Difference between revisions of "Femoral head"
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The sections show a femoral head with loss of cartilage and focal vertical cleft formation in the remaining thinned cartilage. | The sections show a femoral head with loss of cartilage and focal vertical cleft formation in the remaining thinned cartilage. Subchondral sclerosis is present. The underlying bone is viable. Bone marrow is present. The red blood cells have a sickled morphology. | ||
==Osteoarthritis== | ==Osteoarthritis== | ||
Revision as of 15:00, 6 December 2012
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.
General
Risk factors:
- Oral steroids, e.g. prednisone.[3]
- Cushing disease.
- Cushing syndrome.
- Radiation.
Gross
Features:[4]
- Wedge-shaped pale yellow abnormality below cartilage.
- +/-Cartilage separates from the bone.
- +/-Deformation of femoral head.
Image:
Microscopic
Features:[5]
- Empty lacunae (indicative of necrotic bone).
Sign out
FEMORAL HEAD, RIGHT, HIP ARTHROPLASTY: - AVASCULAR NECROSIS OF THE FEMORAL HEAD.
Remote AVN
FEMORAL HEAD AND JOINT CAPSULE, LEFT, HIP ARTHROPLASTY: - FEMORAL HEAD WITH OSTEOARTHRITIS AND MARKED DEFORMATION CONSISTENT WITH HISTORY OF AVASCULAR NECROSIS. - JOINT CAPSULE WITH MINIMAL CHRONIC INFLAMMATION.
Micro
The sections show a femoral head with loss of cartilage and focal vertical cleft formation in the remaining thinned cartilage. Subchondral sclerosis is present. The underlying bone is viable. Bone marrow is present. The red blood cells have a sickled morphology.
Osteoarthritis
- See Osteoarthritis.
Infection
- See Osteomyelitis.
Rheumatoid arthritis
Main article: Rheumatoid arthritis
Fracture of bone due to metastatic carcinoma
Main article: Fracture of bone
- AKA pathologic fracture.
General
- Uncommon ~ 10 of 90 suspected cases.[6]
- 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.
- Hemorrhage.
Microscopic
Features:
- Non-vital bone.
- Loss of osteocytes.
DDx:
Commonly concurrent pathology:
- Osteoporosis - thinner cortex, decreased trabecular thickness and number.[8]
- Osteoarthritis.
Sign out
FEMORAL HEAD AND SURROUNDING TISSUE, LEFT, HIP ARTHROPLASTY: - NON-VITAL BONE CONSISTENT WITH FRACTURE. - BENIGN FIBROADIPOSE TISSUE. - 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.
- ↑ URL: http://www.merckmanuals.com/professional/musculoskeletal_and_connective_tissue_disorders/osteonecrosis/osteonecrosis.html. Accessed on: 30 April 2012.
- ↑ Lester, Susan Carole (2005). Manual of Surgical Pathology (2nd ed.). Saunders. pp. 224. ISBN 978-0443066450.
- ↑ Steffen, RT.; Athanasou, NA.; Gill, HS.; Murray, DW. (Jun 2010). "Avascular necrosis associated with fracture of the femoral neck after hip resurfacing: histological assessment of femoral bone from retrieval specimens.". J Bone Joint Surg Br 92 (6): 787-93. doi:10.1302/0301-620X.92B6.23377. PMID 20513874.
- ↑ 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.