Difference between revisions of "Femoral head"
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Many of these can be "gross only". | Many of these can be "gross only". | ||
=Gross= | |||
Features to comment on:<ref name=Ref_Lester225>{{Ref Lester|225}}</ref> | |||
*Liberality (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?). | |||
*Other (osteophytes? pannus?). | |||
Notes: | |||
*Some advocate the use of cardboard when cutting<ref name=pmid18486895>{{Cite journal | last1 = Dimenstein | first1 = IB. | title = Bone grossing techniques: helpful hints and procedures. | journal = Ann Diagn Pathol | volume = 12 | issue = 3 | pages = 191-8 | month = Jun | year = 2008 | doi = 10.1016/j.anndiagpath.2007.06.004 | PMID = 18486895 }}</ref> -- weird. | |||
=Criteria for gross only= | =Criteria for gross only= | ||
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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. | |||
*Pathologic fracture. | *Pathologic fracture. | ||
*Infection ([[osteomyelitis]]). | |||
=Specific diagnoses= | =Specific diagnoses= | ||
| Line 18: | Line 33: | ||
===Gross=== | ===Gross=== | ||
Features: | Features:<ref name=Ref_Lester224>{{Ref Lester|224}}</ref> | ||
*Cartilage separates from the bone. | *Wedge-shaped pale yellow below cartilage. | ||
*+/-Cartilage separates from the bone. | |||
*+/-Deformation of femoral head. | |||
===Microscopic=== | ===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 }} | 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> | </ref> | ||
*Empty lacunae. | *Empty lacunae (indicative of necrotic bone). | ||
==Osteoarthritis== | ==Osteoarthritis== | ||
| Line 31: | Line 48: | ||
==Infection== | ==Infection== | ||
:See ''[[Osteomyelitis]]''. | :See ''[[Osteomyelitis]]''. | ||
==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)]. | |||
=See also= | =See also= | ||
Revision as of 01:34, 28 July 2011
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]
- Liberality (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?).
- Other (osteophytes? pannus?).
Notes:
- Some advocate the use of cardboard when cutting[2] -- weird.
Criteria for gross only
- Well developed features of osteoarthritis.
- 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
General
- May be due to steroids.
Gross
Features:[3]
- Wedge-shaped pale yellow below cartilage.
- +/-Cartilage separates from the bone.
- +/-Deformation of femoral head.
Microscopic
Features:[4]
- Empty lacunae (indicative of necrotic bone).
Osteoarthritis
- See Osteoarthritis.
Infection
- See Osteomyelitis.
Rheumatoid arthritis
Gross
Features:
- Pannus[5] - fibrovascular tissue or granulation tissue.
Image: RA (tumorlibrary.com).
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.
- ↑ 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.
- ↑ Lester, Susan Carole (2005). Manual of Surgical Pathology (2nd ed.). Saunders. pp. 223. ISBN 978-0443066450.