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>
*Liberality (on requisition).
*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:
Must be fulfilled:
*Not a fracture.
*Not a fracture.
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=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''.
===General===
{{Main|Avascular necrosis of the femoral head}}
Risk factors:
*Oral steroids, e.g. prednisone.<ref>URL: [http://www.merckmanuals.com/professional/musculoskeletal_and_connective_tissue_disorders/osteonecrosis/osteonecrosis.html http://www.merckmanuals.com/professional/musculoskeletal_and_connective_tissue_disorders/osteonecrosis/osteonecrosis.html]. Accessed on: 30 April 2012.</ref>
*[[Cushing disease]].
*[[Cushing syndrome]].
*Radiation.
 
===Gross===
Features:<ref name=Ref_Lester224>{{Ref Lester|224}}</ref>
*Wedge-shaped pale yellow below cartilage.
*+/-Cartilage separates from the bone.
*+/-Deformation of femoral head.
 
Image:
*[http://www.flickr.com/photos/11462589@N05/1126710488/in/photostream AVN (flickr.com)].
 
===Microscopic===
Features:<ref name=pmid20513874>{{Cite journal  | last1 = Steffen | first1 = RT. | last2 = Athanasou | first2 = NA. | last3 = Gill | first3 = HS. | last4 = Murray | first4 = DW. | title = Avascular necrosis associated with fracture of the femoral neck after hip resurfacing: histological assessment of femoral bone from retrieval specimens. | journal = J Bone Joint Surg Br | volume = 92 | issue = 6 | pages = 787-93 | month = Jun | year = 2010 | doi = 10.1302/0301-620X.92B6.23377 | PMID = 20513874 }}
</ref>
*Empty lacunae (indicative of necrotic bone).
 
===Sign out===
<pre>
FEMORAL HEAD, RIGHT, HIP ARTHROPLASTY:
- AVASCULAR NECROSIS OF THE FEMORAL HEAD.
</pre>


==Osteoarthritis==
==Osteoarthritis==
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==Rheumatoid arthritis==
==Rheumatoid arthritis==
{{Main|Rheumatoid arthritis}}
{{Main|Rheumatoid arthritis}}
===Gross===
Features:
*Pannus<ref name=Ref_Lester223>{{Ref Lester|223}}</ref> - fibrovascular tissue or granulation tissue.
Image: [http://www.tumorlibrary.com/case/detail.jsp?image_id=3907 RA (tumorlibrary.com)].


==Fracture of bone due to metastatic carcinoma==
==Fracture of bone due to metastatic carcinoma==
{{Main|Fracture of bone}}
{{Main|Fracture of bone}}
*[[AKA]] ''pathologic fracture''.
:''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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===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

Femoral head. (WC)

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:

More stringent - in addition to the above:

  • No history of cancer.

Diagnoses to consider

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

Gross

  • Irregular/jagged femoral neck margin - important.
  • Hemorrhage.

Microscopic

Features:

  • Non-vital bone.
    • Loss of osteocytes.

DDx:

Commonly concurrent pathologies:

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

  1. ↑ Lester, Susan Carole (2005). Manual of Surgical Pathology (2nd ed.). Saunders. pp. 225. ISBN 978-0443066450.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ URL: http://www.path.utah.edu/casepath/ms%20cases/ms%20case%205%20comp/case%205.htm. Accessed on: 11 October 2012.
  5. ↑ 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.
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