Difference between revisions of "Femoral head"
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[[Image:Head of femur.jpg|thumb|right|300px|Femoral head. (WC)]] | |||
The '''femoral head''' is a common [[ditzel]] in surgical pathology at centres which have orthopaedic surgeons. | The '''femoral head''' is a common [[ditzel]] in surgical pathology at centres which have orthopaedic surgeons. | ||
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=Gross= | =Gross= | ||
Features to comment on:<ref name=Ref_Lester225>{{Ref Lester|225}}</ref> | Features to comment on:<ref name=Ref_Lester225>{{Ref Lester|225}}</ref> | ||
* | *Laterality (on requisition). | ||
*Dimensions of head and neck. | *Dimensions of head and neck. | ||
*Shape of head (round? deformed?). | *Shape of head (round? deformed?). | ||
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=Criteria for gross only= | =Criteria for gross only= | ||
{{Main|Gross pathology}} | |||
Must be fulfilled: | |||
*Not a fracture. | |||
*Well developed features of [[osteoarthritis]]. | *Well developed features of [[osteoarthritis]]. | ||
More stringent - in addition to the above: | |||
*No history of cancer. | *No history of cancer. | ||
=Diagnoses to consider= | =Diagnoses to consider= | ||
*Avascular necrosis of the femoral head. | *[[Avascular necrosis of the femoral head]]. | ||
*[[Osteoarthritis]]. | *[[Osteoarthritis]]. | ||
*Rheumatologic disease - rheumatoid arthritis. | *Rheumatologic disease - [[rheumatoid arthritis]]. | ||
*Pathologic fracture. | *[[Pathologic fracture]]. | ||
*Infection ([[osteomyelitis]]). | *Infection ([[osteomyelitis]]). | ||
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==Avascular necrosis of the femoral head== | ==Avascular necrosis of the femoral head== | ||
*[[AKA]] ''avascular necrosis'', abbreviated ''AVN''. | *[[AKA]] ''avascular necrosis'', abbreviated ''AVN''. | ||
{{Main|Avascular necrosis of the femoral head}} | |||
==Osteoarthritis== | ==Osteoarthritis== | ||
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==Rheumatoid arthritis== | ==Rheumatoid arthritis== | ||
{{Main|Rheumatoid arthritis}} | {{Main|Rheumatoid arthritis}} | ||
==Fracture of bone due to metastatic carcinoma== | ==Fracture of bone due to metastatic carcinoma== | ||
{{Main|Fracture of bone}} | {{Main|Fracture of bone}} | ||
:''Pathologic fracture'' redirects here, as the underlying cause is usually a carcinoma. | |||
===General=== | ===General=== | ||
*Uncommon. | *Uncommon ~ 10 of 90 suspected cases.<ref name=pmid15826621>{{Cite journal | last1 = Ramisetty | first1 = NM. | last2 = Pynsent | first2 = PB. | last3 = Abudu | first3 = A. | title = Fracture of the femoral neck, the risk of serious underlying pathology. | journal = Injury | volume = 36 | issue = 5 | pages = 622-6 | month = May | year = 2005 | doi = 10.1016/j.injury.2004.08.034 | PMID = 15826621 }}</ref> | ||
**Usually in patients with a known malignancy and bony metastases. | |||
*Should not be missed. | *Should not be missed. | ||
*Classically in older individuals. | *Classically in older individuals. | ||
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===Gross=== | ===Gross=== | ||
Features: | Features: | ||
*Irregular resection margin. | *Irregular resection margin.† | ||
*Focal, irregular, tan-white discolouration | *Focal, irregular, tan-white discolouration at the fracture site, i.e. [[surgical margin|margin]], and in the marrow space. | ||
Note: | |||
*† Non-fracture resections have a flat resection margin, as they were cut by the surgeon. | |||
Image: | Image: | ||
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===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
*See ''[[adenocarcinoma]]''. | *See ''[[adenocarcinoma]]'', ''[[small cell carcinoma]]''. | ||
DDx: | |||
*[[Traumatic fracture of the femoral neck]]. | |||
===Sign out=== | |||
<pre> | |||
FEMORAL HEAD, LEFT, HIP ARTHROPLASTY: | |||
- METASTATIC SMALL CELL CARCINOMA. | |||
</pre> | |||
==Non-pathologic fracture of the femoral neck== | |||
:''Hip fracture'', ''traumatic hip fracture'' and ''traumatic fracture of the femoral neck'' redirect here. | |||
===General=== | |||
*Common in the eldery. | |||
*Strong association with [[osteoporosis]]. | |||
===Gross=== | |||
*Irregular/jagged femoral neck margin - '''important'''. | |||
*Hemorrhage. | |||
===Microscopic=== | |||
Features: | |||
*Non-vital bone. | |||
**Loss of osteocytes. | |||
DDx: | |||
*[[Pathologic fracture]]. | |||
Commonly concurrent pathologies: | |||
*[[Osteoporosis]] - thinner cortex, decreased trabecular thickness and number.<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> | |||
*[[Osteoarthritis]]. | |||
===Sign out=== | |||
<pre> | |||
FEMORAL HEAD AND SURROUNDING TISSUE, RIGHT, HIP ARTHROPLASTY: | |||
- BONE WITH CHANGES CONSISTENT WITH FRACTURE. | |||
- BENIGN FIBROADIPOSE TISSUE AND CARTILAGE. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
<pre> | |||
FEMORAL HEAD AND SURROUNDING TISSUE, LEFT, HIP ARTHROPLASTY: | |||
- NON-VITAL BONE CONSISTENT WITH FRACTURE. | |||
- BENIGN FIBROADIPOSE TISSUE AND CARTILAGE. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
====With degenerative joint disease==== | |||
<pre> | |||
FEMORAL HEAD AND SURROUNDING TISSUE, RIGHT, HIP ARTHROPLASTY: | |||
- BONE WITH CHANGES CONSISTENT WITH FRACTURE. | |||
- DEGENERATIVE JOINT DISEASE. | |||
- BENIGN FIBROADIPOSE TISSUE AND CARTILAGE. | |||
- NEGATIVE FOR MALIGNANCY. | |||
</pre> | |||
=See also= | =See also= | ||
Latest revision as of 02:28, 23 October 2014
The femoral head is a common ditzel in surgical pathology at centres which have orthopaedic surgeons.
Many of these can be "gross only".
Gross
Features to comment on:[1]
- Laterality (on requisition).
- Dimensions of head and neck.
- Shape of head (round? deformed?).
- Resection margin (irregular?).
- Cartilage (thinning/eburnation? separation from the cartilage).
- Bone (subchondral cysts? subchondral sclerosis?).
- Presence of soft tissue.
- Other (osteophytes? pannus?).
Notes:
- Some advocate the use of cardboard when cutting[2] -- weird.
Criteria for gross only
Main article: Gross pathology
Must be fulfilled:
- Not a fracture.
- Well developed features of osteoarthritis.
More stringent - in addition to the above:
- No history of cancer.
Diagnoses to consider
- Avascular necrosis of the femoral head.
- Osteoarthritis.
- Rheumatologic disease - rheumatoid arthritis.
- Pathologic fracture.
- Infection (osteomyelitis).
Specific diagnoses
Avascular necrosis of the femoral head
- AKA avascular necrosis, abbreviated AVN.
Main article: Avascular necrosis of the femoral head
Osteoarthritis
- See Osteoarthritis.
Infection
- See Osteomyelitis.
Rheumatoid arthritis
Main article: Rheumatoid arthritis
Fracture of bone due to metastatic carcinoma
Main article: Fracture of bone
- Pathologic fracture redirects here, as the underlying cause is usually a carcinoma.
General
- Uncommon ~ 10 of 90 suspected cases.[3]
- Usually in patients with a known malignancy and bony metastases.
- Should not be missed.
- Classically in older individuals.
Gross
Features:
- Irregular resection margin.†
- Focal, irregular, tan-white discolouration at the fracture site, i.e. margin, and in the marrow space.
Note:
- † Non-fracture resections have a flat resection margin, as they were cut by the surgeon.
Image:
Microscopic
Features:
DDx:
Sign out
FEMORAL HEAD, LEFT, HIP ARTHROPLASTY: - METASTATIC SMALL CELL CARCINOMA.
Non-pathologic fracture of the femoral neck
- Hip fracture, traumatic hip fracture and traumatic fracture of the femoral neck redirect here.
General
- Common in the eldery.
- Strong association with osteoporosis.
Gross
- Irregular/jagged femoral neck margin - important.
- Hemorrhage.
Microscopic
Features:
- Non-vital bone.
- Loss of osteocytes.
DDx:
Commonly concurrent pathologies:
- Osteoporosis - thinner cortex, decreased trabecular thickness and number.[5]
- Osteoarthritis.
Sign out
FEMORAL HEAD AND SURROUNDING TISSUE, RIGHT, HIP ARTHROPLASTY: - BONE WITH CHANGES CONSISTENT WITH FRACTURE. - BENIGN FIBROADIPOSE TISSUE AND CARTILAGE. - NEGATIVE FOR MALIGNANCY.
FEMORAL HEAD AND SURROUNDING TISSUE, LEFT, HIP ARTHROPLASTY: - NON-VITAL BONE CONSISTENT WITH FRACTURE. - BENIGN FIBROADIPOSE TISSUE AND CARTILAGE. - NEGATIVE FOR MALIGNANCY.
With degenerative joint disease
FEMORAL HEAD AND SURROUNDING TISSUE, RIGHT, HIP ARTHROPLASTY: - BONE WITH CHANGES CONSISTENT WITH FRACTURE. - DEGENERATIVE JOINT DISEASE. - BENIGN FIBROADIPOSE TISSUE AND CARTILAGE. - NEGATIVE FOR MALIGNANCY.
See also
References
- ↑ Lester, Susan Carole (2005). Manual of Surgical Pathology (2nd ed.). Saunders. pp. 225. ISBN 978-0443066450.
- ↑ Dimenstein, IB. (Jun 2008). "Bone grossing techniques: helpful hints and procedures.". Ann Diagn Pathol 12 (3): 191-8. doi:10.1016/j.anndiagpath.2007.06.004. PMID 18486895.
- ↑ Ramisetty, NM.; Pynsent, PB.; Abudu, A. (May 2005). "Fracture of the femoral neck, the risk of serious underlying pathology.". Injury 36 (5): 622-6. doi:10.1016/j.injury.2004.08.034. PMID 15826621.
- ↑ URL: http://www.path.utah.edu/casepath/ms%20cases/ms%20case%205%20comp/case%205.htm. Accessed on: 11 October 2012.
- ↑ Blain, H.; Chavassieux, P.; Portero-Muzy, N.; Bonnel, F.; Canovas, F.; Chammas, M.; Maury, P.; Delmas, PD. (Nov 2008). "Cortical and trabecular bone distribution in the femoral neck in osteoporosis and osteoarthritis.". Bone 43 (5): 862-8. doi:10.1016/j.bone.2008.07.236. PMID 18708176.