - '''key feature'''. | ||
DDx: | |||
*[[Heterotopic ossification]] - bone, not cellular, no inflammation. | |||
Images: | Images: | ||
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==Paget disease of the bone== | ==Paget disease of the bone== | ||
{{Main|Paget's disease of the bone}} | |||
==Fibrous dysplasia== | ==Fibrous dysplasia== | ||
*[[AKA]] ''osteitis fibrosa''. | *[[AKA]] ''osteitis fibrosa''. | ||
{{Main|Fibrous dysplasia}} | |||
==Desmoplastic fibroma== | ==Desmoplastic fibroma== | ||
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DDx: | DDx: | ||
*[[Fibrous dysplasia]] - has woven bone. | *[[Fibrous dysplasia]] - has woven bone. | ||
*Low grade fibrosarcoma. | *Low grade [[fibrosarcoma]]. | ||
==Gaucher disease== | ==Gaucher disease== | ||
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*[[Giant cell tumour of bone]]. | *[[Giant cell tumour of bone]]. | ||
Images | ====Images==== | ||
<gallery> | |||
Image:Central_giant_cell_granuloma_-_intermed_mag.jpg | CGCG - intermed. mag. (WC/Nephron) | |||
Image:Central_giant_cell_granuloma_-_high_mag.jpg | CGCG - high mag. (WC/Nephron) | |||
</gallery> | |||
===Molecular=== | ===Molecular=== | ||
Recurrent [[chromosomal translocation]]:<ref name=pmid22285042/> | Recurrent [[chromosomal translocation]]:<ref name=pmid22285042/> | ||
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===Gross=== | ===Gross=== | ||
*Marbled appearance. | *Marbled appearance. | ||
* | *Thickening with obliteration of the marrow space. | ||
*Patchy (brown) surface due to vascularization/[[extramedullary hematopoiesis]].<ref name=Ref_AoGP469>{{Ref AoGP|469}}</ref> | |||
Image: | Image: | ||
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===General=== | ===General=== | ||
*Very common. | *Very common. | ||
*Associated with [[bone fractures|fractures]]. | *Associated with [[bone fractures|fractures]], esp. wrist, [[traumatic hip fracture|hip]] & vertebra.<ref name=pmid22537071>{{Cite journal | last1 = Lix | first1 = LM. | last2 = Azimaee | first2 = M. | last3 = Acan Osman | first3 = B. | last4 = Caetano | first4 = P. | last5 = Morin | first5 = S. | last6 = Metge | first6 = C. | last7 = Goltzman | first7 = D. | last8 = Kreiger | first8 = N. | last9 = Prior | first9 = J. | title = Osteoporosis-related fracture case definitions for population-based administrative data. | journal = BMC Public Health | volume = 12 | issue = 1 | pages = 301 | month = Apr | year = 2012 | doi = 10.1186/1471-2458-12-301 | PMID = 22537071 }}</ref> | ||
*Radiologic diagnosis. | *Radiologic diagnosis - bone mineral density. | ||
* | |||
Etiology:<ref name=Ref_PCPBoD8_617>{{Ref PCPBoD8|617}}</ref> | |||
*Primary (senile). | |||
*Secondary: | |||
**Endocrine: | |||
***Hyperparathyroidism. | |||
**Gastrointestinal: | |||
***Malabsorption, e.g. [[celiac disease]], [[cystic fibrosis]], [[Crohn's disease]]. | |||
***Starvation. | |||
**Psychiatric: | |||
***Anorexia nervosa. | |||
***Bulimia nervosa. | |||
**Neoplasia: | |||
***[[Multiple myeloma]]. | |||
**Drugs: | |||
***Systemic steroids.<ref name=pmid16243531>{{Cite journal | last1 = Dalle Carbonare | first1 = L. | last2 = Bertoldo | first2 = F. | last3 = Valenti | first3 = MT. | last4 = Zenari | first4 = S. | last5 = Zanatta | first5 = M. | last6 = Sella | first6 = S. | last7 = Giannini | first7 = S. | last8 = Cascio | first8 = VL. | title = Histomorphometric analysis of glucocorticoid-induced osteoporosis. | journal = Micron | volume = 36 | issue = 7-8 | pages = 645-52 | month = | year = 2005 | doi = 10.1016/j.micron.2005.07.009 | PMID = 16243531 }}</ref> | |||
===Gross=== | ===Gross=== | ||
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===Microscopic=== | ===Microscopic=== | ||
Features: | Features (femoral neck):<ref name=pmid18708176>{{Cite journal | last1 = Blain | first1 = H. | last2 = Chavassieux | first2 = P. | last3 = Portero-Muzy | first3 = N. | last4 = Bonnel | first4 = F. | last5 = Canovas | first5 = F. | last6 = Chammas | first6 = M. | last7 = Maury | first7 = P. | last8 = Delmas | first8 = PD. | title = Cortical and trabecular bone distribution in the femoral neck in osteoporosis and osteoarthritis. | journal = Bone | volume = 43 | issue = 5 | pages = 862-8 | month = Nov | year = 2008 | doi = 10.1016/j.bone.2008.07.236 | PMID = 18708176 }}</ref> | ||
* | *Thinner cortex. | ||
*Decreased trabecular thickness | |||
*Decreased number of trabeculae. | |||
Note: | |||
*One study looking at iliac bone biopsies suggests trabeculae are no different in osteoporosis.<ref name=pmid3414359>{{Cite journal | last1 = Chappard | first1 = D. | last2 = Alexandre | first2 = C. | last3 = Riffat | first3 = G. | title = Spatial distribution of trabeculae in iliac bone from 145 osteoporotic females. | journal = Acta Anat (Basel) | volume = 132 | issue = 2 | pages = 137-42 | month = | year = 1988 | doi = | PMID = 3414359 }}</ref> | |||
=See also= | =See also= | ||
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*[[Chondro-osseous tumours]]. | *[[Chondro-osseous tumours]]. | ||
*[[Femoral head]]. | *[[Femoral head]]. | ||
*[[Spine]]. | |||
*[[Hematopathology]]. | *[[Hematopathology]]. | ||
*[[Soft tissue lesions]]. | *[[Soft tissue lesions]]. | ||
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{{reflist|2}} | {{reflist|2}} | ||
[[Category: | =External links= | ||
*[http://www.medicalhistology.us/twiki/bin/view/Main/CartilageAndBoneAtlas08 Bone and cartilage histology (medicalhistology.us)]. | |||
[[Category:Bone]] |
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